ABSTRACT
Background: Contraceptives are an important component of women's reproductive health care, as they not only reduce the number of unwanted pregnancies, but also improve reproductive function. However, oral contraceptives are known to increase the risk of venous thromboembolism. This risk is increased by infection with the COVID-19 virus that predisposes patients to both venous and arterial thrombosis as a result of excessive inflammation, platelet activation, aggravated endothelial dysfunction, and congestive events. If these patients have hereditary thrombophilia, the risk of venous thromboembolism becomes fatal. Case report: The paper describes a clinical case of a patient with total portal vein thrombosis, who have been taking oral contraceptives for a long time and recovering from the novel coronavirus infection. Studying the blood coagulation system and folate cycle genes, by using PCR, has revealed a gene mutation in the plasminogen activator inhibitor (serpine). The authors demonstrate the data of spiral computed tomography of the abdominal organs, as well as changes in laboratory parameters. Conclusion(s): A balanced approach is required when prescribing combined oral contraceptives during the COVID-19 pandemic, especially in women with prothrombotic mutations.Copyright © A group of authors, 2023.
ABSTRACT
Background: Contraceptives are an important component of women's reproductive health care, as they not only reduce the number of unwanted pregnancies, but also improve reproductive function. However, oral contraceptives are known to increase the risk of venous thromboembolism. This risk is increased by infection with the COVID-19 virus that predisposes patients to both venous and arterial thrombosis as a result of excessive inflammation, platelet activation, aggravated endothelial dysfunction, and congestive events. If these patients have hereditary thrombophilia, the risk of venous thromboembolism becomes fatal. Case report: The paper describes a clinical case of a patient with total portal vein thrombosis, who have been taking oral contraceptives for a long time and recovering from the novel coronavirus infection. Studying the blood coagulation system and folate cycle genes, by using PCR, has revealed a gene mutation in the plasminogen activator inhibitor (serpine). The authors demonstrate the data of spiral computed tomography of the abdominal organs, as well as changes in laboratory parameters. Conclusion(s): A balanced approach is required when prescribing combined oral contraceptives during the COVID-19 pandemic, especially in women with prothrombotic mutations.Copyright © A group of authors, 2023.
ABSTRACT
Background: Contraceptives are an important component of women's reproductive health care, as they not only reduce the number of unwanted pregnancies, but also improve reproductive function. However, oral contraceptives are known to increase the risk of venous thromboembolism. This risk is increased by infection with the COVID-19 virus that predisposes patients to both venous and arterial thrombosis as a result of excessive inflammation, platelet activation, aggravated endothelial dysfunction, and congestive events. If these patients have hereditary thrombophilia, the risk of venous thromboembolism becomes fatal. Case report: The paper describes a clinical case of a patient with total portal vein thrombosis, who have been taking oral contraceptives for a long time and recovering from the novel coronavirus infection. Studying the blood coagulation system and folate cycle genes, by using PCR, has revealed a gene mutation in the plasminogen activator inhibitor (serpine). The authors demonstrate the data of spiral computed tomography of the abdominal organs, as well as changes in laboratory parameters. Conclusion(s): A balanced approach is required when prescribing combined oral contraceptives during the COVID-19 pandemic, especially in women with prothrombotic mutations.Copyright © A group of authors, 2023.
ABSTRACT
This article discusses measures to prevent and treat Covid-19 infection. Collaboration at the local, regional, national and international levels, with a focus on high-quality research, evidence-based practice, the sharing of data and resources, and upholding all ethical standards in the face of unprecedented challenges, will be key to the success of these efforts. In addition, the demand for unproven therapies can lead to shortages of drugs that are approved and indicated for other conditions, leaving patients who rely on these drugs for chronic conditions without effective therapy. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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To date, the association of SARS-CoV-2 infection with the reactivation of herpes viruses has been determined. This has been proven not only by the results of laboratory studies, but also by a clinically confirmed subsequent manifestation of the herpetic process. The article describes a clinical case of Epstein-Barr viral and cytomegalovirus infections reactivation after COVID-19. The child was diagnosed with anicteric form of hepatitis of herpetic etiology. Hepatitis, moderate anicteric form. During treatment, the patient's condition improved. Complete clinical recovery with normalization of the activity of alanine and aspartate aminotransaminases occurred 1 month after the onset of the disease, but the level of lymphocytes and gamma-glutamyl transpeptidase still remained moderately elevated. According to the ultrasound of the abdominal organs, the size of the liver returned to normal. The presented case illustrates that mixed infections are a quite possible situation during the COVID-19 pandemic, which must be taken into account when working with such patients. Copyright © 2022 National Academy of Pediatric Science and Innovation. All rights reserved.
ABSTRACT
BACKGROUND: Here we discuss a chronic kidney disease (CKD) patient with large pericardial effusion who arrested secondary to tamponade and had an unintentional pericardial decompression secondary to cardiopulmonary resuscitation (CPR) that subsequently saved his life. AIM OF THE STUDY: To bring to light management difficulties in chronic kidney disease patients undergoing maintenance hemodialysis with large pericardial effusion METHODS: 67-year-old male a case of CKD on maintenance hemodialysis (for last two years) but inadequately dialyzed over last two months after recent Covid pneumonia was detected to have large pericardial effusion on echocardiography. He was planned for intensive heparin-free dialysis in view of absence of frank clinical and echocardiographic findings of tamponade with close surveillance for pericardial effusion. 60 minutes into hemodialysis patient developed dyspnea hypotension and cardiac arrest. Return of spontaneous circulation was achieved after three cycles of cardiopulmonary resuscitation. Echocardiography (echo) guided pericardiocentesis was planned based on clinical suspicion of tamponade. But echocardiography revealed only mild pericardial effusion. Chest X-ray showed new left pleural effusion. Pleurocentesis revealed hemorrhagic fluid. Subsequently done CT thorax showed multiple rib fractures. Patient was discharged on day eleven in stable condition with repeat chest X ray and echocardiography showing no further collection. RESULT(S): Though cardiac tamponade is largely a clinical diagnosis, various other features like echocardiography aid in its diagnosis. Diagnosis of tamponade in CKD patient with pericardial effusion is difficult because of several reasons. All classical clinical features of tamponade like hypotension or elevated systemic pressures may not be manifested all the time in cases of tamponade. Our patient developed clinical signs of tamponade 60 minutes into dialysis session indicating that precipitation of tamponade was likely due to reduction in preload due to ultrafiltration (UF) during hemodialysis. Though, daily dialysis is the initial preferred treatment of choice for uremic pericardial effusions in CKD patients without clinical or echocardiographic signs of tamponade, there are case reports which support early pericardiocentesis as treatment of choice in all large pericardial effusions in CKD patients on maintenance hemodialysis (MHD). In our case of large pericardial effusion, due to absence of frank clinical/ echocardiographic evidence of tamponade, we were prompted to go for aggressive dialysis treatment plan, but had tamponade during dialysis. CPR can cause inadvertent injury to surrounding structures, ribs, abdominal organs, and vascular injury. In our case, CPR-associated injury leads to unintentional pericardial decompression probably due to rib injury or due to high force generated during CPR coupled with high pericardial pressures which overcame the tensile strength of pericardium resulting in pericardial decompression. Findings of fractured ribs on CT scan post-resuscitation in our case supports that high force and pressure were generated during CPR. CONCLUSION(S): This case report supports early pericardiocentesis as treatment of choice for large pericardial effusion in CKD patients on MHD. Also, care should be taken while dialyzing these patient as rapid UF can precipitate tamponade.
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Introduction: Diaphragmatic hernias (DH) in most cases are the consequence of a diaphragmatic trauma causing a missed injury. Less frequently, DHs are congenital. Case Presentation: A 52 years old patient came to our attention due to a worsening severe dyspnea. A chest CT scan were performed, showing an extensive left-side DH.We present the video of the surgical procedure. The patient mentioned a severe left hemithorax trauma occurred almost twenty years before due to a motorbike accident. Possibly, a diaphragmatic injury was not diagnosed at the time. Subsequently, a Covid-19-related chronic cough resulting in a persistently increased intra abdominal pressuremayhave caused the herniation of abdominal viscera. The surgical procedure was laparoscopic. The whole greater omentum and most of the transverse colon were herniated and, after a thorough adhesiolysis between the herniated tissues and the left diaphragmatic crus, the DH was reduced. It was confirmed the presence of a 8 cm defect of the left hemidiaphragm, it was repaired with a absorbable continuous suture. A 08x10 cm Bio-A patch was positioned over. The herniated tissues were meticulously examined and showed no signs of damage. Conclusion(s): Diaphragm's injuries are unfortunately difficult to diagnose in an acute setting, thus remaining often unbeknownst to the surgeon. Some patients never develop any symptoms because of such missed diaphragmatic injuries. Some others instead, due to an increase in the intra abdominal pressure, may develop symptomatic DHs. In the latter case, surgical management becomes mandatory.
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Purpose: The global COVID-19 pandemic has significantly altered delivery of healthcare. Hospital resource utilization has been impacted on multiple levels including solid organ transplantation and overall access to transplant care. In the United States, significant regional variation and decreased living donor transplantation occurred during the initial 6 months of the pandemic. We examined the multi-year impact of COVID-19 on pediatric organ donation and transplantation. Method(s): Pediatric (<18 years of age) organ donation and transplant data was obtained from the Organ Procurement and Transplantation Network (OPTN). Data included pediatric donors after brain death (pDBD), donors after circulatory death (pDCD), living donors (LD), and recipient details including total number of transplants, waitlist deaths, and removals were reviewed between January 2019 to December 2021. Result(s): Total pediatric transplants performed in 2019, 2020, and 2021 were 1923, 1766, and 1890 (p=0.004) respectively. Organ specific data is outlined in Table 1. In 2019, 2020, and 2021, living donor transplantation accounted for 320, 288, and 311 (p=0.838) cases, while 1579, 1456, and 1552 (p=<0.0001) deceased donor allografts were utilized. There were 171, 176, and 209 pDCD and 746, 684, and 713 pediatric pDBD donors. Living donors across all recipient ages were 7391, 5725, and 6539. 2392, 2337, and 2430 pediatric patients were added to all organ waitlists during the study period. 2347, 2198, and 2288 children were removed from the waitlist with 93, 82, and 76 of those cases due to patient death. There was no statistically significant difference in the proportion of pediatric patients added to the waitlist vs those removed during 2019-2021 (p=0.505) Conclusion(s): Transplant volume transiently decreased in the first six months of the COVID-19 pandemic. However, transplantation rates in children, specifically abdominal organ transplantation, increased to nearly pre-pandemic levels in 2021. Lung transplants were significantly decreased during the study period. Pediatric donation remained relatively steady from 2019-2021. Living donor transplantation in children was significantly impacted in 2020. Waitlist additions/removals remained consistent throughout the study period. (Table Presented).
ABSTRACT
Tuberculosis (TB) is a communicable bacterial infection caused by Mycobacterium tuberculosis. It is the second leading fatal infectious disease after COVID-19. Tuberculosis also stands at 13th position, with respect to the leading cause of death. In 2020, around 86% of new tuberculosis cases were reported in 30 countries, of which two-thirds of cases were recorded in eight countries alone, with India leading the chart. Tuberculosis in a mentally ill patient is a common entity because of its common comorbidities, but prolonged antipsychotic drug therapy is rare. Here we discuss a case of a 36 years old female who was brought dead to casualty. She was apparently alright 10 days back and then developed symptoms like fever, breathlessness, and cough. She had severe anorexia and cachexia for the past few months. She has been under antipsychotic medication for schizophrenia. On autopsy, there were multiple whitish nodules present all over the intestine and various abdominal organs. We identified disseminated tuberculosis, and we analyzed histopathology and microbiology of tissues. We reported Ziehl-Neelsen staining negative for TB. Culture reported positive for Mycobacterium tuberculosis. Histopathology study tissues showed caseous necrotizing granulomas. As seen in some literature, tuberculosis can be seen in mentally ill patients, whereas literature showing the association between tuberculosis and antipsychotic drugs is less. This article highlights the association between such occurrence of tuberculosis while undertaking antipsychotic drug therapy.
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Background: Trauma is one of the leading causes of deaths worldwide for all age groups, especially in the younger age group. The purpose of the current study is to assess/analyze the factors for mortality in penetrating abdominal traumas with respect to the total number of intra-abdominal organs injured, related extra-abdominal injuries, gender, type of injury, time of arrival, and amount of blood transfusion needed during the pandemic. Methods: A retrospective study including 523 patients underwent laparotomy in Al-Emamien Al-Kadhimin Medical City from March 2020 to September 2021 for a penetrating abdominal injury due to blast injury, bullet, shrapnel injury, and stab wounds. The study population with penetrating abdominal traumas and indicative abdominal signs was subjected to exploratory laparotomy. Results: In this study, 465 (88.9%) males and 58 (11.1%) females participated;the highest rate was found in small bowel injuries (40.73%) followed by large bowel injuries (21.99%), whereas the lowest rate was found in gallbladder injury (1.34%). Chest injuries represent the highest rate among extra-abdominal injuries (18.36%), whereas head and neck represent the lowest rate (1.34%). Regarding the risk factors affecting the mortality rate, the highest rate of mortality was found in the case of gunshot (13.11%), followed by shrapnel (6.38%) and stab wound injuries (5.26%), which was the lowest. Conclusion: Penetrating abdominal injuries were the most common among males, small bowel injuries are the commonest organs affected by the penetrating abdominal injuries, shrapnel injuries were the commonest causes in our country, and the highest mortality rate was related to gunshot and number of organs affected and delay of arrival to the hospital and number of pints of blood received.
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Background and Aims: Long COVID is a syndrome affecting patients infected with SARSCoV- 2 who show a broad spectrum of symptoms, such as fatigue and dyspnoea, persisting for several months after the initial infection. Patients with type 2 diabetes (T2D) have frequent co-morbidities affecting multiple organs. Both long COVID and T2D are multi-system conditions associated with abnormalities in organ structure and function. Therefore, multi-organ assessment is critical for monitoring organ health and early detection of co-morbidities in both conditions. This study aimed to define the prevalence of multi-organ abnormalities in patients with long COVID and patients with T2D with a rapid, non-contrast, magnetic resonance imaging (MRI) scan. Methods: Overall, 135 long COVID patients without diabetes were recruited in the COVERSCAN study (NCT04369807) at a median of 183 days since first COVID-19 symptoms. 135 patients with established T2D were recruited in the MODIFY study (NCT04114682). MRI data were acquired to derive abdominal organ-specific measures of size, fat deposition and fibroinflammation (CoverScan®, Perspectum Ltd.). Reference values of MRI metrics were based on 92 healthy volunteers and published literature. The prevalence of abnormalities for each measure was assessed using Fisher's exact tests in the whole cohort and in a subset of patients with obesity (BMI≥30 kg/m2). Results: The demographics of the three cohorts were as follows: long COVID: median age 54 yrs [interquartile interval 46–60], 56% male, BMI 27 kg/m2 [26–31];T2D: 62 yrs [54–70], 59% male, BMI 32 kg/m2 [28–35], median T2D duration 11 yrs;healthy volunteers: 44 yrs [32–53], 66% male, BMI 23 kg/m2 [21–25]). There was a high prevalence of abdominal organ abnormality in both long COVID and T2D patient groups (Figure, left), including increased fat deposition (steatosis) in the liver, pancreas, and kidney (Figure, right). 35% of patients with T2D had clustering of abnormalities involving at least 2 organs, compared to 23% in long COVID. Abnormalities affecting the liver (steatosis, fibroinflammation and hepatomegaly) and renomegaly were more common in T2D than in long COVID (p<0.001). Considering only patients with obesity, liver fibroinflammation, hepatomegaly, and renomegaly remained significantly more prevalent in T2D than in long COVID (p<0.05). Conclusion: Long COVID and established T2D have distinct profiles of multi-organ impairment, more prevalent with obesity but not fully explained by it. Multi-organ MRI assessment can enrich the current blunt assessment of multi-system/multi-organ abnormalities in diverse disease states to inform earlier intervention and treatments. (Figure Presented) Left: Prevalence (%) of organ abnormalities in long COVID patients (black numbers) and T2D patients (grey numbers) (liver, pink;pancreas, yellow;kidney, green;spleen, blue). Right: Prevalence of organ steatosis, fibroinflammation and increased organ size by patient group. Colour per organ as in left figure.
ABSTRACT
Introduction: Here, we discuss a chronic kidney disease (CKD) patient with large pericardial effusion who arrested secondary to tamponade and had an unintentional pericardial decompression secondary to cardio pulmonary resuscitation (CPR) that subsequently saved his life. Methods: PRESENTATION 67 years old male, a case of CKD on maintenance hemodialysis (for last two years) but inadequately dialyzed over last two months after recent covid pneumonia was detected to have large pericardial effusion (red arrows) on echocardiography (Figure 1). He was planned for intensive heparin free dialysis in view of absence of frank clinical and echocardiographic findings of tamponade with close surveillance for pericardial effusion. 60 minutes into hemodialysis, patient developed dyspnea, hypotension, and cardiac arrest. Return of spontaneous circulation was achieved after three cycles of cardiopulmonary resuscitation. Echocardiography (echo) guided pericardiocentesis was planned based on clinical suspicion of tamponade. But, echocardiography revealed only mild pericardial effusion (Figure 1). Chest x ray showed new left pleural effusion. Pleurocentesis revealed hemorrhagic fluid. Subsequently done CT thorax showed multiple rib fractures. Patient was discharged on day eleven in stable condition with repeat chest X ray and echocardiography showing no further collection. Figure1: Panel A ( Pre CPR echo, Large pericardial effusion - red arrows), Panel B (Post CPR echo, minimal pericardial effusion) [Formula presented] Results: DISCUSSION Though cardiac tamponade is largely a clinical diagnosis, various other features like echocardiography aid in its diagnosis. Diagnosis of tamponade in CKD patient with pericardial effusion is difficult because of several reasons. All classical clinical features of tamponade like hypotension or elevated systemic pressures may not be manifested all the time in cases of tamponade. Our patient developed clinical signs of tamponade 60 minutes into dialysis session indicating that precipitation of tamponade was likely due to reduction in preload due to ultrafiltration (UF) during hemodialysis. Though, daily dialysis is the initial preferred treatment of choice for uremic pericardial effusions in CKD patients without clinical or echocardiographic signs of tamponade, there are case reports which support early pericardiocentesis as treatment of choice in all large pericardial effusions in CKD patients on maintenance hemodialysis (MHD). In our case of large pericardial effusion, due to absence of frank clinical/ echocardiographic evidence of tamponade, we were prompted to go for aggressive dialysis treatment plan, but had tamponade during dialysis. CPR can cause inadvertent injury to surrounding structures, ribs, abdominal organs and vascular injury. In our case, CPR associated injury lead to unintentional pericardial decompression probably due to rib injury or due to high force generated during CPR coupled with high pericardial pressures which overcame the tensile strength of pericardium resulting in pericardial decompression. Findings of fractured ribs on CT scan post resuscitation in our case supports that high force and pressure were generated during CPR. Conclusions: This case report supports early pericardiocentesis as treatment of choice for large pericardial effusion in CKD patients on MHD. Also, care should be taken while dialyzing these patient as rapid UF can precipitate tamponade. No conflict of interest
ABSTRACT
A high incidence of thrombotic events has been reported in patients with coronavirus disease (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We report 3 clinical cases of patients in Italy with COVID-19 who developed abdominal viscera infarction, demonstrated by computed tomography.