ABSTRACT
Objectives: Severe acute respiratory syndrome-coronavirus 2/COVID-19 infection is still a global concern, with pregnant women are considered as vulnerable population. Until now, the characteristics of pregnant women in Indonesia who are infected with COVID-19, as well as pregnancy and neonatal outcomes, are still unknown. This study aims to obtain national data, which are expected to be useful for the prevention and management of COVID-19 in pregnant women in Indonesia. Method(s): There were 1,427 patients recruited in this retrospective multicenter study. This study involved 11 hospitals in 10 provinces in Indonesia and was carried out using secondary patient data from April 2020 to July 2021. COVID-19 severity was differentiated into asymptomatic-to-mild symptoms and moderate-to-severe symptoms. The collected data include maternal characteristics, laboratory examinations, imaging, pregnancy outcomes, and neonatal outcomes. Result(s): Leukocyte, platelets, basophil, neutrophils segment, lymphocytes, monocytes, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), urea, and creatinine were found to be significantly associated with severity differences (p < 0.05). Moderate-severe symptoms of COVID-19 also shown to have suggestive pneumonia findings on chest X-ray findings. Patients with asymptomatic-to-mild symptoms had significantly (p < 0.001) higher recovery rate, shorter hospital stay, less intensive care unit (ICU) admission, and had more vaginal delivery. Neonates from mother with mild symptoms also had significantly (p < 0.001) higher survival rate, higher birth weight, and higher APGAR score. Conclusion(s): Several laboratory and radiology components, as well as maternal and neonatal outcomes are related to the severity of COVID-19 in pregnant women in Indonesia.Copyright © The Author(s). 2023.
ABSTRACT
Background: At our hospital, people with COVID-19 (coronavirus disease 2019) had a high rate of pulmonary barotrauma. Therefore, the current study looked at barotrauma in COVID-19 patients getting invasive and non-invasive positive pressure ventilation to assess its prevalence, clinical results, and features. Methodology: Our retrospective cohort study comprised of adult COVID-19 pneumonia patients who visited our tertiary care hospital between April 2020 and September 2021 and developed barotrauma. Result(s): Sixty-eight patients were included in this study. Subcutaneous emphysema was the most frequent type of barotrauma, reported at 67.6%;pneumomediastinum, reported at 61.8%;pneumothorax, reported at 47.1%. The most frequent device associated with barotrauma was CPAP (51.5%). Among the 68 patients, 27.9% were discharged without supplemental oxygen, while 4.4% were discharged on oxygen. 76.5% of the patients expired because of COVID pneumonia and its complications. In addition, 38.2% of the patients required invasive mechanical breathing, and 77.9% of the patients were admitted to the ICU. Conclusion(s): Barotrauma in COVID-19 can pose a serious risk factor leading to mortality. Also, using CPAP was linked to a higher risk of barotrauma.Copyright © 2021 Muslim OT et al.
ABSTRACT
The aim is to examine dynamics of avidity maturation of IgG antibodies against SARS-CoV-2 RBD depending on the type of immunization (vaccination or infection), as well as on the duration and frequency of immunization. Materials and methods. The study was performed on two sample cohorts collected at two time points during COVID-19 pandemic. The first cohort (group No. 1) consisted of 87 samples of blood sera obtained from COVID-19 convalescents in the period from March to September 2020. The second cohort included 204 samples obtained in September 2021 from two patient groups. Group No. 2 (n = 64) - patients immunized with a full course of Gam-Covid-Vac, group No. 3 (n = 140) - COVID-19 convalescent patients and subjects vaccinated with Gam-Covid-Vac ("hybrid immunity"). Results and conclusion. The dynamics of avidity maturation for SARS-CoV-2 RBD IgG antibodies depending on the method and frequency of immunization, showed that the most effective immunity was formed in COVID-19 convalescent patients and subjects vaccinated with a full course of Gam-Covid-Vac. The "hybrid" immunity showed not only a significantly higher (compared with groups No. 1 and No. 2) level of IgG antibodies (median 228 BAU/ml vs 75 or 119 BAU/ml, p < 0.001), but also a higher level of avidity (IA 90.5% vs 54.5 and 76.6, respectively, p < 0.001, 4M urea). In the test for assessing the avidity index with the denaturing agent 8M urea in patients with "hybrid immunity", the median level of IA was 25% versus 14.8% and 16% in COVID-19 convalescents and vaccinated subjects (p < 0.001), only in 8 patients IA was higher than 50%. While comparing a single infection of COVID-19 with a full course of Gam-Covid-Vac, it was shown that vaccination leads to higher IgG levels (median values in groups 119 and 75 BAU/ml, p < 0.001) and to a higher avidity index (median 76.6% vs 54.5%). Thus, the more rapid induction of high-avidity antibodies was in vaccinated individuals at early stages of immunization (up to 4 months), during the period when IgG avidity maturation has not yet been completed. Our results showed that during this period vaccination leads to production of antibodies with avidity index at median level of 82% versus 36% in COVID-19 convalescents at similar time point.Copyright © 2023 Saint Petersburg Pasteur Institute. All rights reserved.
ABSTRACT
BACKGROUND: One of the most precocious Italian COVID-19 outbreaks began in February 2020 in Medicina, a small town in the province of Bologna. We compared the characteristics of different cohorts, to identify potential predictive factors for outcome: patients of Medicina outbreak versus those of the surrounding district (Imola), and before or after the local medical intervention. METHOD(S): Between March the 3rd and April the 9th, 2020 167 adults with COVID-19 were admitted to the Emergency Department (ED) (78 from Medicina cluster, 89 from Imola district). Data at ED presentation were collected;hospitalized patients were followed until death or discharge. RESULT(S): Medicina and Imola cohorts were similar in age, main comorbidities, clinical presentation, laboratory tests, arterial blood gas analysis (ABG), death and acute respiratory distress syndrome (ARDS) rates. Age, hypertension, diabetes, chronic obstructive pulmonary disease, dyspnea, body temperature, quickSOFA Score, elevated C-reactive protein (CRP), creatinine, urea, DELTA A-a O2, respiratory rate and FiO2 were associated with death and ARDS. Elevated Glasgow Coma Scale, diastolic blood pressure, oxygen peripheral saturation, P/F and pH were associated with patient survival and protective from ARDS. After the intervention in Medicina district, patients presenting at ED were younger and with long-lasting symptoms;CRP values were significantly lower, ABG and respiratory clinical parameters were less severely impaired. These differences did not affect the outcome. CONCLUSION(S): Since the results of our study are consistent with worldwide evidences, we suggest that the early insight of a small local SARS-CoV-2 outbreak can be representative and predictive of the subsequent course of the virus in wider areas. This must be kept in mind to manage next epidemic waves.Copyright © 2022 EDIZIONI MINERVA MEDICA.
ABSTRACT
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.
ABSTRACT
Introduction: On December 31, 2019, China reported cases of pneumonia of unknown etiology in the city of Wuhan, Hubei Province of China. With further investigations, the Chinese health authorities, on 7th January 2020 reported the agent as the novel Coronavirus, 2019-nCOV. Initially, Wuhan and later the entire Hubei province was brought under stringent lockdown. Material(s) and Method(s): This retrospective record analysis study involving laboratory investigations was carried out in a single center in the months of June and July 2022. The ethical clearance for this single-centre study was obtained from the Institutional Ethics Committee (IEC). This study included 112 patients, of ages more than or equal to 18 years, who were confirmed cases of COVID-19 with at least one reverse transcriptase polymerase chain reaction test positive and admitted for inpatient treatment for a minimum of 8 days or longer in the wards or ICU between May 2020 to March 2022. Result(s): A total of 112 patients who had a positive RT PCR test were identified and included in the study after excluding patients who had sought discharge against medical advice, who had been referred to other hospitals and patients with a history of chronic renal failure. The mean age of patients included was 60.25 + 15.66. Among these patients 76 (67.9%) were male and 36 (32.1%) were female. Of the 112 patients, 47 patients (42%) survived of which 21(32.3%) were male, 15(31.9%) were female and 65 patients (58%) did not survive, of which 44(67.7%) were male and 21(32.3%) were female. Conclusion(s): Through this study, we can see that all the parameters considered ie. Serum Albumin, Serum Blood urea nitrogen (BUN), D dimer, BUN/Albumin ratio (BAR) and D dimer/Albumin ratio (DAR) are very solid indicators of predicting the outcome of admitted COVID-19 patients.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
ABSTRACT
Objectives: In this study, we aimed to investigate the prognostic value of the neutrophile-lymphocyte ratio and the effects of age, gender, and comorbidities on mortality. Method(s): In our study, 100 patients who had a ground-glass opacification on computed thorax tomography and who had a positive polymerase chain reaction test were included in our study. Demographic data, laboratory data and comorbidities of the patients were recorded. Result(s): Sixty-five (65%) of the patients participating in the study were male. The mean age of the patients was 66 (21.5). The mortality rate was found to be 27% (n=27) High neutrophile-lymphocyte ratio, low lymphocyte count, high urea, and creatin levels were significant in terms of mortality. In addition, advanced age, diabetes mellitus, and hypertension are other factors that have an impact on mortality. Conclusion(s): The neutrophile-lymphocyte ratio can solely be used as a prognostic marker because it is simple and economical.©Copyright 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.
ABSTRACT
Objective: To evaluate the effectiveness and safety of ivermectin in patients with mild and moderate COVID-19. Method(s): This study was a single-center, randomized, open-label, controlled trial with a 2-arm parallel-group design on 68 patients with COVID-19. According to the 1:1 ratio between the study groups (ivermectin group and standard treatment group), patients were randomly admitted to each intervention arm. Result(s): The mean age of the participants in the ivermectin group was (48.37+/-13.32) years. Eighteen of them were males (54.5%) and the participants in the control group had a mean age of (46.28+/-14.47) years, with nineteen of them being males (59.4%). As a primary outcome, after 5 days of randomization, there was no significant difference between the ivermectin group and the control group in the length of stay in the hospital (P=0.168). ICU admission (P=0.764), length of stay in ICU (P=0.622), in-hospital mortality (P=0.427), adverse drug reactions, and changes in the mean difference of laboratory data had not any significant difference between the two groups (except for urea change). In addition, the radiologic findings of the two groups of patients were not significantly different. Linear regression analysis showed that for every 10 years increase of age, 0.6 day of hospitalization duration was increased. There was no statistically significant association between other variables and clinical outcomes. Conclusion(s): Among adult hospitalized patients with moderate to severe COVID-19, there was no significant relationship between the administration of ivermectin single dose in a five-day course and clinical improvement, and mortality of the participants.Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Aim: This study aimed to compare clinical data and laboratory results in patients examined for suspected pulmonary embolism (PE) in the emergency department based on three groups: patients with coronavirus disease-2019 (COVID-19), patients with PE and patients with both COVID-19 and PE. Material(s) and Method(s): This retrospective study was approved by the local ethics committee of the university. Patients included in the study were divided into three groups: Group 1, consisting of COVID-19-polymerase chain reaction (PCR) (negative) and PE (positive) patients;Group 2, consisting of COVID-19-PCR (positive) and PE (negative) patients, and Group 3, consisting of COVID-19-PCR (positive) and PE (positive) patients. Result(s): The three patient groups included in the study had no difference in terms of age (p = 0.916) or sex. The laboratory results of the groups were compared using the Kruskal-Wallis test, which showed significant differences in the levels of white blood cells (p = 0.005), lymphocytes (p < 0.001), neutrophils (p = 0.016), D-Dimer (p < 0.001) and lactate (p = 0.001). Receiver operating characteristic curve analysis with a cut-off value of >2590 for D-Dimer showed 71.43% specificity and 78% sensitivity in differentiating Group 1 from Group 2, and with a cut-off value of >3640, it had 80% specificity and 81.82% sensitivity in differentiating Group 3 from Group 2. Discussion(s): COVID-19 leads to increased incidence of PE. In addition to clinical data, D-Dimer and lactate levels can be used in the differentiation of these patients.Copyright © 2022, Derman Medical Publishing. All rights reserved.
ABSTRACT
Aim: The aim of this study is to analyze the effectiveness of the leukocyte albumin ratio (LAR) in predicting mortality in critical COVID-19 patients. Material(s) and Method(s): In this retrospectively-designed study, we evaluated a total of 98 critical patients who were hospitalized in the intensive care unit. Patients were divided into two groups according to hospital mortality as survivors (n=43) and non-survivors (n=55). Result(s): The non-survivors group was statistically significantly older (67.3+/-9.7 versus 62.5+/-10.9;p=0.023). HT and DM were detected more in the non-survivors group than in the survivors group (p=0.031, p=0.018, respectively). Mean LAR values were significantly higher in non-survivors than in survivors (5.9+/-3.5 versus 3.3+/-1.4;p<0.001). LAR values was positively correlated with urea (r=0.43, p<0.001), LDH (r=0.35, p<0.001), ferritin (r=0.25, p=0.015), procalcitonin (r=0.34, p<0.001), and pro-BNP (r=0.24, p=0.015) levels. A cut-off value of 3.71 ng/mL for LAR predicted mortality with a sensitivity of 76% and a specificity of 70% (AUC:0.779 95% Cl:0.689-0.870;p<0.001). Multivariable logistic regression analysis revealed that older age (OR:1.114, 95% CI:1.020-1.218;p=0.017) and increased ferritin (OR:1.003, 95% CI:1.001-1.004;p=0.002) and LAR (OR:1.583, 95% CI:1.073-2.337;p=0.021) values were independent predictors of mortality in patients with critical COVID-19. Discussion(s): LAR can be a useful and prognostic marker that can be used to predict mortality in COVID-19 patients admitted to the intensive care unit.Copyright © 2022, Derman Medical Publishing. All rights reserved.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. Since 2019, it has spread all over the globe, causing a pandemic that is still ongoing. COVID-19 vaccines protect against this disease through different strategies. Pfizer-BioNTech and Sinopharm vaccines were the most used vaccines in Iraq. Both vaccines have a specific mechanism to trigger the immune system in cells. This research aims to compare the biochemical and immunological responses in vaccinated individuals with either the Pfizer-BioNTech COVID-19 vaccine or the Sinopharm vaccine. This cohort study included 120 Iraqi adults vaccinated with two doses, 21 days apart, using either the Pfizer or the Sinopharm vaccine. Forty subjects received the Pfizer vaccine, 40 subjects received the Sinopharm vaccine, and the other 40 subjects were unvaccinated. After 6 weeks, the second dose was administered, and the blood samples were collected. Our findings revealed that the biochemical biomarkers, urea, creatinine, aspartate aminotransferase, and alkaline phosphatase, seem to be not affected by the vaccines used. However, both vaccines significantly reduced alanine aminotransferase levels (p < 0.05). In contrast, the immunological biomarkers such as IgG, IgM, C3, IL-2, and hs-CRP remarkably responded to both vaccines (p < 0.01), while procalcitonin levels were significantly increased by the Pfizer vaccine (p < 0.05). The study concluded that the Pfizer-BioNTech vaccine boosted the immune system more than the Sinopharm vaccine. A booster dose is advised for people who have already taken Sinopharm or have long-term immunosuppressive diseases.Copyright © 2022 Edan, Khalaf, Geeran, licensee HBKU Press.
ABSTRACT
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.
ABSTRACT
Background: To determine the association between various demographic indicators and biochemical markers in COVID-19 patients in Western-Punjab. Material(s) and Method(s): An observational cross-sectional study was done on one hundred and fifty cases of all ages admitted in Isolation ward, reporting to Adesh Institute of Medical Sciences and Research, Bathinda, India with COVID-19(RT-PCR/ or RAT) from January 2022 to March 2022 were included. Clinical features like fever, cough and shortness of breath were recorded. Blood sample was collected in plain tube for biochemical markers like serum albumin, creatinine, ferritin, LDH, CRP and urea, SGOT, SGPT, procalcitonin, D-dimer, ESR, IL-6, ALP, bilirubin were analysed. Association of the clinical features and these biochemical markers were determined. Result(s): Patients were divided into 3 groups according to different ages (<40 years, 40-60 years, >60 years). Out of 150 patients 26 (17.3%) belonged to age group < 40, 60 (40.0%) belonged to age group 40-60 years and 64 (42.7%) belonged to age group >60 years. Mean age was 55.93 + / - 14.91. Out of 150, 39 (26.0%) were females and 111(74.0%) were males. 44 (29.3%) cases had hypertension and 59(39.3%) cases had diabetes mellitus. Urea levels in 118 (78.7%) patients were above normal reference values e and was statistically significant (p<0.015). 73 (48.7%) had SGOT levels above normal range [statistically significant (p<0.025)] while as 63 (42%) had SGOT above normal range [statistically significant (p<0.001)]. 98 (65.3 %) had IL-6 above normal range [statistically significant (p<0.003)]. While as albumin levels in 38 (25.3%) patients were within normal range and 112 (74.7%) patients had albumin below normal range [statistically significant (p<0.014)]. ESR (100%), D-dimer (100%), procalcitonin (100%), LDH (94%) were uniformly raised in almost all patients. Rest of the markers like ferritin (74%), bilirubin (6%), CRP (90%), creatinine (15.3%), ALP (14.7%) was also raised but was not statistically significant. Conclusion(s): Indian patients with COVID-19 disease showed variable pattern of clinical features.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
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.
ABSTRACT
Background: It is believed that COVID-19, in those with comorbidities, has an increasingly rapid and severe progression, often resulting in mortality. This study explores various comorbid conditions, disease severity, and clinical outcomes in patients infected with COVID-19. Method(s): This is a prospective observational study. Clinical data of COVID-19 patients admitted at Goa Medical College between November 23, 2020, to December 23, 2020, are summarized and analyzed using Google forms, spreadsheets, and R programming language. Result(s): A total of 100 patient data was collected, including 5% mild, 61% moderate, and 34% severe cases. Fever (83%) was the most common symptom, followed by dry cough (83%), dyspnoea (79%), and fatigue (32%). The most common comorbidities identified were diabetes (66%), hypertension (57%), and cardiovascular and cerebrovascular conditions (27%). Clinical outcome in patients was pneumonia (84%), ARDS (40%), bronchiolitis (10%), and shock (3%). Conclusion(s): Our study estimated that older men with underlying hypertension, diabetes, cardiovascular, and cerebrovascular conditions are at higher risk for severe clinical form. Fever, cough, and dyspnea were the most common signs on admission. The laboratory parameters showed a significant increase in CRP, ferritin, LDH, procalcitonin, ESR, and d-dimer in the case of SARS-CoV-2 infection.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.
ABSTRACT
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.
ABSTRACT
Objectives: The aim is to investigate the usefulness of lactate dehydrogenase (LDH)/Albumin, LDH/Lymphocyte and LDH/Platelet ratios on the prognosis of coronavirus disease (COVID-19) Alpha (B.1.1.7) variant pneumonia. Method(s): A total of 113 patients who were diagnosed with COVID-19 pneumonia and 60 healthy control group were included in this study. The cases were divided into 2 as classic COVID-19 group, and COVID-19 B.1.1.7 variant group. Complete blood count (CBC) and biochemical parameters of the patients were analyzed retrospectively. Patients with COVID-19 B.1.1.7 variant group were also grouped according to the length of stay in the hospital and the days of hospitalization. Result(s): LDH/Albumin, LDH/Platelet, and LDH/Lymphocyte ratios were found to be higher in COVID-19 B.1.1.7 variant group when compared to the control group (p<0.001). The ferritin, neutrophils/lymphocyte (NLR) ratio, procalcitonin (PCT) and LDH/Albumin had the highest area under the curve (AUC) values in the COVID-19 B.1.1.7 variant group (0.950, 0.802, 0.759, and 0.742, respectively). Albumin, Lymphocytes and hemoglobin values were significantly higher in the COVID-19 B.1.1.7 variant group than in the classic COVID-19 group (p<0.05). Conclusion(s): LDH/Albumin and LDH/Lymphocyte ratios may be useful for clinicians in predicting the risk of progression to pneumonia in COVID-19 B.1.1.7 variant patients. Copyright © 2022 the author(s), published by De Gruyter.
ABSTRACT
Background: Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious sequelae of acute COVID-19 infection affecting children. This study was done over a period of 12 months from December 2020 to November 2021 to describe the clinical presentation, laboratory abnormalities, and outcome of children with MIS-C. Method(s): Seventy-eight children below 12 years of age who satisfied the WHO diagnostic criteria for MIS-C were included in the study. Clinical parameters were recorded at admission. Relevant laboratory investigations, radiological studies, and outcome were documented. Result(s): The most commonly affected age group was 6-12 years with a female predominance. COVID RTPCR was negative in all patients. Most cases presented 2-6 weeks after the onset of acute COVID-19 infection. Lethargy, poor feeding, vomiting, abdominal pain, loose stools, cough, and cold are common symptoms of MIS-C syndrome in children and the common signs were rash, conjunctival congestion, hypotension, tachycardia, tachypnea, and hypoxemia. Gastrointestinal system was the commonly affected followed by the hepatic, renal, and cardiovascular systems. Coronary artery abnormalities were seen in 20% of cases. IVIg was the mainstay of therapy used in 95% of patients. Mortality was 1.3%. Cases responded well to IVIg and steroids. Conclusion(s): Overall, the short-term outcome was favorable with low mortality in our study cohort. One-fifth of children had coronary artery abnormalities during acute phase underscoring the need for long-term follow-up. Copyright © 2022, The Author(s).
ABSTRACT
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.