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The Covid 19 pandemic remains a serious public health problem until effective drugs and/or vaccines are available. Can we explain why so many people remain asymptomatic but nevertheless highly contagious explaining the speed with which the pandemic has spread around the world? Can we explain why the acute respiratory distress syndrome (ARDS) appears late but can so quickly have a fatal outcome? In the lung, mucociliary clearance (CMC) and alveolar clearance (CA) depend on the transport of sodium through the plasma membrane of epithelial cells. This transport is mediated by a highly selective sodium channel (Epithelial Sodium Channel = ENaC) which could be a key element in the pulmonary pathophysiology of SARS-CoV-2 infection.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.
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Introduction: The coronavirus disease 2019 (COVID-19) mainly causes pulmonary disease. However, extrapulmonary manifesta-tions, which affect the gastrointestinal tract and hepatobiliary system, have been reported. Case Presentation: Here we reported a 4-year-old boy with acute lymphoblastic leukemia and abdominal pain who had acute necrotic pancreatitis secondary to COVID-19. Conclusion(s): According to the COVID-19 epidemic, if drug-induced pancreatitis is ruled out, viral causes, especially COVID-19, should be considered.Copyright © 2023, Author(s).
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Myocarditis can lead to myocardial infarction in the absence of coronary artery obstruction. We report a case of probable myocarditis, complicated by myocardial infarction with non-obstructive coronary arteries. A 19-year-old man presented with chest pain typical of myocarditis. He was a smoker but was otherwise well. Electrocardiogram revealed diffuse ST-elevation and echocardiography revealed a thin, akinetic apex. Troponin-T levels on admission were raised leading to an initial diagnosis of myocarditis being made. However, late gadolinium enhancement study on cardiac magnetic resonance imaging demonstrated transmural enhancement typical of ischaemia. Coronary angiogram was normal, leading to a likely diagnosis of myocardial infarction with non-obstructive coronary arteries. It is important to highlight that coronary assessment remains important when working up for myocarditis, as myocardial infarction with non-obstructive coronary arteries can often complicate myocarditis in cases of normal angiography. Another important lesson was on how cardiac magnetic resonance imaging provided vital evidence to support underlying ischaemia despite normal coronary angiogram, leading to a diagnosis of myocardial infarction with non-obstructive coronary arteries. Myocardial infarction with non-obstructive coronary arteries remains a broad 'umbrella' term and cardiac magnetic resonance imaging, as well as more invasive coronary imaging techniques during angiography, can further assist in its diagnosis. Our case provides a reminder that myocardial infarction with non-obstructive coronary arteries, although increasingly recognised, remains under-diagnosed and can often overlap with peri-myocarditis, highlighting the need to employ multi-modality imaging in guiding management.Copyright © The Author(s) 2021.
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Covid19 is still one of the major public health problems of all countries nowadays. The most common cardiac manifestations reported till now are acute coronary syndrome, myocarditis, and arrhythmia. The prevalence of COVID-19 induced arrhythmias is different in recent reports and varies from benign sinus tachycardia to more ominous cases of severe bradycardia or even malignant ventricular arrhythmias. Here in, we describe a case of complete heart block in severe covid-19 pneumonia and review all recent relevant case reports published to date in order to understand the probable mechanisms and contributing factors of this rare complication of the disease.Copyright © 2022, Isfahan University of Medical Sciences(IUMS). All rights reserved.
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Toxic epidermal necrolysis (TEN), is an acute, life-threatening emergent disease involving the skin and mucous membranes with serious systemic complications. It is characterized by widespread epidermal sloughing. Drugs are the most common triggers of TEN, but infection, vaccination, radiation therapy and malignant neoplasms can all induce it in susceptible patients. We report two cases in whom a hair dye and a COVID-19 vaccine (BioNTech, Pfizer) were believed to be the causative agents. These patients have to undergo repeated debridements of the necrotic tissue. In this manuscript the anesthetic management of TEN patients is discussed. Detailed preoperative evaluation, aggressive fluid and electrolyte replacement, avoidance of hypothermia during debridement, minimizing anesthetic agents and limiting traumatic procedures are key points in the management.Copyright © 2023 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
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Aim: There are several methods to diagnose COVID-19. Early diagnosis and treatment are important in pregnant women with COVID-19. This study aims to investigate whether the APRI score is a method that can be used in the diagnosis of COVID-19 in pregnancy. Material(s) and Method(s): A cross-sectional retrospective study was conducted between March 2020 and November 2020. Pregnant women who were found to be COVID-19 positive by the RT-PCR test were included in the study. The same number of healthy pregnant women who were matched for age, BMI, and gestational week without any systemic disease were included as a control group. Age, gravida, parity, gestational week, BMI, mode of delivery, complete blood count, liver function tests, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and APRI scores were evaluated. The sensitivity and specificity of NLR, PLR, and APRI score in the diagnosis of COVID-19 were investigated. Result(s): Gravida, parity, gestational week, body mass index, and rate of previous vaginal delivery were similar between PCR-positive and negative patients. PCR-positive patients had significantly higher APRI scores (0.4+/-0.3 vs 0.2+/-0.0), NLR scores (7.7+/-5.3 vs 4.2+/-1.9) and PLR scores (217.3+/-105.7 vs 140.8+/-57.6) than PCR negative patients. The sensitivity of the NLR to detect COVID-19 was 69.44%, the specificity was 77.5%, the sensitivity of the PLR to detect COVID-19 was 58.33% (CI = 40.8-74.5), and the specificity was 87.5%. The APRI score sensitivity was 80.56%, and specificity was 80.0%. Discussion(s): The APRI score can be useful in predicting COVID-19 infection in pregnant women.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Background: Reviewing the laboratory studies, we observe some drugs with other specified applications, which cause serious inhibitory immune responses in the body. Selective Serotonin Reuptake Inhibitors (SSRIs) are among these drugs. Therefore, the current research aimed to evaluate the effectiveness of one of the SSRI drugs called fluvoxamine on the cytokine levels in COVID-19 patients. Material(s) and Method(s): The current research included 80 patients with COVID-19 hospitalized in ICU in Massih Daneshvari Hospital. They were entered into the research by an accessible method of sampling and then divided into two groups randomly. One of the groups underwent the treatment with fluvoxamine as the experimental group and the other group did not receive fluvoxamine as the control group. Interleukin-6 (IL-6) and CRP levels were measured before the onset of fluvoxamine consumption and when discharging from the hospital in all members of the sample group. Result(s): The current study showed that IL-6 levels increased, while CRP levels decreased in the experimental group significantly (P-value<= 0.01). After consuming fluvoxamine, IL-6 and CRP levels were higher and lower in the females compared to the males, respectively. Conclusion(s): Considering the effectiveness of fluvoxamine on IL-6 and CRP in COVID-19 patients, it may ultimately come true to use this drug to improve both psychological and physical conditions simultaneously and leave the COVID-19 pandemic behind with less pathology.Copyright © 2022 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran.
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Background: COVID-19 is associated with higher mortality rates in patients with cancer. In this study, we aimed to evaluate the clinical outcomes, and laboratory and imaging data of patients with solid tumor infected with COVID-19 infection. Method(s): This is a cross-sectional retrospective study performed in 2020-2022 on 85 patients with a previous diagnosis of solid tumors infected with COVID-19. We included all patients with tumors of solid organs that were diagnosed with COVID-19 infection and required hospitalization those patients previously hospitalized for treatments and were infected with COVID-19 during hospitalization. Demographic data of patients were collected using a checklist. We collected data regarding clinical outcome (discharge, hospitalization or death), duration of hospitalization, requiring ICU admission, duration of hospitalization divided by received drugs and type of tumor and mean survival time. Furthermore, we collected laboratory data from all patients. The radiologic characteristics of patients were also extracted from their data. Result(s): Breast cancer was the most common solid tumor (34.9%), followed by lung cancer (19.3%). The mortality rate was 24.1% (20 patients). The highest mortality rate in this study was for metastatic intestinal cancer to the lung (100%, one patient), followed by metastatic prostatic cancer to lung (50%, three patients). The highest hospitalization duration was for patients with glioblastoma multiform (GBM) (30 days). The mean survival time among patients with mortality was 19.15+/-1.80 days. The mean CT severity score of all patients was 27.53+/-22.90. Patient's most common radiologic sign was air space consolidation (89.1%). The highest CT severity score was found in patients with stomach cancer (46.67+/-5.77). Conclusion(s): The mortality rate in this study was 24.1%. Based on the results of our study and previous research, special care should be provided to patients with solid tumors during the COVID-19 pandemic and in infected cases.Copyright © 2022, E-Century Publishing Corporation. All rights reserved.
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Ventricular tachycardia (VT) is a type of broad complex tachycardia originating from a focus in the ventricle. It is one of the four important rhythms which can lead to cardiac arrest. Accurate and timely diagnosis of true VT is the cornerstone for proper management in the emergency department (ED). We present an interesting case of an electrocardiographic artifact mimicking VT, which led to a diagnostic dilemma in the ED.Copyright © 2023 Rehman, Albaroudi, Akram, Ahmad, licensee HBKU Press.
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Background: COVID-19 has become a serious health problem worldwide. Objective(s): The current study investigated the prognostic factors associated with demographical parameters, clinical and vital signs, and laboratory results for predicting severity and mortality in patients infected with COVID-19. Method(s): This retrospective analysis was conducted on the medical records of 372 COVID-19-positive patients hospitalized at the Khatam al-Anbiya Hospital, Shoushtar, Iran, from Sep 2020 to Sep 2021. The association of demographic parameters, clinical and vital signs, and laboratory results with severity and patients' outcomes (survival/mortality) was studied. The patients were divided into the non-severe group (n = 275) and the severe group (n = 97). COVID-19 disease severity was determined based on the severity of pulmonary involvement using CT chest images. The collected data were analyzed using IBM SPSS software for Windows (version 18). Logistic regression analysis was employed using the Forward LR method to predict COVID-19 severity and mortality. Result(s): The rates of mortality and the severe form of the disease were 87.1% (n = 324) and 12.9% (n = 48), respectively. A prognostic value was observed in predicting COVID-19 severity and mortality for some clinical and vital signs (diabetes (P < 0.001, P = 0.019), hypertension (P = 0.024, P = 0.012), pulmonary diseases (P = 0.038, P < 0.001), and anosmia (P = 0.043, P = 0.044) and paraclinical parameters (FBS (P = 0.014, P = 0.045), BUN (P = 0.045, 0.001), Cr (P = 0.027, P = 0.047), Neut (P = 0.002, P = 0.005), and SpO2 (P = 0.014, P = 0.001)). Cardiovascular disorders (P = 0.037), fever (P = 0.008), and dyspnea (P = 0.020) were also effective at predicting disease-related mortality. Multiple logistic regression analyses showed that diabetes disease, the place of residence, PCO2, and BUN with R2 = 0.18, and age, pulmonary diseases, and BUN with R2 = 0.21 were involved in predicting the severity and mortality, respectively. Conclusion(s): It seems that in addition to the BUN, diabetes and pulmonary diseases play a more significant role in predicting the severity and mortality due to COVID-19, respectively.Copyright © 2023, Author(s).
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Aim: In this study, we aimed tto compare the 30-day mortality prediction abilities of the acute physiology and chronic health evaluation II (APACHE II), CURB-65, pneumonia severity index (PSI), A-DROP, Infectious Diseases Society of America/American Thoracic Society severity criteria, and I-ROAD scores in patients aged over 80 years admitted to the intensive care unit with COVID-19 pneumonia. Material(s) and Method(s): The study was conducted with a single-center retrospective observational design and included patients aged 80 years and older who were admitted to the intensive care unit due to COVID-19 pneumonia between March 2020 and August 2021. Patient demographic data, imaging findings, blood test results, discharge status, length of stay in the intensive care unit, duration of mechanical ventilation, inotropic drug administration status, presence/ absence of mortality and vital signs at the time of admission were obtained from the hospital automation system. Then, the above-mentioned scores were calculated and compared statistically. Result(s): The study was completed with 119 patients, 60 (50.4%) women and 59 (49.6%) men. The mean age of all patients was 84 (80-98) years, and the mortality rate was 84.03% (n=100). Among the scoring systems, I-ROAD had the highest area under the curve (AUC) value (0.703), APACHE II had the highest specificity (94%), and A-DROP had the highest sensitivity (64%). Discussion(s): According to our results, the I-ROAD scoring system is an effective tool that can be used in the prediction of mortality related to COVID-19 pneumonia among intensive care patients aged >=80.Copyright © 2023, Derman Medical Publishing. All rights reserved.
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Background: In early 2020, severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) pandemics caused previously unheard of health, social, and economic problems worldwide. The disease can affect different organs such as the lungs, heart, pancreas, kidney, and unusual symptoms can be seen. Information on the clinical impact of SARS-CoV-2 infection on renal function among pediatric age groups is scarce. Case Report: In this report, we presented a 13-year-old boy who was admitted to our hospital with the relapse of nephrotic syndrome caused by COVID-19. The patient had mild upper respiratory tract symptoms, eyelid edema and progressive swelling of the lower extremities. Clinical remission was achieved with oral prednisolone therapy without the use of any antiviral drugs. Conclusion(s): Patients with nephrotic syndrome presenting with relapse should be evaluated for potential COVID-19 infection during the pandemic. The use of routine doses of prednisolone appears to be safe in mild disease. Copyright © 2023 by Erciyes University Faculty of Medicine.
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We report a case of neoplastic cardiac tamponade, a life-threatening condition, as the initial presentation of an anterior mediastinal malignancy. A 69-year-old gentleman with no known history of malignancy presented to the emergency department with shortness of breath, reduced effort tolerance and chronic cough. Clinically, he was not in distress but tachycardic. He was subjected to echocardiography which revealed large pericardial effusion with tamponade effect. Pericardiocentesis drained 1.5 L of haemoserous fluid. CECT thorax, abdomen and pelvis revealed an anterior mediastinal mass with intrathoracic extension complicated with mass effect onto the right atrium and mediastinal vessels. Ultrasound-guided biopsy histopathology examination revealed thymoma. Due to locally advanced disease, tumour resection was not possible, and patient was referred to oncology team for chemoradiotherapy. We report this case study not only due to the rarity of the case but also to highlight its diagnostic challenge due to the COVID-19 pandemic. Copyright © The Author(s) 2022.