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1.
Journal of Clinical and Diagnostic Research ; 16(9):XD01-XD03, 2022.
Article in English | EMBASE | ID: covidwho-2033408

ABSTRACT

Chronic lymphocytic leukaemia is a haematological malignancy that occurs due to an increased proliferation of mature B lymphocytes. It is considered to be the most common leukaemia in adults. Hyponatremia is commonly seen in such patients. This case report is about a 75-year-old male, who presented with giddiness, followed by altered sensorium. However, the patient had no motor weakness or sensory loss. Initially, a diagnosis of posterior circulation stroke was made but Magnetic Resonance Imaging (MRI) brain did not show associated signs. The routine investigations showed highly elevated total leukocyte count and hyponatremia. The patient was worked up for malignancy and diagnosed with Chronic lymphocytic leukaemia. Oncology reference was taken and treated with tablet Ibrutinib. On discharge, the patient's mentation improved, and he is on regular follow-up.

2.
Turk Beyin Damar Hastaliklar Dergisi ; 28(2):87-93, 2022.
Article in Turkish | EMBASE | ID: covidwho-2033366

ABSTRACT

INTRODUCTION: In the coronavirus disease 2019 (COVID-19) pandemic, there may be a decrease in the number of acute stroke intervention and acute treatment, and delays in treatment periods. In this study, it was aimed to compare the clinical features of patients presenting with acute stroke during the COVID-19 pandemic and in the pre-pandemic period. METHODS: Patients hospitalized with the diagnosis of cerebrovascular disease (CVD) between January 01, 2019 and May 31, 2021 were included in the study. Demographic characteristics and stroke risk factors of the patients were recorded. Stroke type and ischemic disease subtypes were determined, and patients' admission National Institutes of Health Stroke Scale (NIHSS) score, symptom-door time, door-consultation time, door-to-door Needle time and door-groin puncture time, intravenous tissue type plasminogen activator (IV tPA) and endovascular thrombectomy (EVT) applications were recorded. Discharge modified Rankin Scale (mRS) and NIHSS scores and mortality rates were evaluated. Patients hospitalized in two separate periods of 14 months each were compared by dividing them into pre-pandemic and pandemic periods. RESULTS: Before COVID-19, 316 patients (female 45.25%, age: 66.75±13.68 years) and during the pandemic period 341 (female 41.94%, age: 68.34±13.55 years) patients were included in the study. During the pandemic period, an increase in the number of hemorrhagic CVD and transient ischemic attacks, a decrease in the number of ischemic stroke and cerebral venous thrombosis (CVT) hospitalizations, a decrease in cardioembolic strokes and an increase in lacuner ischemic CVD subtypes were observed (p<0.01). The number of large vessel atherosclerosis, IV tPA and EVT were found to be similar before and after the pandemic. In the pandemic period, although it did not reach statistical significance compared to the pre-pandemic period, prolongation was recorded in the symptom-door, door-consultation, door-needle and door-groin puncture times (p>0.05). The COVID-19 test was positive after hospitalization in 5 (1.8%) patients with ischemic stroke hospitalized during the pandemic period. During the pandemic period, admission NIHSS, discharge NIHSS and mRS scores and mortality rates were found to be significantly higher between hemorrhagic and ischemic stroke patients (p<0.01). DISCUSSION AND CONCLUSION: The COVID-19 pandemic adversely affects the management of acute stroke. The duration of acute stroke treatment is delayed due to pre-hospital and in-hospital reasons. With the heavy burden of stroke during the pandemic period, poor clinical outcome and high mortality are observed.

3.
HemaSphere ; 6:3200-3201, 2022.
Article in English | EMBASE | ID: covidwho-2032144

ABSTRACT

Background: Arterial thrombotic events (ATE) are important cause of noncancer-related deaths among patients with cancer. It is estimated that the prevalence of ATE among those patients is between 2-5%. However, data regarding acute myeloid leukemia (AML) related ATE are scarce and far less available than those related to venous thrombotic events. Aims: To determine the incidence of ATE in nonM3-AML patients and to underline the potential risk factors for ATE development. Methods: The single center, retrospective, cohort study was carried out in University Clinical Center of Serbia. Adult patients, who were diagnosed with nonM3-AML between January 2009. and December 2021. were included. In all patients the occurrence of ATE (e.g. a heart attack, a stroke, critical limb ischemia) was assessed during the active treatment and the three months following the last chemotherapy session. Diagnosis of ATE was established using clinical, laboratory and radiological methods. Patients who experienced venous thromboembolism during the treatment period were excluded. Demographic data, presence of obesity, smoking status, history of thrombosis, baseline laboratory findings (complete blood count, fibrinogen, D-dimer, PT, aPTT, LDH), leukemia-related parameters (cytogenetics (including ELN risk stratification), flow cytometry), Khorana score, ECOG PS, HCT CI score, concurrent COVID-19 were collected from patients' health records. The methods of descriptive (mean ± standard deviation, median (range), frequency (%)) and analytic statistics (Student's t-test, chi-squared test) were used. Results: A total of 545 patients (293 males (53.8%)) were included in the study. Median age of the study population was 58 (range: 18-81) years. ATE was noted in 18/545 (3.3%) subjects with following distribution: ischemic stroke 12/18 (66.7%), myocardial infarction 5/18 (27.8%), and acute lower extremity arterial thrombosis 1/18 (5.5%). ATE was diagnosed most commonly during the induction (8 (44.4%) patients), reinduction (3 (16.7%) patients) and consolidation (4 (22.2%) patients) cycles. However, cases of ATE were noted at diagnosis (1 (5.6%) patient), after transplantation (1 (5.6%) patient) or at relapse (1 (5.6%) patient) as well. ATE were significantly more frequent among patients with previous history of thromboembolic events (p = 0.016). Moreover, ATE were more common in patients with adverse cytogenetic abnormalities (p < 0.001). Other examined parameters did not significantly differ between those with and without ATE. Summary/Conclusion: The incidence of arterial thrombosis in our group was 3.3% which is in accordance with the previously published studies. Since the great number of already known risk factors for the arterial thrombosis are modifiable (e.g. smoking, diet, physical activity, excessive drinking?) it is important to actively work on the reduction on those risk factors, especially if the patient has the history of previous thromboembolic event and/or suffer from high risk AML. Prophylactic therapy with antiplatelet agents is aggravated due to the lack of firmer evidences and the presence of thrombocytopenia. Therefore further studies regarding this issue are needed.

4.
HemaSphere ; 6:4034-4035, 2022.
Article in English | EMBASE | ID: covidwho-2032106

ABSTRACT

Background: ERN-EuroBloodNet was established in 2017 as the European Reference Network on Rare Hematological Disorders (RHDs) bringing together nationally recognized centres of excellence with the goal of promoting EU best health care in RHDs. ERN-EuroBloodNet has been recently enlarged integrating 103 HCP from 24 EU-MS. Aims: ERN-EuroBloodNet was conceived to contribute to innovative, efficient and sustainable health systems and facilitate access to better and safer healthcare for EU citizens while decreasing the cross-border health barriers. Methods: Since 2017, ERN-EuroBloodNet established the state-of-the art of RHD allowing the implementation of transversal and disease-specific strategies, where actions on very rare RHD were prioritized. Results: Profile. 182 expert profiles were created freely accessible. Expert centers follow 65,000 RHD patients and treat 5,000 new patients per year, while 24 patients requested support for cross-border health assistance. Expertise. The need to improve access to next-generation sequencing for non-oncological RHD and bone marrow transplantation for sickle cell disease (SCD) was identified. Also, significant disparities in the clinical practice of primary vitreoretinal lymphoma were found and we demonstrated that less than 30% of children with SCD benefit from adequate annual stroke risk monitoring. Guidelines. A repository of 68 Clinical Practice Guidelines (CPG) classified on quality of evidence and consensus approach was created. Recommendations for diagnosis and treatment of methemoglobinemia was published in collaboration with EHA. A CPG on Adult Burkitt Lymphoma is under development. Next topics focus long-term complications in hemoglobinopathies and patients' pathways&summary. Education. ERN-EuroBloodNet Webinars were launched for professionals with 26 Thursdays Webinars and 3 EBAH accredited Topic on Focus on Cutaneous Lymphoma, Thrombotic Microangiopathies, and Bone Marrow Failures. A collaboration was established for EHA & ERN-EuroBloodNet Spotlight on Castleman Disease. For patients, 3 Topic on Focus were launched for Myelodysplastic syndromes, SCD, and Cutaneous lymphoma. Past webinars are available at EuroBloodNet EDU Youtube channel. Preceptorships on SCD will be launched soon. Telemedicine. 43 complex cases have been inter-professionally discussed in the Clinical Patient Management System with 21 outcome reports delivered. Registries. 184 Registries were identified through the European Rare Blood Diseases Platform (ENROL), endorsed by the EHA. The ENROL project, which includes rare anemias, dendritic cell leukemia and von Villebrand's disease pilots, aims to collect exhaustive and therefore epidemiological data for RHDs. The final objective is a possibility of EU health planningl and the promotion of research by identifying cohorts of patients. ERNEuroBloodNet launched the collaborative platform on patients with red blood cells and COVID-19 containing so far 373 patients. Collaborations. collaborative research projects were encouraged like EC-funded projects i.e., genomics and personalized medicine in hematological diseases (GenoMed4All) and the properties and viability of erythrocytes (EVIDENCE), or the International Hemoglobinopathy Research Network (INHERENT) for genomic and phenotypic correlations. Summary/Conclusion: The implementation of well-defined strategies but above all adapted to the specific and not yet covered needs of RHD has led to the realization of concrete projects. This has laid the foundations to strengthen health systems in the field of RHD and allow them to flourish under the new EU4Health programme.

5.
Neurología Argentina ; 2022.
Article in Spanish | ScienceDirect | ID: covidwho-2031598

ABSTRACT

Resumen Introducción y objetivos: El accidente cerebrovascular isquémico (ACVi) es la tercera causa de muerte y la primera de discapacidad en el mundo. Desde marzo de 2020 la pandemia por COVID-19 generó modificaciones en la práctica médica diaria, así como impacto en el acceso a los centros de salud. El objetivo de este trabajo es evaluar el efecto de la pandemia por COVID-19 en el número de admisiones, tiempo de consulta y tasas de tratamiento del ACVi en nuestro centro. Materiales y métodos: Estudio descriptivo y retrospectivo, con 115 pacientes entre marzo 2019 y marzo 2021. Se compararon características clínicas, tiempo de consulta, admisiones, severidad y tasas de tratamiento pre-pandemia y durante la misma Resultados: Ambos grupos presentaron eventos leves (71% vs 59%, p>0.05). Se observó aumento en el tiempo de consulta hasta inicio de terapia con trombolisis durante la pandemia (mediana 2,1 vs 3,5 horas, p=0.02). No se observaron diferencias significativas en las tasas de reperfusión, tiempo de consulta y tiempo puerta-aguja. Conclusión: En nuestro trabajo se observó diferencia significativa entre el tiempo de inicio de los síntomas y el tratamiento con trombolisis durante la pandemia. Por otro lado, no se observaron diferencias significativas en relación al número de admisiones, tiempo de consulta y tiempo puerta-aguja o tasa de tratamiento de los pacientes con ACVi durante la pandemia por COVID-19. Creemos que este trabajo puede aportar un acercamiento a la epidemiología en el ámbito privado regional y una potencial base para continuar analizando los daños colaterales y consecuencias a largo plazo generadas por la pandemia por COVID-19. Introduction and objectives: Ischemic stroke is the third leading cause of death and the first cause of disability in the world. Since March 2020, the COVID-19 pandemic has generated changes in daily medical practice, as well as an impact on access to health centers. The objective of this study is to evaluate the effect of the COVID-19 pandemic on the number of admissions, consultation time and treatment rates of stroke in our center. Materials and methods: Descriptive and retrospective study, with 115 patients between March 2019 and March 2021. Clinical characteristics, admissions time, severity and treatment rates pre-pandemic and during the same were compared. Results: Both groups presented mild events (71% vs 59%, p>0.05). There was an increase in the time from consultation to initiation of thrombolysis therapy during the pandemic (median 2.1 vs. 3.5 hours, p=0.02). No significant differences were observed in reperfusion rates, consultation time and door-to-needle time. Conclusion: In our study, a significant difference was observed between the time of symptom onset and treatment with thrombolysis during the pandemic. On the other hand, no significant differences were observed in relation to the number of admissions, consultation time and door-to-needle time or treatment rate of patients with stroke during the COVID-19 pandemic. We believe that this work can provide an approach to epidemiology in the private regional setting and a potential basis for further analysis of the collateral damage and long-term consequences generated by the COVID-19 pandemic.

6.
Frontiers in Pharmacology ; 13, 2022.
Article in English | Scopus | ID: covidwho-2022841

ABSTRACT

Cryptotanshinone (CTS), a diterpenoid quinone, is found mostly in Salvia miltiorrhiza Bunge (S. miltiorrhiza) and plays a crucial role in many cellular processes, such as cell proliferation/self-renewal, differentiation and apoptosis. In particular, CTS’s profound physiological impact on various stem cell populations and their maintenance and fate determination could improve the efficiency and accuracy of stem cell therapy for high-incidence disease. However, as much promise CTS holds, these CTS-mediated processes are complex and multifactorial and many of the underlying mechanisms as well as their clinical significance for high-incidence diseases are not yet fully understood. This review aims to shed light on the impact and mechanisms of CTS on the actions of diverse stem cells and the involvement of CTS in the many processes of stem cell behavior and provide new insights for the application of CTS and stem cell therapy in treating high-incidence diseases. Copyright © 2022 Guo, Ma, Wang, Wui-Man Lau, Chen and Li.

7.
Frontiers in Genetics ; 13, 2022.
Article in English | EMBASE | ID: covidwho-2009857

ABSTRACT

Aims: The causal relationship between COVID-19 infection and stroke has not yet been fully established. This study aimed to explore this causality using two-sample Mendelian randomization (MR). Materials and Methods: Genetic variants associated with COVID-19 infection and stroke were both obtained from genome-wide association study (GWAS) summary data. The single nucleotide polymorphisms (SNPs) were selected as instrumental variables. The standard inverse variance weighted (IVW) was primarily used to assess this causality. Finally, sensitivity analysis was performed to evaluate the reliability and stability. Results: The results showed that being hospitalized due to COVID-19 had a positive effect on stroke [OR = 1.05;95% CI= (1.01, 1.10);p = 2.34 × 10−5] and ischemic stroke [OR = 1.06;95% CI= (1.02, 1.11);p = 2.28 × 10−6] analyzed by inverse variance weighted. Moreover, the results revealed that severe respiratory symptoms due to COVID-19 had a positive effect on stroke [OR = 1.04;95% CI= (1.00, 1.06);p = 0.04] and that the causal effect of severe respiratory symptoms due to COVID-19 on ischemic stroke estimated by IVW suggested a positive effect [OR = 1.06;95% CI= (1.02, 1.09);p = 0.0068], too. Conclusion: In summary, this study showed that severe COVID-19 might increase the risk of stroke, thus much more attention should be paid to patients with severe COVID-19.

8.
Neuropsychiatric Disease and Treatment ; 18:1907-1916, 2022.
Article in English | EMBASE | ID: covidwho-2009784

ABSTRACT

Background: There have been reports suggesting an increased incidence of acute ischemic stroke among anti-SARS-CoV-2 vaccinees. We aimed to systematically review the literature to summarize the available evidence on the association between SARS-CoV-2 vaccination and acute ischemic stroke. Methods: A systematic literature search on MEDLINE, LitCovid and LIVIVO databases was performed for eligible randomized controlled trials, observational studies, registries and case reports that reported on imaging-confirmed acute ischemic stroke in the context of any SARS-CoV-2 vaccination with BNT162b2, mRNA-1273, Ad26.COV2.S, ChAdOx1 or Gam-COVID-Vac. Literature search was limited to English and German languages and publication date before October 19, 2021. Results: We identified a total of 395,105,670 individuals who underwent vaccination. We found 21 sources, including 2 cohort studies, 4 registry studies, 3 randomized clinical trials, and 12 case reports. Individuals included in these studies were at least 16 years old. Cari et al observed a higher likelihood of acute ischemic stroke in vaccinees aged 18–64 years, compared to Whiteley et al observing vaccinees older than 70 years when vaccinated. In addition, differences in the likelihood of acute ischemic stroke were found among the vaccines studied, although no overall increased stroke incidence was demonstrated with vaccination. Conclusion: In this systematic review of the available literature, we found that the risk of acute ischemic stroke does not appear to be increased in vaccinated individuals who have received any of the currently licensed SARS-CoV-2 vaccines compared with the baseline incidence of stroke.

9.
PLoS ONE ; 17(8 August), 2022.
Article in English | EMBASE | ID: covidwho-2009680

ABSTRACT

Background Immunization stress-related responses presenting as stroke-like symptoms could develop following COVID-19 vaccination. Therefore, this study aimed to describe the clinical characteristics of immunization stress-related responses causing stroke-like events following COVID-19 vaccination in Thailand. Methods We conducted a retrospective study of the secondary data of reported adverse events after COVID-19 immunization that presented with neurologic manifestations. Between March 1 and July 31, 2021, we collected and analyzed the medical records of 221 patients diagnosed with stroke-like symptoms following immunization. Two majority types of vaccines were used at the beginning of the vaccination campaign, including CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca). Demographic and medical data included sex, age, vaccine type, sequence dose, time to event, laboratory data, and recovery status as defined by the modified Rankin score. The affected side was evaluated for associations with the injection site. Results Overall, 221 patients were diagnosed with immunization stress-related responses (strokelike symptoms) following CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca) vaccinations. Most patients (83.7%) were women. The median (interquartile range) age of onset was 34 (28-42) years in patients receiving CoronaVac and 46 (33.5-60) years in those receiving ChAdOx1. The median interval between vaccination and symptom onset for each vaccine type was 60 (16-960) min and 30 (8.8-750) min, respectively. Sensory symptoms were the most common symptomology. Most patients (68.9%) developed symptoms on the left side of the body;99.5% of the patients receiving CoronaVac and 100% of those receiving ChAdOx1 had a good outcome (modified Rankin scores ≤2, indicating slight or no disability). Conclusions Immunization stress-related responses presenting as stroke-like symptoms can develop after COVID-19 vaccination. Symptoms more likely to occur on the injection side are transient (i.e., without permanent pathological deficits). Public education and preparedness are important for administering successful COVID-19 vaccination programs.

10.
Annals of the Rheumatic Diseases ; 81:376, 2022.
Article in English | EMBASE | ID: covidwho-2008865

ABSTRACT

Background: Data on the long-term efficacy and safety of tocilizumab (TCZ) for giant cell arteritis (GCA), including incidence and timing of disease relapse after TCZ discontinuation, is limited. Objectives: We aimed to evaluate the long-term outcomes of GCA patients treated with TCZ in a real-world setting. Methods: Retrospective analysis of GCA patients treated with TCZ for >9 months at a single center between 2010-2021. Time to relapse and annualized relapse rate during and after TCZ treatment, prednisone use and safety were assessed. Relapse was defned as the re-appearance of clinical manifestations of GCA that required treatment intensifcation regardless of the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels. The duration of TCZ treatment was determined as per the best clinical judgement of the treating rheumatologist. Results: A total of 57 GCA patients were followed for a mean (SD) period of 3.4 (1.7) years. Baseline characteristics and treatments received are shown in Table 1. Patients were maintained on their initial TCZ course for a mean (SD) period of 2.0 (1.3) years. The initial TCZ course lasted >12 months in 50 (88%) patients. During the initial TCZ course, 8 (14.0%) patients relapsed. Kaplan-Meier (KM) estimated relapse rates on TCZ were 10.5% and 14.9% at 12 and 18 months, respectively (Figure 1A). TCZ was discontinued due to long-term remission in 37 (64.9%) patients and after an adverse event in 6 (10.5%) patients. Of the 43 patients stopping TCZ due to remission or adverse event, 19 (44.2%) subsequently relapsed. KM estimated relapse rates after TCZ discontinuation were 30.4% and 44.0% at 12 and 18 months, respectively (Figure 1B). Overall, 12 patients received more than one TCZ course. The aggregation of all TCZ courses (mean 2.5 years) and all periods off TCZ following the initial TCZ treatment (mean 0.9 years) showed that 11 (19.3%) patients relapsed while on TCZ and 20 (35.1%) patients relapsed during time off TCZ. An analysis adjusting for age, sex, prednisone dose at initiation of frst TCZ course, and disease type (new onset vs. relapsing) at initiation of frst TCZ course showed an annualized relapse rate (95% CI) of 0.1 (0.0-0.2) during TCZ treatment and 0.4 (0.3-0.7) off TCZ (rate ratio 0.2, p<0.0001). By the end of follow up, 42 (73.7%) patients were able to wean off prednisone. During the study, 12 serious adverse events occurred in 11 (19.3%) patients. Among those 12 events, 3 (25%) were related or possibly related to TCZ exclusively (i.e., soft tissue infection, bacteremia, and COVID-19), 3 (25%) to prednisone exclusively (i.e., osteoporotic fracture, diabetic ketoacidosis and stroke), and 2 (16.7%) to either TCZ or prednisone (i.e., pneumonia and sepsis). Conclusion: Long-term TCZ treatment was efficacious in maintaining disease remission and sparing the use of prednisone in patients with GCA. Over 40% of patients stopping TCZ after long-term remission or adverse event relapsed following TCZ discontinuation.

11.
Annals of the Rheumatic Diseases ; 81:1075-1076, 2022.
Article in English | EMBASE | ID: covidwho-2008847

ABSTRACT

Background: Giant cell arteritis-related stroke is rare, with high early mortality and major morbidity in survivors. Objectives: To increase the awareness of coexistence of giant cell arteritis-re-lated stroke and rheumatoid arthritis. Methods: A case report and discussion. Results: A 73 year-old man with seronegative elderly-onset rheumatoid arthritis (EORA) presented to the emergency department (ED) with a one week history of frontal headache, vomiting and dizziness. He had multiple cardiovascular comor-bidities and took multiple medications, including methotrexate and sulfasalazine. He also had long-standing history of thrombocytopenia without requiring any treatment. Neurological examination performed in the ED was unremarkable. His C-reactive protein (CRP) was 69mg/L and erythrocyte sedimentation rate (ESR) 82mm/hour. Computed tomography (CT) of the brain was normal. The headache settled with analgesia. A diagnosis of probable tension-type headache, with underlying active EORA, was made. One month later, he presented to an ophthalmologist with recurrence of headache associated with visual disturbance and was diagnosed with giant cell arteritis (GCA). Both CRP (77mg/L) and ESR (85mm/hour) remained raised. Neither temporal artery biopsy nor temporal artery ultrasound were possible due to the coronavirus disease 2019 (COVID-19) pandemic. The headache and visual symptoms resolved completely a week after prednisolone 60mg daily was prescribed. In parallel, the CRP dropped to 2mg/L and ESR 16mm/hour. The patient's glucocorticoid dose was then tapered. While on prednisolone 20mg daily, about 3 weeks later, he developed slurred speech and generalized weakness. Examination showed cerebellar signs and MRI brain showed acute cerebellar infarct. He was treated pragmatically as an atherosclerotic stroke with clopidogrel, and the steroid was rapidly tapered in view of absence of headache and normalization of infammatory markers. Four weeks later, he was noted to have persistent confusion and unsteadiness of gait. CRP was elevated at 92mg/L. An urgent positron emission tomography-CT (PET-CT) scan showed infammation in the vertebral arteries [Figure 1] and cerebellar stroke. Prednisolone 40mg daily was restarted which led to a rapid improvement in his symptoms and normalization of infammatory markers. The glucocorticoids were tapered in a slower manner this time. A diagnosis of GCA-related cerebellar stroke with vertebral vasculitis was made and, with glucocorticoids, the patient made a good clinical recovery. His infam-matory joints pain also improved in parallel. Conclusion: Stroke or transient ischemic stroke are rare complications, reported in 2.8-16% of patients with active GCA. Most studies report strokes as occurring between the onset of GCA symptoms and 4 weeks after commencement of glucocorticoids1-3. Vertebrobasilar territory is involved in 60-88% of cases of GCA-related stroke1-3. In contrast, the vertebrobasilar territory is affected only in 15-20% of atherosclerotic strokes1,2. One study reported fatal outcomes in 11 out of 40 patients (28%) with GCA-related stroke, 7 within 2-13 days of stroke2. To conclude, this case demonstrates that high-dose glucocorticoids with slower tapering were able to control GCA-related stroke due to vertebral vasculitis in patient with EORA on background methotrexate and sulfasalazine.

12.
Journal of Neuroimaging ; 32(4):770-771, 2022.
Article in English | EMBASE | ID: covidwho-2008751

ABSTRACT

Background and Purpose: Since the implementation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, we see continued hesitancy across the world regarding the potential emergence of immune and thromboembolic complications with these injections. This has included temporary pauses over concerns for thromboembolic events and cardiac inflammation.We provide discussion of a 57-year-old patient who suffered multiple ischemic strokes, with no prior history of vascular events after receiving her SARSCoV- 2 (messenger ribonucleic acid [mRNA]) vaccination with workup suggesting CNS vasculitis in the setting of multiple positive immune markers and propose the need for further investigation in this area. Methods:Review of case presentation, testing, imaging, and laboratory studies. Results: CT angiography was performed but could not identify any vascular pathology in the large vasculature. Brain MRI/MR angiography demonstrated strokes in multiple vascular territories (similar findings on first and second admission). Conventional angiogram was completed, which also did not demonstrate large vessel abnormalities. Telemetry was unremarkable. Echocardiogram (transthoracic and transesophageal) was performed without cardioembolic source identified. Serum and CSF laboratory studies were completed and suggestive of a CNS immune process and given the overall clinical picture were most consistent with probable small vessel CNS vasculitis. Conclusion: In presenting this patient's background and medical history, which includes autoimmune hepatitis, we propose there may be a subpopulation who could be at higher risk of immune reactions in the setting of these vaccinations and that while generally still safe for the overall population, in these particular subpopulations increased caution may be warranted pending further investigation, particularly if considering the newermRNA vaccinations.

13.
Journal of the American College of Cardiology ; 80(11):1107-1109, 2022.
Article in English | EMBASE | ID: covidwho-2007792
14.
Surgical Neurology International ; 13, 2022.
Article in English | EMBASE | ID: covidwho-2006708

ABSTRACT

Background: Mucormycosis, which was previously considered to be rare, has emerged with a new challenge in patients infected with or recovering from COVID-19. Immunocompromised patients are particularly prone to developing this disease. The most common form of presentation is rhino-orbito-cerebral mucormycosis (ROCM). We present various neurosurgical approaches to an entire spectrum of its clinical manifestations. Methods: This is a retrospective study of patients who were admitted to the neurosurgery department with ROCM and a history of COVID-19 infection between November 1, 2020, and September 1, 2021. All cases of ROCM underwent contrast-enhanced computed tomography/magnetic resonance imaging of the brain, paranasal sinuses, and orbit. A tissue biopsy was sent for histopathological analysis. All confirmed cases received liposomal amphotericin B and surgical treatment was immediately undertaken. Results: Out of 200 patients with ROCM, 40 patients presented with neurological manifestations. Seven out of 40 patients had focal lesions in the brain and skull bone that needed neurosurgical intervention along with sinus debridement and antifungal treatment. These seven patients presented with different clinical manifestations: large-vessel stroke (one), medium-vessel stroke (one), frontal lobe abscess (one), frontal bone osteomyelitis (two), isolated central nervous system involvement (one), and mucor mimicking trigeminal schwannoma (one). The surgical intervention included decompressive craniectomy, frontal craniotomy, subtemporal craniotomy, and a minimally invasive supraorbital keyhole approach. Conclusion: In high-risk patients, a high level of clinical suspicion combined with appropriate investigations should be performed as soon as possible. Symptoms and early warning signs should not be overlooked, as treatment delays can be fatal. A minimally invasive surgical approach is possible in view of decreasing the morbidity of large craniotomy.

15.
NeuroQuantology ; 20(10):1457-1471, 2022.
Article in English | EMBASE | ID: covidwho-2006545

ABSTRACT

This study is a systematic review of rehabilitation techniques, medical and nursing care, and heart monitoring in patients with lung involvement and fractures and multiple traumata. The lung is one of the main organs affected by the corona virus. According to the guidelines published in March 2020 for physiotherapists in the treatment of patients with COVID-19, cardiopulmonary physiotherapy focuses on the treatment and rehabilitation of acute and chronic respiratory conditions of patients, and the goal is to improve the physical strength of people following the disease. Based on this, physiotherapy can play an effective role in respiratory treatment and physical rehabilitation of patients with COVID-19. Dr. Kia added: People who have underlying risk factors and heart problems are more exposed to Covid-19, and of course, this virus itself can cause heart disease in people who do not have heart disease. A significant number of hospitalized corona patients suffer from myocardial damage, which is associated with an increased risk of death in these people. Myocardial damage can be caused in two ways: myocarditis or heart failure, which can be measured by echocardiography or blood markers. Another damage that the corona virus causes to the heart is the blockage of the coronary arteries in the form of MI or acute heart attacks. Another damage is cardiac arrhythmias or disturbances in the normal rhythm of the heart with the mechanism of the virus attack on the conduction system of the heart, which causes the person to experience an increase or decrease in the heart rate. Another complication of this virus is thrombosis or blood clots in the body or lung embolism or strokes. One of the symptoms that patients report these days when visiting doctors or medical centers is the feeling of pain while lying down, and in fact, it is most likely inflammation of the pericardium or pericarditis, which is caused by the attack and attack of the corona virus on the heart. The person becomes inflamed and it is one of the common symptoms of this disease.

16.
Indian Journal of Critical Care Medicine ; 26:S74-S75, 2022.
Article in English | EMBASE | ID: covidwho-2006363

ABSTRACT

Aim and background: Acute pulmonary thromboembolism is the most serious clinical presentation of venous thrombo-embolism with fatal pulmonary thromboembolism (PTE) being a common cause of sudden death. In yesteryears of practicing clinical medicine, PTE was the most common cause of unexplained sudden deaths in hospitalized patients. However, our understanding of the disease has improved with time and the growth of clinical scores, laboratory evidence, and radiographic scans. In few of the patients, the diagnosis is still missed and these are the nightmarish cases for the emergency physician. Especially after the second wave of the COVID pandemic, many patients presented to the emergency department (ED) even without any risk factors for pulmonary thromboembolism. Diagnosing patients without risk factors for PTE is quite challenging and suspicion of PTE should be kept in the differential diagnosis if patients are presenting with uncommon clinical history and examination. Objective: To decrease the incidence of missed diagnosis of PTE in ED. Materials and methods: The study was conducted using ED records of patients who had a confirmed diagnosis of PTE on CT pulmonary angiography (CTPA) between March and September 2021. COVID-19 infection was ruled out at the time of presentation to ED using a rapid antigen test and subsequently with RT PCR within the next 24 hours. The presenting complaints, past history of COVID-19 infection and COVID vaccination, WELLS score, ECG, CXR, ABG, D dimers, bedside echocardiography, and results of CTPA were collected and tabulated. The symptoms were divided into 2 groups-typical and atypical. Group I with typical symptoms studied patients who presented with acute onset of dyspnea, chest pain, and cough without expectoration. Group II with atypical symptoms included patients who presented with hemoptysis, wheeze, cerebrovascular accident, syncope, arrhythmias, and acute onset of delirium. The null hypothesis was that atypical symptoms of PTE make the diagnosis difficult (late) and have a poorer prognosis. Results: The comparative analysis with descriptive statistics will be presented at the conference. In Group II patients, three parameters were clinically significant enough to early diagnosis of PTE. These were sinus tachycardia on ECG, raised D dimers, and a low TAPSE on echocardiography. TAPSE or tricuspid annular plane systolic excursion with a cutoff <1.7 cm was found to be highly specific in our study. Conclusion: Acute pulmonary embolism can be a complex interplay between several different symptoms and between different organs that can lead to a potentially life-threatening cardiovascular condition that may be difficult to diagnose. The differential diagnosis of PTE should be kept in mind if a patient presents with rare clinical findings. Detailed physical examination, Wells-scoring, D dimers, and point of care ultrasonography (POCUS) examination are very crucial in diagnosing the patient. Working in this approach will decrease the incidence of missed diagnoses.

17.
Indian Journal of Critical Care Medicine ; 26:S35-S36, 2022.
Article in English | EMBASE | ID: covidwho-2006334

ABSTRACT

Occurrence of acute limb ischaemia (ALI) in patients with SARS-CoV-2 is an uncommon complication. COVID-19 has been associated with thrombotic disease secondary to a hypercoagulable state. COVID-19 appears to cause a hypercoagulable state through mechanisms unique to SARS-CoV-2 and centres on the cross-talk between thrombosis and inflammation. The proposed hypothesis includes a severely heightened inflammatory response that leads to thrombotic inflammation, through a mechanism such as cytokine storm, complement activation, and endothelitis. The innate and adaptive immune responses result in immunemediated thrombosis, leading to thrombotic complications, such as myocardial infarction, pulmonary embolism, deep vein thrombosis, and stroke. The activation of coagulation (D-dimer) and thrombocytopenia are important prognostic markers in SARSCoV- 19 infections. At our institution, we found six patients to have ALI and reviewed their characteristics and outcomes. Our findings showed that in severe COVID-19 disease, the association of ALI had high mortality. Materials and methods: It is a retrospective observational study performed at Bangalore Baptist hospital during the COVID-19 pandemic (August 2020 to August 2021). We report a case series of 6 ALI patients aged between 30 and 55 years. All the patients were tested positive for SARS-CoV-2 disease. All our patients received standard treatment care as per institution protocol for SARS-CoV-2 disease. They were all commenced on therapeutic anticoagulation at admission to ICU. Baseline coagulation profile and inflammatory markers and their trends were followed in all patients. The diagnosis of ALI in all ventilated patients was done clinically by the presence of pallor, pulselessness, acrocyanosis, blisters, and dry care unit with SARS-CoV-2 disease, 6 patients had developed limb ischemia (1.4%). Male and female preponderance was equal. Among 6 patients, 1 was newly detected diabetes mellitus, 2 were diabetic and hypertensive of which one had right upper limb post-polio paralytic sequelae, and the rest had no co-morbidities. The mean duration of ICU stay and mechanical ventilation days was 22 days and 17.8 days, respectively. All the patients had lower limb ischemia of which 3 were unilateral. Discoloration extended up to the ankle joint in almost all cases. As these patients were on the ventilator secondary to severe hypoxemia or vasopressor support, they were managed conservatively. Two patients presented with stroke, pyelonephritis with acute kidney injury, and septic shock requiring high vasopressor support. 5 of 6 patients died during the course of treatment (mortality 83%). All patients showed high inflammatory markers especially D-dimer during the initial development phase of limb ischemia. 1 survived patient required bilateral foot amputation due to dry gangrene. Conclusion: Limb ischemia with tissue necrosis is a dreadful complication and is associated with high mortality. High incidence of thrombosis despite therapeutic anticoagulation raises a question about pathophysiology unique to COVID-19. Evidence of inflammatory-mediated thrombosis and endothelial injury are possible explanations which would support the use of immunotherapy in addition to anticoagulation for the treatment of thrombotic events. Further insight into the cause and management of thrombosis is needed.

18.
Indian Journal of Critical Care Medicine ; 26:S10-S11, 2022.
Article in English | EMBASE | ID: covidwho-2006323

ABSTRACT

Case report: COVID-19 infection though mainly presents as a respiratory disease it can also present as secondary stroke due to thrombotic complications. We report a case of a 28-year lean male with no underlying comorbidities and addiction who had a history of fever, cough, and neck weakness of 10 days duration and presented to us with sudden painless loss of vision in both eyes. On the evaluation of his d-dimers, serum LDH was raised. HRCT showed a CTSI of 17/25. His MRI brain showed hyperintense foci of diffusion restriction in the occipital lobe suggestive of acute infarct within the territory of a respective posterior cerebral artery. Conclusion: Stroke in COVID-19 is seen more among patients with severe respiratory disease due to thrombotic complications. Though elderly age and co-morbidities are a risk factor for increased disease severity and complications, severe disease can occur in young healthy individuals. Thus, COVID-19 disease is an independent risk factor for stroke.

19.
Frontiers in Pediatrics ; 10, 2022.
Article in English | EMBASE | ID: covidwho-2005896

ABSTRACT

COVID-19 and multisystem inflammatory syndrome in children (MIS-C) have been associated with a higher incidence of hypercoagulability and thromboembolic events (TEs), even in children, leading to relevant morbidity, and mortality. However, our understanding of such complications in childhood is limited. To better understand the incidence, clinical manifestations, risk factors, and management of COVID-19 and MIS-C-related TEs in children, a review of the current literature and a brief update on pathophysiology are given. Sixty-two studies, describing 138 patients with TEs associated with COVID-19 or MIS-C, were included. The overall number of TEs was 157, as 16 patients developed multiple TEs: venous TEs represented the majority (54%), followed by arterial thrombosis (38%, mainly represented by arterial ischemic stroke-AIS), and intracardiac thrombosis (ICT) (8%). Within the venous TEs group, pulmonary embolism (PE) was the most frequent, followed by deep venous thrombosis, central venous sinus thrombosis, and splanchnic venous thrombosis. Notably, 10 patients had multiple types of venous TEs, and four had both venous and arterial thrombosis including a newborn. Most of them (79 cases,57%) had at least one predisposing condition, being obesity the most frequent (21%), especially in patients with PE, followed by malignancy (9%). In 35% of cases, no data about the outcome were available About one-third of cases recovered, 12% improved at discharge or follow-up, and 6% had persistent neurological sequelae. The mortality rate was 12%, with death due to comorbidities in most cases. Most fatalities occurred in patients with arterial thrombosis. Pediatricians should be aware of this life-threatening possibility facing children with SARS-CoV-2 infection or its multisystemic inflammatory complication, who abruptly develop neurological or respiratory impairment. A prompt intensive care is essential to avoid severe sequelae or even exitus.

20.
Journal of NeuroInterventional Surgery ; 14:A124, 2022.
Article in English | EMBASE | ID: covidwho-2005441

ABSTRACT

Background The COVID-19 pandemic has impacted every aspect of our current lives. Therefore, it is important to identify whether there is a change in the number of mechanical thrombectomy (MT) cases that could be attributed to COVID- 19 shutdowns. Methods This is a retrospective cohort study utilizing a prospectively maintained institutional database that tracks MT data at our institution. The study date ranges from August 21, 2018 to October 20, 2021. Patients were dichotomized by the arrival date of March 19, 2020 into pre-and post-COVID-19 shutdown groups. Stroke-onset-to-arrival time is defined as the patient's last known normal to when they arrived at our institution. We utilized univariate analyses to assess MT differences between three settings, 'drip and ship', emergency department, and in-patient admission. Results Of the 544 patients during this time period, 289 (53.1%) presented during the pre-COVID-19 shutdown timepoint while 255 (46.9%) presented after. Of the 289 pre-COVID-19 patients, 158 (54.7%) arrived by 'drip & ship', 120 (41.5%) presented to the emergency department, and 11 (3.8%) had a stroke in the in-patient setting. Of the 255 post-COVID-19 shutdown patients, 197 (77.3%) arrived by 'drip & ship', 41 (16.1%) presented to the emergency department, and 17 (6.7%) had a stroke in the inpatient setting. The changes in presentation location between the pre-and post-COVID-19 shutdown timepoint were statistically significant (p<0.001). Among the 'drip and ship' patients, the onset-to-arrival time to our institution lengthened from 386.2 to 488.6 minutes after the COVID- 19 shutdown (p=0.002) while the onset-to-arrival times did not significantly differ for emergency department and inpatient admits (p>0.05). The arrival-to-puncture time increased from 107.1 minutes to 133.0 minutes after COVID-19 shutdowns for those presenting to the emergency department (p<0.001) while there was no significant difference between 'drip and ship' and in-patient times (p>0.05). The onset-to-recanalization time significantly increased for 'drip and ship' patients from 487.5 to 604.1 minutes after COVID-19 shutdowns (p=0.0037) while the difference was not significant for those presenting to the emergency department. Conclusion There appears to be a 3-fold decrease in MT presenting to the emergency department at our institution since the COVID-19 shutdown while 'drip and shipped' and inpatient admits have increased slightly. For patients admitted to the emergency department, there was a statistically significant ∼25-minute increased arrival-to-puncture time after COVID- 19 shutdowns. Further monitoring of presentation over the next year as the pandemic wanes will be revealing to any lasting impact on patient triage and treatment based on the COVID-19 pandemic.

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