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1.
J Med Case Rep ; 16(1): 233, 2022 Jun 10.
Article in English | MEDLINE | ID: covidwho-2108903

ABSTRACT

BACKGROUND: Coronavirus disease 2019 is an infectious disease with many presentations, and many of its effects on the human body are still unknown. Pheochromocytoma is a neuroendocrine tumor that may occur sporadically or be a manifestation of a hereditary disease line multiple endocrine neoplasia type 2. CASE PRESENTATION: In this study, we report a case of an Iranian patient infected with coronavirus disease 2019, causing unusual presentations of pheochromocytoma, including myocarditis and cerebrovascular involvement. CONCLUSIONS: We discovered a case of pheochromocytoma as an unusual presentation of COVID-19. In further investigations we also discovered thyroid medullary carcinoma and at the end MEN 2 syndrome was diagnosed. After proper treatment many symptoms were eliminated.


Subject(s)
Adrenal Gland Neoplasms , COVID-19 , Multiple Endocrine Neoplasia Type 2a , Pheochromocytoma , Thyroid Neoplasms , Adrenal Gland Neoplasms/pathology , Humans , Iran , Multiple Endocrine Neoplasia Type 2a/diagnosis , Pheochromocytoma/complications , Pheochromocytoma/diagnosis , Pheochromocytoma/pathology , Thyroid Neoplasms/diagnosis
2.
BMC Cardiovasc Disord ; 22(1): 473, 2022 11 08.
Article in English | MEDLINE | ID: covidwho-2108742

ABSTRACT

BACKGROUND: Spontaneous coronary artery dissection (SCAD) has emerged as an increasingly diagnosed cause of ST-segment elevation myocardial infarction (STEMI), which is easily missed or delayed. The effective use of coronary angiography (CAG) and advanced intracoronary imaging examinations in STEMI patients has led to increased detection of SCAD. CASE PRESENTATION: A 59-year-old woman with acute angina pectoris was diagnosed with STEMI detected by electrocardiography combined with measurement of myocardial enzymes. Due to the ongoing pandemic of coronavirus disease 2019 (COVID-19) in Wuhan, she was first given thrombolytic therapy after excluding contraindications according to the requirements of the current consensus statement; however, subsequently, both the symptoms of ongoing chest pain and the electrocardiographic results indicated the failure of thrombolytic therapy, so the intervention team administered rescue percutaneous coronary intervention treatment under third-grade protection. CAG confirmed total occlusion in the distal left anterior descending (LAD) artery, with thrombolysis in myocardial infarction (TIMI) 0 flow, whereas the left circumflex and right coronary arteries appeared normal, with TIMI 3 flow. Intravenous ultrasound (IVUS) was further performed to investigate the causes of occlusion, which verified the absence of atherosclerosis but detected SCAD with intramural haematoma. During the operation, the guidewire reached the distal end of the LAD artery smoothly, the balloon was dilated slightly, and the reflow of TIMI blood could be seen by repeated CAG. During the follow-up period of one and a half years, the patient complained of occasional, slight chest tightness. The repeated CAG showed that the spontaneous dissection in the LAD artery had healed well, with TIMI 3 flow. The repeated IVUS confirmed that the SCAD and intramural haematoma had been mostly resorbed and repaired. CONCLUSION: This was a case of failed STEMI thrombolysis in our hospital during the outbreak of COVID-19. This case indicates that doctors need to consider the cause of the disease when treating STEMI patients, especially patients without traditional cardiovascular risk factors. Moreover, CAG and intracoronary imaging examinations should be actively performed to identify the aetiology and improve the treatment success rate.


Subject(s)
COVID-19 , Myocardial Infarction , ST Elevation Myocardial Infarction , Female , Humans , Middle Aged , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/therapy , COVID-19/complications , Myocardial Infarction/therapy , Coronary Angiography/adverse effects , Thrombolytic Therapy/adverse effects , Hematoma/complications
3.
J Card Surg ; 2022 Nov 06.
Article in English | MEDLINE | ID: covidwho-2108105

ABSTRACT

A 57-year-old man suffered chest pain during the COVID-19 pandemic, but he delayed medical treatment due to fear of infection. After 4 months, symptoms of chest tightness and shortness of breath appeared. Electrocardiogram (ECG) revealed old myocardial infarction; color sonography and myocardial computed tomography revealed apical myocardial defect. He refused surgery and percutaneous transcatheter closure, and follow-up observation. After 22 months, the symptoms of chest tightness and shortness of breath aggravated. He recovered after percutaneous transcatheter closure, and was discharged. This case shows delayed closure is one of the possible options for patients without severe organ dysfunction or hemodynamic disturbance.

4.
Front Oncol ; 12: 968110, 2022.
Article in English | MEDLINE | ID: covidwho-2109815

ABSTRACT

Duodenal adenocarcinoma (DA) is an extremely rare and highly aggressive malignant tumor of the digestive system. Due to the lack of specific clinical characteristics, it is easy to misdiagnosis and miss diagnosis, and the lack of specific consensus and recommendation for treatment, so it often refers to stomach cancer and colorectal cancer. Now, we report a case of a patient with advanced DA who achieved complete remission (CR) after undergoing chemoradiotherapy combined with targeted therapy. The patient was pathologically diagnosed with DA after radical surgery in October 2020, and he failed to undergo adjuvant chemotherapy on time due to the COVID-19 outbreak. The patient found multiple lymph node liver and abdominal metastases 6 months after the operation. Considering the progression of the disease, XELOX regimen (oxaliplatin + capecitabine) chemotherapy was given for 1 cycle. After 1 cycle of treatment, the tumor markers remained elevated; the carcinoembryonic antigen (CEA) was 5.03 ng/ml (0-5 ng/ml), and the carbohydrate antigen 19-9 (CA19-9) was 747.30 U/ml (0-37 U/ml). The patient also developed intolerable capecitabine-related treatment-related adverse events (TRAEs), namely, hand-foot syndrome. For the above reasons, capecitabine was replaced as S-1 at cycle 2, and the chemotherapy regimen became SOX (oxaliplatin + S-1); bevacizumab injection was also added to the SOX regimen, and it was further treated regularly for 7 cycles with the regimen of SOX plus bevacizumab. Liver metastases showed a continuous narrowing trend throughout the treatment period; tumor markers also showed a downward trend. Finally, the patient achieved complete remission (CR) at cycle 7. After completion of chemotherapy, radiotherapy was administered to the resistant metastatic lymph nodes present in the patient's abdominal cavity for a total of 10 times. However, the patient developed severe bone marrow suppression and obstructive jaundice during the course of radiotherapy and finally failed to complete the radiotherapy plan. Currently, the patient continued maintenance therapy with bevacizumab and S-1 and showed no recurrence or metastasis after review. In this case of advanced DA, we referred to both CRC and gastric cancer in the treatment regimen of the patient. At the same time, targeted drugs and radiotherapy were also added to the basis of chemotherapy, which has no clear consensus recommendation or case for reference in the treatment of advanced DA. Thankfully, the patient's disease was controlled and remained stable after treatment with this regimen. Therefore, for patients with advanced DA who lack standardized treatment regimens and guidelines, the combination of chemotherapy with targeted therapy and radiotherapy may be one of the effective treatment modalities.

5.
ESC Heart Fail ; 2022 Nov 08.
Article in English | MEDLINE | ID: covidwho-2103543

ABSTRACT

This case study aimed to identify rare viral myocarditis combined with encephalitis as a COVID-19 vaccine complication. A 59-year-old male patient with a 2 day history of headache and rapidly progressive cognitive decline, who had received the third dose of COVID-19 vaccine 12 days before, was admitted to our hospital. The patient had no underlying systemic conditions, no prior medical history, and no prior history of COVID-19 infection. The patient was diagnosed with viral myocarditis and encephalitis by two neurologists and two cardiologists after laboratory examination, head computed tomography, and magnetic resonance imaging evaluation. The patient experienced cardiogenic shock and developed severe arrhythmia, resulting in his death 10 h after admission. Clinically suspected lethal viral myocarditis combined with encephalitis in the patient could be related to COVID-19 vaccination. Adverse effects of the Chinese COVID-19 vaccine, especially serious complications, have been uncommon. This case study highlights a rare complication after COVID-19 vaccination that needs high attention.

6.
Surg Neurol Int ; 13: 465, 2022.
Article in English | MEDLINE | ID: covidwho-2100857

ABSTRACT

Background: Due to the SARS-CoV-2 virus pandemic and its rapid spread worldwide, an early and effective detection strategy was the nasopharyngeal reverse transcription polymerase swab tests, a procedure still performed today. A relatively safe procedure when done correctly, however, one of the rare complications reported in the literature includes a cerebrospinal fluid (CSF) leak. Case Description: A 69-year-old female patient presented to the emergency department with clear fluid rhinorrhea, clinically diagnosed with a CSF fistula after a SARS-CoV-2 nasopharyngeal swab. Resulting computed tomography and magnetic resonance images did not report any abnormalities; however, persistence of clear fluid rhinorrhea obligated pharmacological treatment without resolution, requiring insertion of a lumbar catheter to achieve clinical resolution. Conclusion: It is essential to train staff to correctly administer nasopharyngeal swabs and thus reduce the rate of complications, as well as early recognition of symptoms and signs of CSF fistula.

7.
World J Transplant ; 12(10): 325-330, 2022 Oct 18.
Article in English | MEDLINE | ID: covidwho-2100240

ABSTRACT

BACKGROUND: In the era of the coronavirus disease 2019 (COVID-19) pandemic, kidney tran splant recipients are more susceptible to severe acute respiratory syndrome co ronavirus (SARS-CoV-2) infection, developing severe morbidity and graft im pairment. Pregnant women are also more likely to develop severe COVID-19 di sease, causing pregnancy complications such as preterm births and acute kidney injury. CASE SUMMARY: Herein, we report the case of a pregnant woman with a third kidney tran splantation who developed COVID-19 disease. The reduction of immunosuppressive drugs and strict monitoring of trough blood levels were needed to avoid severe SARS-CoV-2-related complications, and permitted to continue a healthy pregnancy and maintain good graft function. In such a complex scenario, the con comitance of COVID-19-related morbidity, the risk of acute rejection in the hype rimmune recipient, graft dysfunction and pregnancy complications make the management of immunosuppression a very difficult task and clinicians must be aware. CONCLUSION: Tailoring the immunosuppressive regimen is a key factor affecting both the graft outcome and pregnancy safety.

8.
J Med Case Rep ; 16(1): 400, 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2098450

ABSTRACT

BACKGROUND: Mucormycosis is a rare, life-threatening fungal infection that affects immunocompromised hosts. Diabetes mellitus is a common predisposing condition and most often presents with rhino-orbital-cerebral infection. Association with coronavirus disease 2019 infection was revealed following a resurgence in cases of mucormycosis during the second wave of the pandemic wherein poorly controlled diabetes mellitus was the most significant risk factor in the affected population. Rhino-orbital-cerebral mucormycosis has a high mortality rate, and cerebral involvement is a poor prognostic factor. Herein, we report a case of newly diagnosed diabetes mellitus with concurrent coronavirus disease 2019 infection complicated by diabetic ketoacidosis and rhinocerebral mucormycosis at presentation, describe the diagnostic and therapeutic challenges, and discuss the interventions that ultimately resulted in a favorable clinical response. CASE PRESENTATION: We describe the case of a previously healthy 13-year-old African American female patient with newly diagnosed diabetes mellitus and concurrent severe acute respiratory syndrome coronavirus 2 infection whose disease course was complicated by rhinocerebral mucormycosis. She presented with fever, altered mental status, and Kussmaul respirations and was diagnosed with diabetic ketoacidosis with concern for cerebral edema. Concern for infectious cerebritis arose due to recurring fevers and persistently altered mental status despite correction of her metabolic derangements. This raised concern for infectious cerebritis and prompted evaluation with serial head imaging, lumbar puncture, and initiation of broad empiric antimicrobial regimen. Head imaging revealed an evolving cerebral abscess, and fungal deoxyribonucleic acid was identified on blood metagenomics testing, which ultimately confirmed the diagnosis of rhinocerebral mucormycosis. Treatment was challenging as she required surgical debridement of the frontal lobe and aggressive antifungal therapy complicated by electrolyte derangements and electrocardiogram changes that necessitated modification of the antimicrobial regimen. Despite these challenges and high mortality rate, the patient was discharged from the hospital in stable condition to inpatient rehabilitation service for reconditioning after prolonged hospitalization. CONCLUSION: Rhinocerebral mucormycosis mortality is associated with delays in therapeutic interventions, thus a high index of suspicion and early recognition were essential for timely initiation of antifungal therapy and surgical debridement.


Subject(s)
Brain Abscess , COVID-19 , Diabetes Mellitus , Diabetic Ketoacidosis , Encephalitis , Mucormycosis , Female , Humans , Adolescent , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/therapy , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/therapy , COVID-19/complications , Antifungal Agents/therapeutic use , Brain Abscess/microbiology , Encephalitis/drug therapy , Diabetes Mellitus/drug therapy
9.
Pain Pract ; 2022 Oct 30.
Article in English | MEDLINE | ID: covidwho-2097851

ABSTRACT

As the vaccination efforts against the coronavirus disease-2019 (COVID-19) continue, more patients are likely to present with complications related to COVID-19 vaccination. We describe the first reported case of complex regional pain syndrome (CRPS), involving the upper extremities, that occurred after COVID-19 vaccination. The patient presented with acute-onset severe arm pain and swelling following vaccine administration. Based on the clinical, electrodiagnostic, and radionuclide three-phase bone scan findings, the patient was diagnosed with postvaccination CRPS. The COVID-19 vaccine possibly elicited an immune-mediated inflammatory response to the injected antigen in the patient, who was predisposed to CRPS due to inflammatory immunity. The COVID-19 vaccine elicited an immune-mediated inflammatory response to the injected antigen, resulting in CRPS following COVID-19 vaccination.

10.
Emergency and Critical Care Medicine ; 1(1):45-48, 2021.
Article in English | Scopus | ID: covidwho-2097485

ABSTRACT

Malignant hyperthermia is a rare but potentially fatal condition. We present 2 cases of young patients with coronavirus disease 2019 (COVID-19) requiring intubation for hypoxic respiratory failure who both developed significant hyperthermia post intubation and were suspected to have malignant hyperthermia. However, the 2 patients had different responses to conservative management and dantrolene. These cases highlight the increased challenge imposed by intubation complications when managing patients with COVID-19. Copyright © 2021 Shandong University, published by Wolters Kluwer, Inc.

11.
Acta Colombiana de Cuidado Intensivo ; 22:S129-S132, 2022.
Article in English, Spanish | Scopus | ID: covidwho-2094951

ABSTRACT

SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection is a respiratory infection initially identified in Wuhan, China, in December 2019. Some of the patients have been found to show no signs of respiratory distress;however, when oxygen saturation levels are measured, they are abnormally lower than expected in relation to their clinical condition. This is why we collected a series of cases from patients diagnosed with COVID-19 (Coronavirus disease 2019) who underwent a 2-min walking test during the initial evaluation in the emergency department. A drop in oxygen saturation below 90% was considered a positive result. Eighty-five percent of patients with a positive walking test required in-hospital management and 70% required oxygen supplementation during hospitalization. This clinical tool could help determine which of these patients might require in-hospital care due to occult hypoxemia, considering the current epidemiological situation and high bed occupancy rates. © 2022 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

12.
Medical Journal of Malaysia ; 77(Supplement 3):38, 2022.
Article in English | EMBASE | ID: covidwho-2093182

ABSTRACT

Musculoskeletal manifestation in child with cerebral palsy post COVID-19 can present with refusal to walk and rehabilitation can facilitate recovery. He is a 4-year-old boy with spastic bilateral cerebral palsy gross motor function classification system level 4 presented to the outpatient rehabilitation consult 3 weeks after COVID-19 infection with refusal to walk. He had 2 days of fever and was relatively well. Subsequently, he refused to stand or walk after 1 week from the onset of fever. During clinical examination, he was uncooperative and refused weight bearing on left lower limb which was kept in a flexed hip and knee position. Further investigation was conducted which included left lower limb X-ray and inflammatory markers. All investigations were reported normal. Child was given a provisional diagnosis of post COVID-19 myalgia. Oral analgesic was prescribed to children for pain control. He was enrolled in a multidisciplinary rehabilitation programme with the aim for gradual return to walking. Exercise prescription included gentle stretching to prevent contractures. Child was put on supported standing with gradual increase time. Play therapy was included to encourage child's participation. He was able to return to his previous walking status after 10 sessions of therapy.Early rehabilitation intervention with strategy to identify the complications in a child with disability post COVID-19 infection may leverage the recovery in this special group.

13.
Medical Journal of Malaysia ; 77(Supplement 3):34, 2022.
Article in English | EMBASE | ID: covidwho-2092920

ABSTRACT

The COVID-19 pandemic has affected millions of people with a wide range of presentations from asymptomatic to multiorgan failure, including neurological presentations. Facial nerve palsy is a commonly encountered presentation, however a rare presentation of COVID-19. Decio, et al has reported facial nerve palsy in a 15 month old with positive serological testing for COVID-19. We report a rare case of facial nerve palsy as a clinical presentation of COVID-19 infection. A 9 years old boy was admitted in March 2022 to Hospital Sungai Buloh;designated National COVID-19 centre, was referred to the Otorhinolaryngology team for a sudden onset of right sided facial nerve palsy as the main symptom on day 8 of illness of COVID-19 infection. He was treated with standard treatment of tapering dose of oral prednisolone, eye lubricant, eye patch and physiotherapy. The child was followed up in the outpatient clinic in 3 weeks interval revealing partial recovery of the palsy. As seen in this case, facial nerve palsy can be the main presentation of COVID-19 in children making its worthwhile to add this symptom into the spectrum of neurological presentation of COVID-19 and to screen children presenting with facial nerve palsy for COVID-19 in the current epidemiology context.

14.
AME Case Rep ; 6: 37, 2022.
Article in English | MEDLINE | ID: covidwho-2091299

ABSTRACT

Background: Parsonage Turner syndrome is an uncommon condition characterized by acute onset shoulder pain, followed by neurologic deficits such as weakness and paresthesia. It is a condition that is thought to be immune-mediated, and triggered by several recognized factors such as trauma, surgery, infections, and immunizations. Upper extremity Parsonage Turner syndrome may affect any distribution of the brachial plexus and most commonly presents unilaterally. Clinical history and examination are the basis of diagnosis, although electrodiagnostic studies may be important for confirmation. Magnetic resonance and ultrasonographic studies have also been effectively used in the diagnosis of Parsonage Turner syndrome. The case herein presents a patient with multiple possible triggers of Parsonage Turner syndrome. Case Description: We present a case of 62-year-old Caucasian male with bilateral radicular pain and weakness in the upper extremities after cervical spine surgery for a fracture in a patient that was infected with COVID-19. The patient underwent electrodiagnostic testing, as well as ultrasonographic studies that demonstrated Parsonage Turner syndrome. A literature review on Parsonage Turner syndrome associated with trauma, surgery and COVID-19 was also performed. Conclusions: Most cases of Parsonage Turner syndrome have a known associated risk factor. The patient in this report is unique in that they had several known risk factors for Parsonage Turner syndrome simultaneously. For timely and accurate diagnosis, it is important to consider the potential triggers of Parsonage Turner syndrome including trauma, surgery and viral illnesses such as COVID-19.

15.
Pan Afr Med J ; 42: 202, 2022.
Article in English | MEDLINE | ID: covidwho-2090887

ABSTRACT

The pandemic of coronavirus disease 2019 (COVID-19) still remains on an upsurge trend. The second and the waves of this disease have led to panic in many countries, and some parts of the world suffering from the fourth wave. In the midst of this pandemic, COVID-19 patients are acquiring secondary infections such as mucormycosis also known as "black fungus disease". Mucormycosis is a serious, but rare opportunistic fungal infection that spreads rapidly, and hence prompt diagnosis and treatment are necessary to avoid mortality and morbidity rate. We report in this paper, a case of a diabetic patient who presented with bilateral nasal obstruction, anosmia, and frontal headache diagnosed with rhinocerebral mucormycosis developing after COVID-19 infection with a favorable outcome after a medico-surgical treatment. Through this case, we aim to aware patricians of this possible association and the importance of early diagnosis to optimize treatment outcomes.


Subject(s)
COVID-19 , Diabetes Mellitus , Mucormycosis , Opportunistic Infections , Humans , Mucormycosis/diagnosis , Mucormycosis/therapy , COVID-19/complications , COVID-19/diagnosis , Opportunistic Infections/diagnosis , Treatment Outcome
16.
World J Gastrointest Endosc ; 14(10): 628-635, 2022 Oct 16.
Article in English | MEDLINE | ID: covidwho-2090603

ABSTRACT

BACKGROUND: Tracheoesophageal fistulas (TEFs) can be described as a pathological communication between the trachea and the esophagus. According to their origin, they may be classified as benign or malignant. Benign TEFs occur mostly as a consequence of prolonged mechanical ventilation, particularly among patients exposed to endotracheal cuff overinflation. During the severe acute respiratory syndrome coronavirus 2 virus pandemic, the amount of patients requiring prolonged ventilation rose, which in turn increased the incidence of TEFs. CASE SUMMARY: We report the cases of 14 patients with different comorbidities such as being overweight, or having been diagnosed with diabetes mellitus or systemic hypertension. The most common symptoms on arrival were dyspnea and cough. In all cases, the diagnosis of TEFs was made through upper endoscopy. Depending on the location and size of each fistula, either endoscopic or surgical treatment was provided. Eight patients were treated endoscopically. Successful closure of the defect was achieved through over the scope clips in two patients, while three of them required endoscopic metal stenting. A hemoclip was used to successfully treat one patient, and it was used temporarily for another patient pended surgery. Surgical treatment was performed in patients with failed endoscopic management, leading to successful defect correction. Two patients died before receiving corrective treatment and four died later on in their clinical course due to infectious complications. CONCLUSION: The incidence of TEFs increased during the coronavirus disease 2019 pandemic (from 0.5% to 1.5%). We believe that endoscopic treatment should be considered as an option for this group of patients, since evidence reported in the literature is still a growing area. Therefore, we propose an algorithm to lead intervention in patients presenting with TEFs due to prolonged intubation.

17.
Eur Heart J Case Rep ; 6(10): ytac407, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2087761

ABSTRACT

Background: Severe acute respiratory syndrome coronavirus 2 infection is responsible for the coronavirus disease 2019 (COVID-19) pandemics. Omicron (B.1.1.529) variant is the cause for the surge of the COVID-19 pandemics of the end of 2021 and the beginning of 2022, although its subvariants are responsible for the following daily increase of COVID-19 cases in July 2022. Early reports of Omicron variant confirmed patients indicated less severe disease course compared with the disease caused by previously encountered variants with absence of data regarding cardiac involvement by Omicron. Case summary: A 42-year-old male who tested positive for Omicron was admitted on January 2022 with chest pain and ST-segment elevation in the inferior leads. Coronary angiography revealed non-significant coronary artery disease. Cardiac magnetic resonance imaging demonstrated features consistent with myocarditis with involvement of 22% of the left ventricular mass by late gadolinium enhancement involving both the lateral and the septal walls. The second patient is a 60-year-old male presented following syncope and palpitations after he was confirmed with Omicron infection. Upon emergency department arrival he had ventricular tachycardia of 250 beats/minute and underwent urgent cardioversion. During his hospitalization, there was no recurrence of malignant arrhythmia, coronary angiography revealed non-obstructive disease. Cardiac magnetic resonance imaging demonstrated imaging features suggesting acute myocarditis with involvement of 19% of the left ventricular mass. Discussion: This is the first report of myocarditis cases as a possible complication associated with Omicron variant. Despite preliminary reports of less severe disease clinicians should be vigilant for potential deleterious cardiac complications of Omicron.

18.
Eur Heart J Case Rep ; 6(10): ytac404, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2087760

ABSTRACT

Background: COVID-19 has affected individuals across the globe, and those with cardiac implantable electronic devices (CIEDs) likely represent a high-risk group. These devices can be interrogated to reveal information about the patient activity, heart rate parameters, and respiratory rate. Case summary: Four patients with CIEDs and left ventricular dysfunction were admitted to a single institution for COVID-19 infection. Each patient survived hospitalization, and none required intensive care. Retrospectively, CIED interrogation revealed each patient had decreased activity level prior to their reporting COVID-19 symptoms. Similarly, respiratory rate increased before symptom onset for three of the patients, while one did not have these data available. Of the three patients with heart rate variability (HRV) available, two had decreased HRV before they developed symptoms. After hospital discharge, these parameters returned to their baseline. Discussion: This case series suggests physiologic changes identifiable through interrogation of CIEDs may occur prior to the reported onset of COVID-19 symptoms. These data may provide objective evidence on which to base more sensitive assessments of infectious risk when performing contact tracing in communities.

19.
Drug Safety ; 45(10):1209-1210, 2022.
Article in English | EMBASE | ID: covidwho-2085695

ABSTRACT

Introduction: COVID-19 is a complex disease with several clinical phases of progression, affecting many organs apart from the respiratory tract that has shown a worst prognosis in both patients with type 1 and type 2 diabetes mellitus [1]. Based on these considerations, the vaccination for COVID-19 is a priority for this subpopulation [2]. However, few data have been published on the effects of impaired glucose metabolism induced by COVID-19 vaccines. Objective(s): We decided to perform a study to describe Individual Case Safety Reports (ICSRs) of impaired glucose metabolism events reported in the European database (Eudravigilance, EV). Method(s): ICSRs were retrieved for the period from January 1st, 2021 to December 11th, 2021. An ICSR related to events of impaired glucose metabolism was identified by using selected preferred terms (PTs) from Standardized MedDRA Queries ''Hyperglycaemia/new onset diabetes mellitus'' and ''Hypoglycaemia''. Impaired glucose metabolism events were described and analyzed based on the Diabetologists' classification into nine groups: ''diabetes in pregnancy'', ''acute complications of diabetes'', ''pre-diabetes'', ''type 1 diabetes mellitus'', ''type 2 diabetes mellitus'', ''high glucose levels'', ''diabetes mellitus inadequate control'', ''diabetes melli-tus not specified'', and ''hypoglycaemia''. The reporting odds ratios were computed to assess the reporting frequency for COVID-19 mRNA vaccines compared to COVID-19 viral vector-based vaccines. Result(s): During the study period, 3,917 ICSRs with a COVID-19 vaccine as suspected and at least an event of impaired glucose metabolism were retrieved from the EV, of which 2,027 (51.75%) referred to Pfizer-BioNTech vaccine, 586 (14.96%) to Moderna vaccine, 1,163 (29.70%) to Oxford-AstraZeneca vaccine, and 141 (3.59%) to Janssen vaccine. From 3,917 ICSRs, we observed 4,275 impaired glucose metabolism events (1.09 adverse events per ICSR). Most adverse events were classified as serious (2,694;63.02%), and the most reported events were related to ''high glucose levels'' (2,012;47.06%). The mRNA vaccines were associated with an increased reporting frequency of ''type 1 diabetes mellitus'' (ROR 1.86;95% CI 1.33-2.60), ''type 2 diabetes mellitus'' (ROR 1.58;95% CI 1.03-2.42), ''high glucose levels'' (ROR 1.16;95% CI 1.06-1.27), ''diabetes mellitus inadequate control'' (ROR 1.63;95% CI 1.25-2.11), and ''hypoglycemia'' (ROR 1.62;95% CI 1.41-1.86) compared to viral vector-based vaccines. The highest reporting rate per 100,000 was observed for Oxford-AstraZeneca vaccine (1.87;95% CI 1.77-1.97). Conclusion(s): In conclusion, mRNA COVID-19 vaccines were associated with an increased reporting frequency of alterations of glucose homeostasis compared to viral-vector COVID-19 vaccines. Clinicians should be aware of these events to better manage glycaemic perturbations. Larger nationwide studies are warranted to verify these findings.

20.
Autoimmun Rev ; 21(12): 103201, 2022 Sep 20.
Article in English | MEDLINE | ID: covidwho-2085947

ABSTRACT

BACKGROUND: COVID-19 vaccine-associated peripheral and central neuroimmunological disorders have been well described. We present the case of a 56 year old male who developed α3-ganglionic AChR antibody positive Autoimmune Autonomic Ganglionopathy (AAG) after completion of a two-dose course of mRNA (Comirnaty) vaccination for COVID19. RESULTS: A previously hypertensive 56 year old male presented with the subacute onset of severe constipation, urinary retention, erectile dysfunction, sudomotor failure, sicca symptoms, non-reactive pupils and severe orthostatic hypotension shortly after receiving the second dose of an mRNA vaccine against COVID19. Autonomic testing revealed severe cardiovagal, adrenergic and sudomotor impairment, and tonic 'half-mast' pupils with evidence of sympathetic and parasympathetic denervation. Pathological α3-ganglionic ACHR antibodies were positive in serum as detected by a new flow cytometric immunomodulation assay. Malignancy was excluded. The patient was diagnosed with severe, treatment-refractory acute AAG. CONCLUSIONS: While autonomic dysfunction has been previously reported post-COVID19 vaccination, to our knowledge this is the first reported case of antibody-positive AAG in this setting. The severity of this case is in marked contrast to the existing literature on idiopathic antibody-positive autoimmune pandysautonomia.

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