ABSTRACT
Case Report: Pulmonary embolism (PE) is a form of venous thromboembolism (VTE) which causes an obstruction of the pulmonary vasculature. Massive PE can be a fatal, accounting for over 100,000 death/year in the US. Incidence of PEs is increased in COVID-19 infections, due to a hypercoagulable state resulting from endothelial injury, stasis and increase in prothrombic factors. We report a case of a 48-year-old male with past medical history of mild form of COVID-19 infection approx. 6 months back. He was brought to the ED after cardiac arrest resuscitated in the ambulance. 3 days prior to the cardiac arrest he presented in the ED for nonspecific upper respiratory tract symptoms, for which he received symptomatic treatment. During that visit all the workup was negative except for sinus tachycardia. The cause of patient's cardiac arrest was found to be massive bilateral PE leading to right ventricular strain, shock, and HFrEF (20%). Our patient received thrombolytic, ECMO, thrombectomy, anticoagulation, and required complex treatment for several complication during hospitalization. Was eventually discharged home recovered. COVID-19 pandemic has been one of the worst in human history, causing millions of deaths. Symptoms of COVID-19 infection vary from mild upper respiratory disease to respiratory failure or severe VTEs. Multiple studies including a large national study in Sweden reported COVID-19 being an independent risk factor for VTEs, risk extending up to 180 days after COVID-19 infection, especially in unvaccinated population as seen in our patient. New variants of SARS-Cov 2 pose a challenge to control the spread of COVID-19 infection. As more studies support COVID-19 infection association with hypercoagulability status, varied nonspecific symptomology of PE remains a diagnostic and treatment dilemma. Physicians should have low threshold for investigating PEs in patients with unexplained sinus tachycardia or non-specific respiratory distress, especially in an unvaccinated post-COVID-19 patient, including historical mild forms of infection. Many studies have arguably advocated "treatment to prevent thrombotic events” in post COVID- 19 infection, however, vaccination remains the corner stone to reduce morbidity and mortality associated with serious thrombotic events like massive PEs in patients exposed to COVID1-19.
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Background: COVID rapidly became a multisystemic infection with varied cardiovascular complications including Acute Coronary Syndrome. Current literature is limited on the impact of COVID on ACS patients. Methods: We queried the national inpatient sample (NIS) from 2020 to identify patients who were admitted for ACS and stratified them based on the presence or absence of COVID. The adjusted odds ratios (aOR) of in-hospital outcomes and resource utilization were calculated using chi-square statistics in the software STATA v.17. Results: Out of 883940 patients analyzed, who were admitted for ACS, 3900 patients had COVID. On adjusted analysis, patients with COVID had significantly elevated In-Hospital mortality (aOR, 2.91 CI 2.25-3.79), MACCE (aOR 2.53, CI 1.90-3.10), cardiac arrest (aOR 3.34, CI 1.1-10.1) with longer length of stay (6.34 ± 0.39 vs 4.48 ± 0.02). Interestingly, the outcome PCA (aOR, 0.39 CI 0.33-0.46) showed significant improvement. Interestingly, mean costs were elevated in patients without COVID at $105,550.8 vs $98597.7 in patients without COVID. In terms of trends, as exposure increased through the year with the highest levels in December, the mortality also increased (April 18.52% vs 25.64%). Interestingly, the cardiac arrest percentage decreased from April 2020 (7.4%) to Dec 2020 (1.98%) as well as MCS in April 202 (11.11%)vs December 2020 (3.47%) in patients exposed to COVID. Conclusions: In patients admitted for ACS, the presence of COVID significantly increases the risk of MACCE, in-hospital mortality, and cardiac arrest. Prospective trials are necessary for the identification of risk factors to improve clinical outcomes in these patients. Key words: COVID, Sars-2 coronavirus. Coronavirus. ACS. Acute Coronary Syndrome. [Formula presented]
ABSTRACT
Background: The Internet of Medical Things (IoMT) is now being connected to medical equipment to make patients more comfortable, offer better and more affordable health care options, and make it easier for people to get good care in the comfort of their own homes. Objective(s): The primary purpose of this study is to highlight the architecture and use of IoMT (Internet of Medical Things) technology in the healthcare system. Method(s): Several sources were used to acquire the material, including review articles published in various journals that had keywords such as, Internet of Medical Things, Wireless Fidelity, Remote Healthcare Monitoring (RHM), Point-of-care testing (POCT), and Sensors. Result(s): IoMT has succeeded in lowering both the cost of digital healthcare systems and the amount of energy they use. Sensors are used to measure a wide range of things, from physiological to emotional responses. They can be used to predict illness before it happens. Conclusion(s): The term "Internet of Medical Things" refers to the broad adoption of healthcare solutions that may be provided in the home. Making such systems intelligent and efficient for timely prediction of important illnesses has the potential to save millions of lives while decreasing the burden on conventional healthcare institutions, such as hospitals. patients and physicians may now access real-time data due to advancements in IoM. Copyright © 2022 Wal et al.
ABSTRACT
Background: A 54-year- old male presented to our centre with a chronic non-productive cough and breathlessness. Recent history of COVID treated and resolved few months back. He had a history of brain surgery performed five years back but details not known. Physical examination revealed no oedema and bilateral coarse creps with bronchiolar breathing. Laboratory findings indicated neutrophilic leucocytosis, elevated inflammatory markers, with elevated troponin I and D dimers. Urine analysis suggested microscopic haematuria with sediments. While 24 hour quantification revealed sub nephrotic proteinuria. As auto immune workup and vasculitis profile was negative and patient has not improved in spite of standard of therapy hence we went ahead with CT-Chest indicating ground-glass opacities in bilateral lung parenchyma and prominent interlobular/intralobular septal thickening. Then Bronchoscopy done which revealed the blood-stained secretions in the main stem bronchi and diffuse alveolar haemorrhage in bilateral bronchial segments indicating an inflammatory study, while tuberculosis diagnostic panel and infective bio fire panel in BAL was negative. Meanwhile, his repeat BAL culture suggested Carbapenem resistant Acinetobacter baumannii complex infection. As the patient did not respond to the standard of care for vasculitis. Probability considered was a small vessel vasculitis (namely Granulomatous polyangiitis) was considered due to lung manifestation involving upper respiratory tract with epistaxis, neutrophilic leucocytosis, elevated acute reactive protein, and renal manifestation including microscopic haematuria and proteinuria. However he responded poorly to conventional standard of treatment including pulse steroids and IVIG. Hence after MDT discussion we proceeded with lung biopsy which showed linear cores of lung tissue infiltrated by a malignant neoplasm and acinar pattern suggesting Invasive mucinous adenocarcinoma. Hence we went ahead with the biopsy diagnosis for the treatment plan. As he was to be started on chemotherapy, but he suddenly collapsed and went into hypotension, bradycardia, and cardiac arrest. In spite of high supports and post 4 cycles of CPR, was unable to revive and sadly succumbed to his illness. Discussion(s): In this rare case, the original diagnosis pointed to the pulmonary-renal syndrome, an autoimmune disease characterized by diffuse pulmonary haemorrhage and glomerulonephritis. However, negative autoimmune antibodies and vasculitis profile along with lung biopsy results indicated an unusual case of malignant lung adenocarcinoma presented with pulmonary renal syndrome. Conclusion(s): In cases suggesting pulmonary-renal syndromes, if autoimmune work up is negative and response is suboptimal relook the diagnosis.
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Case Report: Over 90% of cases of cryptococcal meningoencephalitis present in immunocompromised patients, with the majority of those being in patients with AIDS. However, this infection can also occur in patients with other immunocompromised states, such as steroid use, malignancy, rheumatologic diseases, and use of immunosuppressive medications. Delay in diagnosis can often lead to rapid neurological deterioration and mortality. Case: A young, otherwise immunocompetent patient, with a history of Chiari I malformation and recent COVID- 19 infection presented with syncope following two weeks of headaches, generalized body aches and weakness after COVID-19 diagnosis. Physical exam demonstrated an isolated CN VI palsy. Head imaging revealed new right caudate infarcts, and a cerebellar tonsillar descent compatible with history of Chiari I malformation. Initial lumbar puncture (LP) was deferred due to congenital brain herniation. Over the next few days, the patient continued to show increasing neurological deficits such as truncal ataxia and increased mood instability. The patient was transferred to the Intensive Care Unit, and LP was obtained under special neuro-critical care direction. Due to increased opening pressures and yeast on gram stain, cryptococcus was suspected and later confirmed. Although anti-fungal therapy was initiated, the patient continued to deteriorate, leading to cardiac arrest, intubation, and placement of lumbar drain. The patient unfortunately did not demonstrate neurologic recovery following arrest and progressed to brain death. Discussion(s): While cryptococcal meningoencephalitis is overwhelmingly a disease of immunocompromised patients, it can occur in immunocompetent hosts, and delay in diagnosis and treatment can lead to adverse and fatal outcomes. This patient had no known underlying conditions besides a recent mild COVID-19 infection and underlying Chiari I malformation, neither of which are known to be associated with cryptococcal meningoencephalitis. These factors may however have played a role in his disease and progression. Copyright © 2023 Southern Society for Clinical Investigation.
ABSTRACT
Larsen syndrome is a rare inherited disease associated with dislocations of multiple joints, typical syndromic facies, and multiple spine abnormalities. They often required multiple corrective orthopedic surgeries to regain their functional ability, thus needing repeated anesthesia. Apart from skeletal deformities, they have predicted difficult airway and need extreme care during intubation and positing of the patient. Abnormal posturing due to spinal deformity and poor pulmonary reserve due to kyphoscoliosis creates an extremely challenging situation for the anesthetist to manage the case during the perioperative period. Here we are describing the perioperative anesthetic management of a patient with Larsen syndrome. Copyright © 2022 Saudi Journal of Anesthesia Published by Wolters Kluwer - Medknow.