Prolonged Use of Tirofiban Infusion Without Percutaneous Coronary Intervention To Achieve Optimal Results in a COVID-19 Positive Patient With Inferior ST Segment Elevated Myocardial Infarction (STEMI) Secondary to Thromboembolism: A Case Report.

Severe acute respiratory syndrome­coronavirus­2 (SARS­CoV­2), responsible for COVID-19, is mainly a respiratory illness, but it can affect other organs also such as heart, kidneys, and liver. Myocardial injury from COVID-19 has been reported in hospitalized patients ranging from pericarditis and myocarditis to acute coronary syndrome (ACS). COVID-19 is highly hypercoagulable state and is associated with both central and peripheral thromboembolism. COVID 19 patients with ACS may not present with classical features of chest pain and electrocardiogram (ECG) is the most important initial investigation in these patients to assess for any ST or T waves changes. COVID-19 patients with cardiac involvement are the most vulnerable group of patients and have increased morbidity and mortality risk. COVID-19 infections can affect the cardiovascular system in patients with or without history of coronary artery disease (CAD), but the risk of type 1 or 2 myocardial infarction (MI), myocardial injury, ST segment elevation, myocarditis, heart failure, cardiogenic shock, and life threatening arrhythmias are more common in the former group. We present a case of 55-year-old patient who presented to our cardiac center with ST elevated myocardial infarction and high blood sugar level. Patient was recently diagnosed with type 2 diabetes mellitus (T2DM) but was not commenced on medications. Echocardiogram showed mildly impaired left ventricular systolic function (LVSF) with inferior wall hypokinesia, and ECG showed inferior leads ST elevation. Coronary angiogram showed severe mid-vessel lesion and occluded posterior left ventricular branch (PLV). Multiple attempts at aspirating the thrombus resulted in thrombolysis in MI grade 2 (TIMI 2) flow in the vessel and patient was commenced on a tirofiban infusion for 72 hours.

Drug-free In vitro Activation for Primary Ovarian Insufficiency.

Primary Ovarian Insufficiency (POI) or Diminished Ovarian Reserve (DOR) are the two conditions that affects women leading to infertility due to the lack of follicular growth and ovulation. Egg / Oocyte donation remains an option for these patients. However, with the development in Reproductive medicine various novel technologies like Ovarian Cryopreservation, Fragmentation, in vitro activation with drug treatment or even drug free autotransplantation enables the possibility of activating the pool of primordial follicles that can lead to successful pregnancy outcomes. Here, we report a case of women with POI, in which drug free in vitro activation of follicles was performed, followed by autotransplantation, which resulted in successful pregnancy. This is first case report from India that shows the procedure works and can be tried for women with POI.

Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance.

BACKGROUND: Troponin elevation is common in hospitalized COVID-19 patients, but underlying aetiologies are ill-defined. We used multi-parametric cardiovascular magnetic resonance (CMR) to assess myocardial injury in recovered COVID-19 patients. METHODS AND RESULTS: One hundred and forty-eight patients (64 ± 12 years, 70% male) with severe COVID-19 infection [all requiring hospital admission, 48 (32%) requiring ventilatory support] and troponin elevation discharged from six hospitals underwent convalescent CMR (including adenosine stress perfusion if indicated) at median 68 days. Left ventricular (LV) function was normal in 89% (ejection fraction 67% ± 11%). Late gadolinium enhancement and/or ischaemia was found in 54% (80/148). This comprised myocarditis-like scar in 26% (39/148), infarction and/or ischaemia in 22% (32/148) and dual pathology in 6% (9/148). Myocarditis-like injury was limited to three or less myocardial segments in 88% (35/40) of cases with no associated LV dysfunction; of these, 30% had active myocarditis. Myocardial infarction was found in 19% (28/148) and inducible ischaemia in 26% (20/76) of those undergoing stress perfusion (including 7 with both infarction and ischaemia). Of patients with ischaemic injury pattern, 66% (27/41) had no past history of coronary disease. There was no evidence of diffuse fibrosis or oedema in the remote myocardium (T1: COVID-19 patients 1033 ± 41 ms vs. matched controls 1028 ± 35 ms; T2: COVID-19 46 ± 3 ms vs. matched controls 47 ± 3 ms). CONCLUSIONS: During convalescence after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered, with limited extent and minimal functional consequence. In a proportion of patients, there is evidence of possible ongoing localized inflammation. A quarter of patients had ischaemic heart disease, of which two-thirds had no previous history. Whether these observed findings represent pre-existing clinically silent disease or de novo COVID-19-related changes remain undetermined. Diffuse oedema or fibrosis was not detected.