Purulent pericarditis can be near fatal

A previously healthy 27 years-old male presented with 2 weeks of substernal chest pain, progressive dyspnea, palpitations, dizziness, and(&) fever. On exam, he had tachypnea & tachycardia, was hypotensive with an elevated JVP & muffled heart sounds. Labs showed elevated WBC, CRP, lactate & high sensitive troponin. Negative for COVID-19, flu. EKG showed sinus tachycardia. CT showed large pericardial effusion with gas in the pericardial space. Echo (Figure 1) revealed large pericardial effusion with tamponade. Emergent pericardiocentesis was performed draining a liter of straw-colored thick fluid (fluid: serum LDH >3) (Figure 2). Cultures grew Strep. Anginosus & Propionibacterium acnes. Extensive infectious & immunological workup returned negative. He had initially improved on broad-spectrum antibiotics however declined clinically on day 5. Repeat CT (Figures 3 & 4) showed recurrent pericardial effusion & mediastinal abscess with trace extravasation of contrast from the esophagus to posterior mediastinum. We present a case of esophageal perforation leading to Pyopneumopericardium. Stephenson et al. reported a case series of 13 patients with esophagopericardial fistulas & pyopneumopericardium with a 100% mortality rate. Another case series showed survival rates of only 17% in 60 patients with pyopneumopericardium secondary to esophageal perforation. Erosion of esophageal ulcers, ingestion of foreign body, iatrogenic, trauma, malignancy, localized inflammation can lead to esophageal perforation. Streptococcus pneumoniae & Staphylococcus aureus are common pathogens involved. Constrictive pericarditis is a possible complication in up to 20 to 30%. Our patient underwent pericardial window & surgical debridement followed by EGD-guided gastro-jejunal tube placement. He did well after 4 weeks of IV antibiotics. Our case demonstrates that early recognition & intervention can favorably alter the course of this potentially fatal cardiac condition.

COVID-19 VACCINE VIS-A-VIS APPLICATION OF PATENT LAW DURING PANDEMIC

The SARS CoV - 2 or the novel coronavirus pandemic has wreaked havoc of biblical proportions on the world. Between the index patient (the first human transmission) in late 2019 and mid 2020, the virus brought the entire world to its knees, effectively changing the status quo and establishing a new world order, in terms of economy, normalcy, public health and social interactions. The virus systematically dismantled fiscal systems across the globe, slashed the job market, and sounded a death knell for major economies around the world by inducing a recession. The USA and the UK, earlier rich job markets, saw more than 30 million people applying for unemployment benefits by the end of April itself. The IMF estimates that the global economy will shrink by 3%,(Jones, L., Palumbo, D. and Brown, D., 2020). Governments scrambled to curb the unrelenting and highly contagious virus through several schemes and rules but the virus thrived on the closely knit social order humans had built for themselves in the many millennia of civilization. In its wake, scientists, researchers, pharmaceutical experts and medical professionals are in the process of aggregating their combined resources to study the virus, in order to invent an antidote or a vaccine that can possibly combat it.While there is rigorous research to end this pandemic, there is also international debate on how one would aim to protect this invention. A patent protects the invention by prohibiting the production, sale, distribution and related processes of the invention by anyone other than the patent holder and his authorized licensees. This is a form of techno-protectionism to ensure that all profits and royalties are funneled to the patent holder and effectively creates a monopoly for the invention in the market. It is no doubt that pharmaceutical researchers and organizations always look to protect their invented product or process legally so as to reap a profit and possess a legally enforceable right to bring a suit against copycat inventions and patent infringements. This article aims to study the possibility of a vaccine juxtaposed with the law of patents, to see how best the rights of the creator of the treatment kit may be protected while also not jeopardizing public health and safety. The author seeks to discuss the cost benefit analysis between the drug development process and patent protection of the developed drug, the concept of compulsory licensing which acts as a safety valve to block the creation of monopolies in the market during times of emergencies, and also bring to light the relatively modern idea of patent pooling to achieve equitable results across the globe.