ABSTRACT
Introduction: Aneurysm formation of internal carotid arteries (ICA) in patients with mucormycosis is a scarce phenomenon. However, the prevalence of rhino-cerebral mucormycosis has been reported to increase after the Coronavirus disease 2019 (COVID-19) pandemic. Case Presentation: Three patients with stroke and subarachnoid hemorrhage presented due to ICA aneurysm after the involvement of adjacent paranasal sinuses (PNS) with mucormycosis. They had a history of diabetes and corticosteroid use. Also, one of them was treated with imatinib. Two out of the three patients were infected with SARS-CoV-2 before developing mucormycosis. Two patients had diagnostic angiography before endovascular intervention. One patient did not undergo any therapeutic intervention due to total artery occlusion, whereas the other patient experienced a successful parent artery occlusion by coiling and only survived this patient. Although all patients received antifungal treatment and surgical debridement, two of them died. Conclusions: In patients with rhino-cerebral mucormycosis, aneurysm evolution should be promptly and meticulously investigated by Magnetic Resonance Angiography (MRA) and Computed Tomography Angiography (CTA). As this type of aneurysm is very fast-growing, as soon as the involvement of the sphenoid sinus is detected, the possibility of ICA aneurysm formation should always be kept in mind. If the patient develops an aneurysm, prompt intensive antifungal therapy and therapeutic endovascular interventions such as stenting, coiling, or sacrificing should be considered as soon as possible to optimize outcomes.
ABSTRACT
Background: This study aimed to evaluate the demographic features in patients with Coronavirus Disease-2019 (COVID-19) and to determine the relationship between Computerized Tomography (CT) and mortality. Objectives: This study aims to evaluate the characteristics for diagnosis and severity of involvement in primary imaging, their adaptation to the course of the disease, and their relationship with mortality. Methods: This retrospective study was conducted on the medical records of 212 patients with suspected COVID-19 admitted to the teaching hospitals of Shiraz University of Medical Sciences from February 20, 2009 to August 2020. The patients’ CT images were also assessed and the frequency of abnormalities was determined. Results: The Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test was positive in 204 patients (99%). Consolidation was observed in all the 206 patients. The highest degree of lung involvement (90%) was observed in 69 patients (33.5%). Atoll sign was also diagnosed in 121 cases (58.7%). Besides, crazy-paving reticular lines, subpleural sparing, and bronchial distortion were observed in 129 (62.6%), 88 (42.7%), and 124 patients (60.2%), respectively. In addition, multi-segment was detected in the CT scan results of 194 cases (94.2%), which was higher compared to the single segment seen in 12 patients (5.8%). Conclusion: CT scan is a relatively sensitive technique for diagnosing COVID-19. The study results revealed a significant relationship between CT scan and death. The disease severity was also accurate using this method.
ABSTRACT
Introduction: COVID-19-related thrombotic events are associated with an increase in the risk of mortality and morbidity. Considering the research on the pathophysiology of the disease, the significance of cardiac thrombosis is being more recognized. Case Presentation: This study aimed to present the first case report of a Left Main Coronary Artery (LMCA) thrombosis due to COVID-19 infection in a middle-aged male with a mechanical valve on anticoagulant therapy and with an International Normalized Ratio (INR) within the therapeutic range. Conclusions: The results suggested that the therapeutic INR range may need to be higher (about 3.5) during the acute phase of COVID-19 infection to prevent thrombotic events amongst patients with COVID-19 who are on anticoagulant therapy. However, further evidence is required to determine the target range for INR in patients with COVID-19 who are on anticoagulants prior to infection.
ABSTRACT
Background: Human health has been challenged drastically by the emergence of COVID-19. This pandemic has imposed a serious burden on different aspects of life. Apart from the high rates of morbidity and mortality, reporting of newly formed variants with enhanced contagious capacity has made the future vague. Existence of different comorbidities is a prominent factor towards poor prognosis and fatal outcomes. Objectives: The present study aimed to identify the most important comorbidities in the COVID-19 patients who passed away during the first wave in Fars province, Iran. Methods: Trained general physicians obtained data from medical files in the referral hospitals of COVID-19 throughout the province. These included demographic data, past medical history, and existence of comorbidities. The data were analyzed using chi-square test, independent sample t-test, and Mann-Whitney test. P-values less than 0.05 were considered statistically significant. Results: Out of the 3700 confirmed cases, 87 patients died from February to May 2020. Among these patients, 81.1% had comorbidities, with hypertension, diabetes, and cardiovascular disease being the most prevalent ones. The results revealed no significant differences between the individuals with and without comorbidities regarding age, gender, and duration of ICU hospitalization. Oxygen saturation was also poor in both groups. However, the patients with comorbidities had significantly higher blood urea nitrogen and creatinine levels compared to their comorbidity-free peers. Conclusions: Cardiovascular disease and the related risk factors contributed greatly to the deadly fate in COVID-19 patients. Hence, early prophylactic and therapeutic interventions should be considered in COVID-19 patients harboring such comorbidities. This can play a pivotal role in reducing the rate of mortality and the consequent financial and social harms.