A catastrophic case of ischemic stroke and acute myocarditis in a young patient following mRNA COVID-19 vaccination: Coincidence or consequence?

A healthy 32-years-old man was admitted in emergency department after cardiac arrest at home. He had complaints of fatigue and general malaise after Pfizer-BioNTech Coronavirus disease-2019 (COVID-19) first dose vaccine 48 hours earlier. Upon hospital admission, patient scored 3 points in Glasgow Coma Scale. Electrocardiogram showed atrial fibrillation with rapid ventricular response and a point-of-care ultrasound demonstrated severe left ventricular dysfunction with global hypokinesia. Blood tests were remarkable for elevation of high-sensitivity cardiac troponin-T and inflammatory parameters, normal platelet and fibrinogen levels and slightly increased D-dimer. A computed tomography (CT) with angiography of the cerebral arteries revealed acute ischemic posterior circulation stroke with total occlusion of the basilar artery and partial occlusion of the left vertebral artery. Life-saving systemic thrombolysis was performed but there was no clinical benefit. Pulmonary embolism was excluded. Transesophageal echocardiography showed severe left ventricular dysfunction (LVEF 30%), global hypokinesia and an apical thrombus with no other significant abnormalities. De novo multiple ischemic injuries were shown in 24h control brain CT. Once autoimmunity, thrombophilia study, PCR and serologic tests for viral infections including SARS-CoV-2 were negative, cardioembolic stroke following post-vaccinal myocarditis was suspected. Brain stem death was verified 72h later and a post-mortem endomyocardial biopsy was performed, although no signal of myocarditis was found. COVID-19 mRNA vaccination is associated with increased risk of myocarditis. We report the first known case of cardioembolic stroke and probable myocarditis after BNT162b2 first dose. This highlights that, although rare and with a predominantly favorable course, vaccine-related myocarditis can have life-threatening complications. (Figure Presented).

Uncertainty calculation methodologies in microflow measurements: Comparison of GUM, GUM-S1 and Bayesian approach.

The importance of measurement quality cannot be over emphasized in medical applications, as one is dealing with life issues and the wellbeing of society, from oncology to new-borns, and more recently to patients of the COVID-19 pandemic. In all these dire situations, the accuracy of fluid delivered according to a prescribed dose can be critical. Microflow applications are growing in importance for a wide variety of scientific fields, namely drug development and administration, Organ-on-a-Chip, or bioanalysis, but accurate and reliable measurements are a tough challenge in micro-to-femto flow operating ranges, from 2.78 × 10-4 mL/s down to 2.78 × 10-7 mL/s (1000 µL/h down to 1 µL/h). Several sources of error have been established such as the mass measurement, the fluid evaporation dependent on the gravimetric methodology implemented, the tube adsorption and the repeatability, believed to be closely related to the operating mode of the stepper motor and drive screw pitch of a syringe pump. In addition, the difficulty in dealing with microflow applications extends to the evaluation of measurement uncertainty which will qualify the quality of measurement. This is due to the conditions entailed when measuring very small values, close to zero, of a quantity such as the flow rate which is inherently positive. Alternative methods able to handle these features were developed and implemented, and their suitability will be discussed.