Retrospective analysis of clinical characteristics and outcomes of coronavirus disease 2019 critically ill patients with or without vascular calcification

Aim To analyze the differences in clinical characteristics and outcomes of coronavirus disease 2019 (COVID-19) critically ill patients with or without vascular calcification. Methods COVID-19 critically ill patients admitted to the intensive care unit of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in February 2020 were analyzed retrospectively. According to the chest CT findings, the patients were divided into vascular calcification group and non-vascular calcification group. The vascular calcification group was further divided into aortic calcification group, coronary calcification group and simultaneous calcification group (both aorta and coronary artery calcification). The clinical characteristics and outcomes of patients were compared in different groups. Results Compared with the non-vascular calcification group, the patients in the vascular calcification group were older and had a higher proportion of hypertension and coronary heart disease, which showed higher levels of leukocyte count, neutro-phil count, C-reactive protein, globulin, lactate dehydrogenase, international normalized ratio, D-dimer, creatinine, crea-tine kinase-MB, high-sensitivity cardiac troponin, myohemoglobin and N-terminal pro-B-type natriuretic peptide, lower levels of lymphocyte count, platelet count, albumin, estimated glomerular filtration rate, and higher risk of death. Compared with aortic calcification group, the outcomes of coronary calcification group and simultaneous calcification group were worse. Conclusion Vascular calcification, especially coronary artery calcification, may be a risk factor for poor prognosis in COVID-19 critically ill patients. © 2022, Editorial Office of Chinese Journal of Arteriosclerosis. All rights reserved.

Esophageal Mucosal Calcinosis: A Rare Site of Calcium Deposition in End-Stage Renal Disease

Introduction: Calciphylaxis, otherwise known as calcium uremic arteriolopathy, is defined as calcium deposition around blood vessels in skin and fat tissue which occurs in 1-4% of patients with end-stage renal disease (ESRD). Calcium deposition in the esophagus is extremely rare;to date, there have been only 4 cases reported worldwide. We report the fifth case of esophageal mucosal calcinosis occurring in a young male with ESRD. Case Description/Methods: A 37-year-old Thai man with ESRD on peritoneal dialysis since 2005 presented with generalized weakness and odynophagia due to oral ulcers, resulting in poor PO intake. He denied drinking alcohol, illicit drug use, or smoking. On exam his abdomen was soft, non-distended, non-tender, without any guarding. Past medical history included hypertension and COVID-19 in January 2022. Laboratory tests revealed neutropenia and pancytopenia, hyperphosphatemia, and hypocalcemia. EGD revealed distal esophageal esophagitis and hemorrhagic erosive gastropathy. Biopsy showed ulcerative esophagitis with dystrophic calcification, consistent with esophageal mucosal calcinosis .No intestinal metaplasia was noted. Immunohistochemistry was negative for CMV, HSV1, and HSV2. The patient was treated with pantoprazole 40mg IV every 12 hours, Magic Mouthwash 5ml qid, and Carafate 10mg qid. He was transferred to a cancer center where he had a bone marrow biopsy formed which was negative. His symptoms resolved and the patient was discharged to home (Figure). Discussion(s): Esophageal mucosal calcinosis is extremely rare. It is due to a combination of factors involving acidosis and the phenotypic differentiation (and apoptosis) of vascular smooth muscle cells (VSMC) into chondrocytes or osteoblast-like cells. These changes, along with the passive accumulation of calcium and phosphate, induce calcification. Acidosis is well-known to promote inflammation of the arterial walls, releasing cytokines that induce vascular calcification. The benefits of treatment with sodium thiosulfate remain unclear. An ample collection of cases should help devise standardized treatment options and establish management guidelines for this condition.

Beyond Articular Cartilage: A Systematic Review of the Extracellular Matrix in Other Components of the Osteoarthritic Joint

Background/Aims Traditionally viewed from the perspective of cartilage degeneration, osteoarthritis is increasingly seen as a disease of global joint dysfunction. Connective tissue extracellular matrix (ECM) is a crucial determinant of joint mechanobiology, providing cells with scaffolding, topographical cues, and a reservoir of soluble factors. While ECM dysregulation has been extensively studied in osteoarthritic cartilage, it remains poorly defined in other joint tissues. Here, we systematically review the composition, architecture, and remodelling of non-cartilage soft joint tissue ECM in human osteoarthritis and animal disease models. Methods A systematic search strategy was run through the MEDLINE, EMBASE and Scopus databases on 30 October 2020 and repeated on 1 October 2021. The search criteria included disease nomenclature, relevant tissues, as well as structural ECM components and architectural features. All papers were independently screened by two reviewers on the Covidence platform according to predefined eligibility criteria. Relevant clinical, demographic, and biological data were extracted from included studies, which were assessed for bias using the OHAT Risk of Bias Rating Tool for Human and Animal Studies. Results 148 of 8,156 identified studies met all eligibility criteria. 113 papers evaluated human osteoarthritis;of 35 animal studies, the most frequently used models involved surgical joint destabilisation in small mammals. ECM was best defined in menisci, ligaments, and synovium;fewer papers assessed skeletal muscles, tendons, and fat pads. Compared to the healthy joint, osteoarthritis is associated with qualitative and quantitative alterations in structural ECM components, most notably collagens and proteoglycans. In recent years, whole proteome sequencing has been employed to address these changes systematically. The mechanical properties of ECM change significantly in osteoarthritis in response to post-translational modifications, extensive calcification, and the marked loss of matrix organisation across the joint. Notably, some aspects of ECM remodelling in these tissues appear to precede discernible cartilage dysregulation. Similar ECM dysregulation is also observed in animal models, although intermodel variability in arthritogenic precipitant and the range of reported outcomes make comparisons difficult. Many studies are limited by significant bias, notably in the infrequent reporting of investigator blinding, and in the poor demographic matching of osteoarthritic and control patients. Encouragingly, the quality of methodology reporting and use of age-matched control populations have improved in recent years. Conclusion Current data provide compelling evidence of whole joint ECM changes in osteoarthritis and importantly suggest that these changes occur early in the disease process. How ECM dysfunction affects the behaviour of tissue-resident cells remains less well understood. Our work will support the design of disease-relevant biomaterials used to model osteoarthritis in vitro, helping to address this issue, by more accurately recreating the extracellular environment. Furthermore, the development of imaging modalities sensitive to connective tissue ECM changes warrants investigation from both diagnostic and prognostic perspectives.

Incidental findings arising from targeted lung health checks: a GP practice perspective

Introduction: Newcastle Gateshead is a phase one Targeted Lung Health Checks site. Walker Medical Group GP practice serves a deprived population and is a designated Deep End practice. We report on the experience of Targeted Lung Health Checks at this practice. Method(s): Invitations were sent to eligible participants registered at the practice. Lung health checks were carried out by telephone according to Standard Protocol in the context of the COVID 19 pandemic. Those meeting criteria for Low Dose CT were invited to a mobile scanner located in the community near to the practice. Scans were reported according to the Standard Protocol. Result(s): Of 1481 eligible patients, 736 (50.44%) attended a telephone lung health check. 458 (63.6%) met criteria for a CT scan, of whom 33 declined a scan and 2 were unable to lie flat. 11 lung cancers (2.6%) and one other cancer were diagnosed. 71 (16.8%) had nodules requiring follow-up. These cases were managed by the TLHC programme and lung cancer MDT. Incidental findings had the greatest impact on general practice. 72.3% of scans showed coronary artery calcification. Of these, over 1 in 4 was not currently prescribed a Statin. New diagnoses of bronchiectasis (8 patients = 2%) and interstitial lung disease (7 patients = 1.6%) required GP action. 5 new cases of undiagnosed thoracic aortic aneurysm were identified, requiring referral for further action (1%). Conclusion(s): Incidental findings of Targeted Lung Health Checks CT scans require substantial input from a GP team. Coronary artery calcification is numerically most significant. Participants and practices should be supported by information and resources. Thoracic aortic aneurysm cases are also found in significant numbers and TLHC projects are advised to work with cardiology and cardiac surgery units when setting up. We plan to explore the reasons for participant refusal of CT scanning. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

A Novel Combined Model to Predict the Prognosis of COVID-19: Radiological-Metabolic Scoring.

AIM: To investigate the performance of a novel radiological-metabolic scoring (RM-S) system to predict mortality and intensive care unit (ICU) requirements among COVID-19 patients and to compare performance with the chest computed-tomography severity-scoring (C-CT-SS). The RM-S was created from scoring systems such as visual coronary-artery-calcification scoring (V-CAC-S), hepatic-steatosis scoring (HS-S) and pancreatic-steatosis scoring (PS-S). METHODS: Between May 2021 and January 2022, 397 patients with COVID-19 were included in this retrospective cohort study. All demographic, clinical and laboratory data and chest CT images of patients were retrospectively reviewed. RM-S, V-CAC-S, HS-S, PS-S and C-CT-SS scores were calculated, and their performance in predicting mortality and ICU requirement were evaluated by univariate and multivariable analyses. RESULTS: A total of 32 (8.1%) patients died, and 77 (19.4%) patients required ICU admission. Mortality and ICU admission were both associated with older age (p < 0.001). Sex distribution was similar in the deceased vs. survivor and ICU vs. non-ICU comparisons (p = 0.974 and p = 0.626, respectively). Multiple logistic regression revealed that mortality was independently associated with having a C-CT-SS score of ≥14 (p < 0.001) and severe RM-S category (p = 0.010), while ICU requirement was independently associated with having a C-CT-SS score of ≥14 (p < 0.001) and severe V-CAC-S category (p = 0.010). CONCLUSION: RM-S, C-CT-SS, and V-CAC-S are useful tools that can be used to predict patients with poor prognoses for COVID-19. Long-term prospective follow-up of patients with high RM-S scores can be useful for predicting long COVID.

Coronary Artery Calcium Score: Current Efficacy of Cardiac CT in Patients at Hail Region, Saudi Arabia

Calcium levels in the Coronary Artery are an indicative marker of the presence and extent of atherosclerosis. This serves as an additional prognostic indicator in addition to traditional risk factors. Moreover, the coronary calcium test is associated with a descriptor known as the calcium score or calcium score (Cs), which is primarily useful for stratifying the risk of asymptomatic patients, while for patients with acute or chronic chest pain, coronary axial computed tomography is generally required. A retrospective analysis of data was conducted in the radiology department of King Salman Specialist Hospital in Hail City, the kingdom of Saudi Arabia, between January and May 2022. A total of 40 patients were randomly selected, 25 males and 15 females. The study included all patients with or suspected of having a calcium deposit who underwent a CT scan using the Siemens SOMATOM definition MDC scan. Patients underwent a scan with the preparations and laboratory tests required for their coronary artery calcium scores. In this study, males were more likely to be affected by calcium deposits (64%), whereas females were 36%. Approximately 50 percent of the study populations were found to be normal (no identifiable calcium deposits) and 37.5% to have moderate calcium deposits. There is a significant association between CACS and moderate CVD risks based on age and gender in this study. Better control of cardiovascular system (CVS) risks is recommended in all primary care centers in the Kingdom of Saudi Arabia (KSA).Copyright © 2022 International Journal of Pharmaceutical Research and Allied Sciences. All rights reserved.

An Eventful Rotational Atherectomy Over the Left Main Stem and Left Anterior Descending Artery in an Elderly Male

Clinical Information Patient Initials or Identifier Number: SHS Relevant Clinical History and Physical Exam: Mr. SHS was admitted in August 2022 for acute decompensated heart failure secondary to NSTEMI, complicated with ventricular tachycardia (VT). CPR was performed for6 minutes on the day of admission and was subsequently transferred to the Cardiac Care Unit. His hospital stay was complicated with Covid-19 infection(category 2b) which he recovered well from. During admission, he developed recurrent episodes of angina. Physical examination was otherwise unremarkable. His ejection fraction was 45%. Relevant Catheterization Findings: Cardiac catheterization was performed, which revealed significant calcification of left and right coronary arteries. There was a left main stem bifurcation lesion (Medina 0,1,1) with subtotal occlusion over ostial the LAD, receiving collaterals from RCA and 90% stenosis over ostial LCx. RCA was dominant, heavily calcified with no significant stenosis. He was counselled for CABG (Syntex score26) but refused. As he was symptomatic, he was planned for PCI to the left coronary system. [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: The left main was engaged with a 7F EBU 3.5guiding catheter via transradial approach. Sion Blue wired into LAD and LCx. IVUS catheter couldn't cross the LAD and LCx lesions, hence we decided for up front rotational atherectomy. Sion blue was exchanged to Rotawire with the assistance of Finecross microcatheter. A 1.5mm burr was used at 180000 rpm. After the first run of rotablation, patient developed chest pain and severe hypotension (BP ranging 50/30). 4 inotropes/vasopressors were commenced. The shock was refractory hence an intraarterial balloon pump was inserted. Symptoms and blood pressure improved. Another 2 runs of atherectomy done (patient developed hypotension after each run). IVUS examination then showed calcification of proximal to mid LAD with an IVUS Calcium score of 3. LAD was further predilated with Scoreflex balloon 3.0/20mm at 8-22ATM. LCx was predilated with Scoreflex balloon 2.0/15mm at 12-14ATM. DCB Sequent Please NEO2.0/30mm was deployed at 7ATM at ostial to proximal LCx. Proximal to mid LAD was stented with Promus ELITE 2.5/32mm at 11ATM, which was then post dilated with stent balloon at 11ATM. Ostial LM to proximal LAD (overlap) was stented with Promus ELITE 4.0/28mm at 11ATM. LMS POT was then done with NC Balloon 4.0/15mm at 24ATM. LCx was rewired and kissing balloon technique with NC balloon 4.0/15mm at 14ATM (LAD) and NC balloon 2.0/10mm at 12ATM (LCx) was done, followed by a final POT with NC balloon 4.0/15mm at 14ATM. Final IVUS showed good MSA. [Formula presented] [Formula presented] [Formula presented] Conclusion(s): This patient developed hemodynamic instability with each rotational atherectomy run, hence we decided not to perform rotablation to the circumflex artery. His hemodynamic condition improved with the use of intra aortic balloon pump. IABP use can reduce procedural event rate and potentially reduce long term mortality in appropriately selected patients who are at high risk of adverse events. He was followed up a month following the procedure and remained asymptomatic. For complex, calcified coronary lesions involving the left main stem, coronary artery bypass graft surgery is an alternative option.Copyright © 2023

Intramedullary spinal cavernous malformations with high ossification: a case report and review of the literature.

BACKGROUND: Cavernous malformations of the spinal cord are a rare type of vascular malformation, comprising approximately 5 to 16% of all vascular lesions in the spinal cord. Depending on their origin position, these malformations can be distributed in different locations within the spinal canal. Although intramedullary cavernous malformations have been reported in the literature, they are exceedingly rare. Furthermore, highly calcified or ossified intramedullary cavernous spinal malformations are even rarer. CASE PRESENTATION: Here, we present a case report of a 28-year-old woman diagnosed with a thoracic intramedullary cavernous malformation. The patient had been experiencing progressive numbness in her distal limbs for a period of 2 months. During routine lung computed tomography screening for COVID-19, a hyperdense mass was noted in the patient's spinal canal. Magnetic resonance imaging revealed a mulberry-shaped intramedullary mass at the T1-2 level. The patient underwent surgical treatment, during which the entire lesion was successfully removed, resulting in a gradual improvement of her symptoms. Histological examination confirmed the presence of cavernous malformations with calcification. CONCLUSIONS: Intramedullary cavernous malformations with calcification are rare and special type that should be treated surgically in the early stage without significant neurological impairment before rebleeding or enlargement of the lesion can occur.

A rare occurrence of tumoural calcinosis of long head biceps tendon post-COVID-19 infection

Tumoural calcinosis is a rare entity commonly caused by hyperphosphatemia due to bone mineral disease, hyperparathyroidism of chronic renal failure. However, our case demonstrated a normo-phosphatemic tumoural calcinosis post-COVID-19. This is a 36-year-old with a multiple history of soft-tissue calcification presented with acute onset severe right shoulder pain associated with anterior shoulder swelling at day 20 post-COVID-19. The clinical examination reveals anterior shoulder swelling at bicipital groove with severe restriction of range of motion due to pain. Ultrasound revealed an initial solid mass arising from the sheath of long head of biceps tendon which turns into cystic mass at week 4 of the disease. Computed tomography scan demonstrate sedimentation sign. His blood parameters revealed normo-calcemic, normo-phosphatemic bone profile, normal renal function and no sign suggestive of rheumatological disease. He was started on short course on non-steroidal anti-inflammatory drugs (NSAIDs) for 3 week and does not require surgical intervention. His symptoms completely resolved after 4 weeks with persistent shoulder swelling. He was started with prophylaxis low phosphate diet to prevent future recurrence. Our case demonstrates that conservative management using the short course of NSAIDs can be beneficial in treating primary normophosphatemic tumoural calcinosis.

Pulse of Asia 2021

The proceedings contain 67 papers. The topics discussed include: cardiovascular system and COVID-19;long term sequale on COVID-19;fighting vascular disease: thoughts about 2022 Taiwan hypertension guidelines;quantification of hemodynamic parameters using 4D flow MRI;nanomedicine for the treatment of atherosclerosis;direct thrombus imaging;clinical outcome in patients with deep vein thrombosis;cardiovascular benefits of SGLT-2 inhibitor;central blood pressure and pressure wave reflection in cardiovascular abnormalities: do not put them in shade;association between excess pressure and cognitive function among elderly population;visceral adipose tissue, coronary artery calcification and heart failure: a moderated mediation analysis;and the cardio-ankle vascular index was associated with CHADS2 score in patients with atrial fibrillation: a coupling registry study.

Looks Like a Vegetation but It Is Not Endocarditis

Background Myxomas are the second most common primary cardiac tumor (PCT) but overall have a low incidence rate. They usually arise from the interatrial septum whereas infective endocarditis (IE) vegetations frequently develop where there is turbulent blood flow, i.e., on the atrial side of the atrioventricular valves. Case A 75 year old male presented with fatigue, shortness of breath (SOB), myalgias and lower extremity edema for 2 weeks. His vital signs were stable and he was afebrile. Blood cultures were negative, WBC was normal, COVID-19 test was negative, and troponin was mildly elevated. TEE showed an ejection fraction of 20% with a large mitral valve (MV) mass (Figure 1A,B). Decision-making The mass was surgically resected and the MV was replaced (Figure 1C). On pathologic evaluation, the mass was confirmed to be a myxoma. The patient was later discharged without complication. Conclusion Clinical features of myxoma can overlap with IE including fever, malaise, SOB, and other signs of valvular obstruction or embolization. About 5% of myxomas originate from the MV and the differential diagnosis for an intra-atrial mass should include IE, PCT, metastatic tumors, and intracardiac thrombus. On echocardiography, myxomas appear irregularly frond-like or grape-cluster in shape. They are typically nonhomogeneous and can have areas of calcifications (Figure 1A). Both TEE and TTE are the mainstay for diagnosis of intracardiac masses and TEE specifically assists in guiding surgical excision. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Coronary artery calcification as a predictor of adverse outcomes in patients hospitalized with COVID-19.

Background: Subclinical coronary artery calcification (CAC) is a risk factor for adverse cardiovascular events, but studies investigating its association with outcomes in hospitalized patients with COVID-19 are limited. Methods: This was a retrospective study of 457 patients without history of clinical coronary artery disease (CAD) who underwent chest CT imaging during COVID-19 hospitalization at MCW/Froedtert-affiliated hospitals from July 1, 2020 to July 1, 2021. Visually estimated CAC (yes/no) and CAC burden (none/mild/moderate/severe) were recorded from radiology reports. Unadjusted and adjusted regression models were used to assess associations between CAC and hospital length of stay (LOS), ICU admission, mechanical ventilation, and mortality. Results: The mean age was 63.1 ± 15.3 years. Presence of CAC was associated with mechanical ventilation (p = 0.01), ICU admission (p = 0.02), in-hospital or 30-day mortality (p < 0.01), and hospital LOS (p < 0.001). Compared to no CAC, hospital LOS was increased for mild (p = 0.01) and severe CAC (p = 0.02) after adjustment for covariates. Severe CAC was also associated with increased ICU admission (OR 3.97; p = 0.002) and mechanical ventilation (OR 3.08; p = 0.03) after adjustment. In unadjusted analysis, in-hospital or 30-day mortality increased with magnitude of CAC severity, with HR 2.43 (p = 0.003) for mild and HR 3.70 (p = 0.002) for severe CAC. However, associations with mortality were not significant after adjustment. Conclusions: CAC is associated with increased ICU admission, mechanical ventilation, hospital LOS, and in-hospital or 30-day mortality for patients hospitalized with COVID-19. Patients with severe CAC, and without clinical history of CAD, represent a high-risk population for morbidity and mortality.

Shoulder Pain and Injury after COVID-19 Vaccination

Shoulder injury related to vaccine administration (SIRVA) is a term given to describe shoulder pain and dysfunction arising within 48 hours after vaccine administration and lasting for more than one week. While SIRVA is most commonly seen after influenza and tetanus vaccines, there have been a few recent case reports describing SIRVA-like symptoms after COVID-19 vaccine administration. Two patients presented to the shoulder surgeon's practice center with complaints of shoulder stiffness and pain following the COVID-19 vaccine. The first patient was a 33-year-old man;he presented within 2 days of onset of the pain and 14 days from the vaccine date. He had a complete restriction of shoulder motion (0degree flexion, and no external or internal rotation) at presentation. This patient was treated with non-steroidal anti-inflammatory drugs (NSAID) and rested in a sling for a week. The second patient was a 53-year-old woman;she presented with a 6-week duration of mild restriction of active shoulder motion and shoulder pain. Her magnetic resonance imaging (MRI) revealed the presence of subacromial-subdeltoid bursitis. She was treated with subacromial steroid injection and range of motion shoulder exercises. Both patients recovered a near-normal range of motion recovery within a month, and their pain improved significantly. The main lessons from this case report were: (1) patients presenting with a recent increase in pain and acute loss of shoulder movements after vaccination may be managed conservatively with rest and NSAID medications and (2) in case of a subacromial-subdeltoid bursitis in the MRI, subacromial injection of steroid may provide good pain relief. Copyright © 2022, Yale Journal of Biology and Medicine Inc. All rights reserved.

Mineralizing angiopathy: an underrecognized clinicoradiologic entity

Case Report: Initial History/Presentation: A term vaccinated 7-month-old male with a history of eczema presents with two hours of right-sided hemiplegia and hemidystonia. Parents deny loss of consciousness, altered mental status, or facial symptoms. He has no known history of recent or remote head trauma. Patient may have had COVID two months prior when he had upper respiratory symptoms, with his mother testing COVID+ at that time. Of note, he received a Moderna COVID vaccination one day prior to onset of symptoms. Physical Exam: Pertinent exam findings include CN II-XII intact, right-sided upper and lower extremity strength 3/5, sensation intact, and truncal ataxia while seated. Physical exam is otherwise unremarkable. Diagnostic Evaluation: Initial lab work revealed leukocytosis (20.9), but otherwise a reassuring CMP, triglycerides, HDL, and LDL. PTT was elevated, but normal on recheck. Protein C antigen and activity were low, but deemed non-concerning by hematology. All other hypercoagulable labs were normal. On imaging, CT Brain showed linear calcifications in bilateral basal ganglia suggestive of mineralizing angiopathy. HisCTA head/neckwas negative.MRI Brain revealed an acute infarct of the body/tail of the left caudate nucleus, posterior limb of internal capsule, and posterior putamen. Clinical Course/Follow-up: Our patient was started on Aspirin 4 mg/kg daily. Throughout the course of his 3-day inpatient stay, he had mild improvement of right-sided strength and function, and continued improvement upon follow-up with his pediatrician. Given the short interval between receiving his COVID vaccination and onset of symptoms, his case was reported to the Vaccine Adverse Event Reporting System. Conclusion(s): From a radiological perspective, mineralizing angiopathy is an uncommon but familiar finding seen in up to 5% of all neonatal head ultrasounds and increasing to nearly 20% in preterm infants. It is most commonly associated with infection, hypoxia, and chromosomal abnormalities but is usually of minimal clinical significance. However, there are numerous reports of basal ganglia and thalamic strokes following minor head trauma in children with mineralizing angiopathy. For radiologists, this association is important to recognize and relay to the primary team so targeted history and MRI, if indicated, may be obtained to expedite definitive diagnosis and initiation of treatment to preserve precious brain tissue. Without a history of head trauma, in this case, stroke provocation is unclear, and other infectious or inflammatory disorders could appear similarly if they induced vasospasm or blood pressure lability. A short-interval timeframe between COVID vaccine administration and symptom onset is likely incidental, but research to exclude or illicit any link may be of benefit. Findings of mineralizing angiopathy on CT in the appropriate clinical setting should prompt further evaluation with emergent MRI to determine the presence of basal ganglia or thalamic stroke. Copyright © 2023 Southern Society for Clinical Investigation.

Coronary artery calcification: Effects on severity and survival in patients with COVID-19.

Background: The aim of this study was to evaluate the effect of coronary artery calcification on disease severity and prognosis in patients with coronavirus disease-2019 (COVID-19). Materials and Methods: One hundred and forty-one patients with COVID-19 were included in this study. The severity of pulmonary involvement and calcification of coronary arteries were assessed by computed tomography scan and calcification was classified by two methods: Weston and segmental. In both the methods, patients were divided into three groups with scores of 0, 1-6, and 7-12, which are called groups 1, 2, and 3, respectively. Results: The mean age of patients was 54.26 ± 14.55. Difference in score of pulmonary involvement was reported to be significant between deceased and discharged patients (11.73 ± 5.26 and 7.28 ± 4.47, P = 0.002, respectively). In Weston score system, the chance of recovery of Group 1 patients was significantly higher than Group 3 (odds ratio [OR] =6.72, P = 0.05, 95% confidence interval [CI] =1.901-50.257). Similar results were observed in the segmental scoring system (OR =6.34, P = 0.049, 95% CI =1.814-49.416). Despite the higher chance of severe disease in patients with coronary artery calcification, this increase was not statistically significant in either Weston or segmental methods (OR =0.47, P = 0.23 and OR =0.85, P = 0.79, respectively). Conclusion: Coronary artery calcification in patients with COVID-19 has a significant association with poor prognosis. However, no significant relationship was observed between this issue and the severity.

Diagnostic delay due to COVID-19 pandemic: a case of uncontrolled growth of peripheral giant cell granuloma

COVID-19 pandemic had several consequences including reduced access to public health care service that led to significant delays in screenings, diagnosis, and treatments. Peripheral giant cell granuloma (PGCG) is a benign exophytic lesion of reactive nature, affecting gingiva and alveolar ridge. Recent studies report its highest prevalence in 5th-6th decade of age, occurring mainly in mandible with an average size of 1.3-1.7 cm. We aimed to show the impact of pandemic on diagnosis delay in a patient with peripheral giant cell granuloma that reached unusual dimensions. ACaucasian 61-year-old male referred to our observation for the presence of an exophytic lesion on edentulous alveolar crest of the mandible. He was an edentulous patient, that developed a lesion of unusual dimensions of 7x4.5x3.5 cm. The soft consistency, slow exophytic growth and bluish-red color suggested an inflammatory hyperplastic nature of the lesion. An excisional biopsy was performed in association with curettage of underlying periosteum. Histological examination revealed presence of spindle-shaped mononuclear cells and multiple multinucleated giant cells in a well vascularized stromal tissue. No calcifications were found. Clinical and histological features suggested the diagnosis of PGCG. This case is clinical evidence of the delays induced by the COVID-19 emergency, which negatively affected all health care and suggests that the PGCG, albeit benign in nature, may have an uncontrolled and non-self-limiting growth, making its surgical removing and healing process more complicated. Copyright © 2022 Edizioni Minerva Medica. All rights reserved.

The prognostic value of the TyG index in non-diabetic COVID 19 patients with myocardial injury

Background and Aim: Insulin resistance (IR) is strongly associated with endothelial dysfunction. There is also evidence that endothelial dysfunction is associated with COVID 19 infection. Triglyceride glucose (TyG) index is newly defined promising surrogate index for IR as a cardiometabolic risk marker. It has been found to be associated with coronary artery calcification and high risk of cardiovascular disease. No data are currently available taking into account the effects of the TyG index on mortality in non-diabetic COVID 19 patients with myocardial injury. We aimed to investigate whether TyG predicts the in hospital mortality in non-diabetic COVID 19 patients with myocardial injury Methods: This was a retrospective study. 218 non-diabetic patients who have myocardial injury due to COVID 19 infection were included in the study. Blood samples including high-sensitivity (hs) cardiac troponin (cTn), triglycerides, eGFR, haemoglobin, platelet, D-Dimer, CRP, albumine, uric acid, ferritin and plasma fasting glucose (PFG) concentrations, were collected from the antecubital vein from each patient after at least 8 h of fasting. The TyG index was calculated as follows: log [serum triglycerides (mg/dL) x plasma glucose (mg/dL)/2]. We defined myocardial injury as cTn concentrations >99th percentile upper reference limit. The study cohort was divided into 2 groups as those survivors and non-survivors. Triglyceride and fasting blood glucose were evaluated in a separate multivariate analysis model (model 1). The receiver operating characteristics (ROC) curve analysis was used to evaluate the sensitivity and specificity of the TyG and it's cut-off value in determining the in-hospital mortality. Survival evaluations for the low-and high TyG groups were determined by using Kaplan-Meier and long-rank test Results: 169 patients were survivors and 49 patients were non-survivors. D-Dimer and CRP levels were more higher in non-survivors group (p<0.01 and p<0.01 respectively). Non survivor patients had also higher TyG index than the others (p<0.01) (Table 1). Age, CHF, uric asid, TG, TyG were found to be independently associated with in-hospital mortality in univariate anaylsis. We used AUC value for diagnostic accuracies and discriminatory performances of the TyG (AUC:0.786, CI 95% 0.721-0.852, p<0.001), TG (AUC:0.738, CI 95% 0.656-0.820, p<0.001), and PFG (AUC:0.660, CI 95% 0.573-0.748, p=0.001) for detecting the in-hospital mortality. The receiver operating characteristics curve analysis revealed a cut off value of TyG index greater than 4.97 predicts the development of in hospital mortality in non-diabetic COVID 19 patients with myocardial injury with a 82% sensitivity, and a 66% specificity. Conclusion(s): A TyG above 4.97 was found as a risk factor for in hospital mortality in non-diabetic COVID 19 patients with myocardial injury. TyG may be a part of cardiovascular mortality to identify individuals at high risk for nondiabetic COVID 19 patients with myocardial injury.

Cardiovascular Calcium Scoring by Deep Learning is Predictive of Mortality in Emergency Department Patients

Introduction: Computed tomography (CT) imaging is widely used in the emergency department (ED) setting. Calcifications of the coronary arteries, heart valves, and aorta are common incidental findings that may herald clinical or subclinical cardiovascular disease. Hypothesis: We sought to determine whether the quantitative burden of cardiovascular calcifications, as measured by a CT-based deep learning pipeline, would be predictive of short-term mortality in a diverse population of ED patients. Method(s): We conducted a prospective single-center cohort study nested in the Quebec COVID-19 Biobank from March 2020 to September 2021. For the purposes of this study, we enlisted adult patients presenting to the ED with cardiopulmonary symptoms who were tested for COVID-19 and underwent CT imaging of the chest. We used a deep learning model previously developed by our team to automate the quantitative scoring of coronary artery calcification (CAC), aortic valve calcification (AVC), mitral annular calcification (MAC), and thoracic aorta calcification (TAC) from the CT images. These calcium scores were categorized as sex-stratified tertiles plus a zero-score referent category. The primary outcome was all-cause mortality at 30 and 90 days adjusted for age, sex, and COVID-19 status using multivariable logistic regression. Result(s): The study sample consisted of 731 ED visits among 271 unique patients with a mean age of 66 years and 47% females. COVID-19 illness was the main diagnosis in 29% of ED visits. The prevalence of any quantifiable calcification was 51% for CAC, 33% for AVC, 23% for MAC, and 80% for TAC. The statistically significant adjusted odds ratios for mortality were 2.50 (1.08, 5.81) in the highest AVC tertile at 30 days, 2.73 (1.37 5.47) in the highest CAC tertile at 90 days, and 4.42 (1.01, 19.4) in the highest TAC tertile at 90 days. These odds ratio remained similar after further adjustment for past history of myocardial infarction or heart failure. Conclusion(s): High calcium scores in the coronary arteries, aortic valve, and thoracic aorta are associated with heightened 30-day mortality in ED patients. Deep learning quantification of calcium scores from clinical CT scans is an opportunistic approach for risk stratification.

Stress Induced Cardiomyopathy After the Covid-19 Vaccine

Introduction: The SARS-CoV-2 virus has potential to cause acute and long-term cardiac effects. The vaccines were developed to prevent severe illness, but there are concerns about vaccine related side effects. Specific to the heart there have been case reports of mRNA vaccine related cardiomyopathies, particularly myocarditis. We present a case of a patient with presumptive stress induced cardiomyopathy in the setting of recent Covid-19 mRNA vaccination. Case Presentation: A 93-year-old female with a past medical history of hypertension presented with worsening shortness of breath and bilateral lower extremity edema. She received her second dose of the Covid-19 mRNA vaccine five days prior to presentation. She had no history of heart disease, was a nonsmoker, and denied alcohol or drug use. In the ED she was noted to be fluid-overloaded, and her CT chest showed minimal coronary calcification and bilateral pleural effusions. She was admitted for heart failure exacerbation and started on IV furosemide. Her transthoracic echocardiogram showed an ejection fraction of 40-45%. The pattern of left ventricular dysfunction was consistent with stress induced cardiomyopathy with apical akinesis and basal sparing of the left ventricular wall segments. Cardiology was consulted and recommended management with diuretics and beta blocker. She had a diuresis of 5 liters during her hospitalization. At clinic follow-up, dyspnea had improved, and her peripheral edema had resolved. Repeat echocardiogram showed recovery of left ventricular ejection fraction to 61% by Simpsons biplane technique with no regional wall motion abnormalities. Further cardiac assessment to evaluate for obstructive coronary artery disease and myocarditis was discussed and offered to the patient but was declined due to her positive response to conservative management. Discussion(s): The precise etiology of stress induced cardiomyopathy is unknown, but it is thought to be secondary to the sudden release of stress hormones. There are isolated reports of stress induced cardiomyopathy associated with Covid-19 vaccination, but the potential mechanism is unclear. An improved understanding of the potential effects of mRNA vaccines may help guide decisions regarding future booster vaccinations.