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1.
Gastroenterology ; 162(7):S-837, 2022.
Article in English | EMBASE | ID: covidwho-1967373

ABSTRACT

Background and Aims: Long COVID is a syndrome affecting patients infected with SARSCoV- 2 who show a broad spectrum of symptoms, such as fatigue and dyspnoea, persisting for several months after the initial infection. Patients with type 2 diabetes (T2D) have frequent co-morbidities affecting multiple organs. Both long COVID and T2D are multi-system conditions associated with abnormalities in organ structure and function. Therefore, multi-organ assessment is critical for monitoring organ health and early detection of co-morbidities in both conditions. This study aimed to define the prevalence of multi-organ abnormalities in patients with long COVID and patients with T2D with a rapid, non-contrast, magnetic resonance imaging (MRI) scan. Methods: Overall, 135 long COVID patients without diabetes were recruited in the COVERSCAN study (NCT04369807) at a median of 183 days since first COVID-19 symptoms. 135 patients with established T2D were recruited in the MODIFY study (NCT04114682). MRI data were acquired to derive abdominal organ-specific measures of size, fat deposition and fibroinflammation (CoverScan®, Perspectum Ltd.). Reference values of MRI metrics were based on 92 healthy volunteers and published literature. The prevalence of abnormalities for each measure was assessed using Fisher's exact tests in the whole cohort and in a subset of patients with obesity (BMI≥30 kg/m2). Results: The demographics of the three cohorts were as follows: long COVID: median age 54 yrs [interquartile interval 46–60], 56% male, BMI 27 kg/m2 [26–31];T2D: 62 yrs [54–70], 59% male, BMI 32 kg/m2 [28–35], median T2D duration 11 yrs;healthy volunteers: 44 yrs [32–53], 66% male, BMI 23 kg/m2 [21–25]). There was a high prevalence of abdominal organ abnormality in both long COVID and T2D patient groups (Figure, left), including increased fat deposition (steatosis) in the liver, pancreas, and kidney (Figure, right). 35% of patients with T2D had clustering of abnormalities involving at least 2 organs, compared to 23% in long COVID. Abnormalities affecting the liver (steatosis, fibroinflammation and hepatomegaly) and renomegaly were more common in T2D than in long COVID (p<0.001). Considering only patients with obesity, liver fibroinflammation, hepatomegaly, and renomegaly remained significantly more prevalent in T2D than in long COVID (p<0.05). Conclusion: Long COVID and established T2D have distinct profiles of multi-organ impairment, more prevalent with obesity but not fully explained by it. Multi-organ MRI assessment can enrich the current blunt assessment of multi-system/multi-organ abnormalities in diverse disease states to inform earlier intervention and treatments. (Figure Presented) Left: Prevalence (%) of organ abnormalities in long COVID patients (black numbers) and T2D patients (grey numbers) (liver, pink;pancreas, yellow;kidney, green;spleen, blue). Right: Prevalence of organ steatosis, fibroinflammation and increased organ size by patient group. Colour per organ as in left figure.

2.
BJU International ; 129:94-95, 2022.
Article in English | EMBASE | ID: covidwho-1956728

ABSTRACT

Introduction & Objectives: Minimally invasive transurethral therapies for benign prostatic hypertension are becoming increasingly common in Europe and America. They may be performed under local anaesthetic and provide a good alternative to invasive procedures in a COVID era. REZUM, a minimally invasive transurethral water-vapor therapy, has been shown to be a safe and effective treatment for BPH, especially where preserved sexual function is a priority. Although short-term clinical outcomes are promising, long-term data from robust studies is lacking. In Australia, there are few providers of REZUM, which utilises steam injections to reduce prostatic tissue. This study aims to investigate the safety and efficacy of REZUM in an Australian cohort. Methods: A clinical audit was conducted of 50 patients who underwent REZUM to treat symptoms of BPH over a 12-month period. Procedures were performed under general anaesthetic. Demographics, comorbidities, sexual function, prostate volume, PSA, voiding flow rate, post-void residual volume and International Prostate Symptom Score were extracted from medical records, in addition to patient's reasons for seeking minimally invasive treatment. Corresponding post-operative data was collected. Descriptive statistics of the cohort were obtained using Stata 16.0. Paired t-test was used to identify if there was a significant difference between IPSS scores pre- and postprocedure Results: Patients accessing treatment ranged from 48 to 84 years (mean 64.6). Median prostate volume was 55mL (inter-quartile range 45-78mls) and mean International Prostate Symptom Score (IPSS) was 20.3. 28% of the cohort cited concern for ejaculatory function, either from medication side effects or TURP, as their primary reason for seeking minimally invasive treatment. A further 25% of the cohort was additionally concerned about other side effects from medications and/or TURP or had experienced medication failure. The mean follow up period was 6 months (range 6-weeks-26 months). 69% of men were satisfied with their symptom improvement at the time of review, with the expectation of ongoing improvement in men who had attended a 6-week post-operative review only. Postprocedure mean IPSS was 7.9 (range 2-33). Mean reduction in IPSS score post-procedure was 12.7 points (p<0.001). 3 men experienced complications (retention, infection, bulbar stricture). Conclusions: REZUM provides a safe alternative to traditional invasive prostatic treatments. It may be performed under local anaesthetic, providing an effective alternative in a COVID era. Men concerned about medications, more invasive treatments and ejaculatory dysfunction are increasingly seeking relief from this minimally invasive option and experiencing good outcomes including significant symptom improvement sustained over medium-term follow up.

3.
Heart ; 108, 2022.
Article in English | EMBASE | ID: covidwho-1935097

ABSTRACT

The proceedings contain 226 papers. The topics discussed include: mitral valve abnormalities in decedents of sudden cardiac death due to hypertrophic cardiomyopathy and idiopathic left ventricular hypertrophy;prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players;clinical outcomes and myocardial recovery in energetics, perfusion and contractile function after valve replacement surgery in severe aortic stenosis patients with diabetes comorbidity;brain phenotype of takotsubo syndrome;improving the diagnostic accuracy of apical hypertrophic cardiomyopathy;investigating a novel role for nesprin-1 and the linc complex in cardiomyocyte mechanotransduction;transcatheter aortic valve implantation in patients with right bundle branch block: should prophylactic pacing be undertaken?;and disease penetrance in asymptomatic carriers of familial cardiomyopathy variants.

4.
Journal of Comprehensive Pediatrics ; 13(1), 2022.
Article in English | EMBASE | ID: covidwho-1928829

ABSTRACT

Background: Coarctation of the aorta (CoA) is a congenital heart defect. Due to the narrowing of the descending aorta, blood flow mainly reduces after the stenosis, and CoA can occur at any region in the thoracic and abdominal aorta. Cardiac surgeons and cardiologists are familiar with postoperative complications of CoA;however, there are also some other complications that have not been reported to date. Case Presentation: The present study investigated three cases of CoA undergoing reconstructive surgery. Nevertheless, a couple of days after the surgery, they manifested symptoms suspected of cerebral infarction. Ischemic infarction was observed after performing brain computed tomography. Additionally, we discuss possible pathophysiology and reasons that can lead to this problem. Conclusions: In this case report, we presented three cases of CoA patients who underwent reconstructive surgery and manifested cerebral infarction as an adverse effect of the reconstructive surgery.

5.
European Heart Journal, Supplement ; 24(SUPPL C):C203-C204, 2022.
Article in English | EMBASE | ID: covidwho-1915569

ABSTRACT

A 76 year old woman was admitted to our hospital for self-limiting dyspnoea (NYHA class III) in oxygen dependence and frequent lipothymia following Valsalva manoeuvres. She was previously admitted to a Spoke Centre for heart failure (HF) with preserved ejection fraction (EF) and a new diagnosis of “pre-capillary pulmonary hypertension (PH)”. Despite a diagnosis of PH of unclear aetiology, she was started on macitentan without being reassessed for functional capacity due to Covid emergency;because of worsening symptoms, she was admitted to our Hub Centre. Resting ECG showed right axis deviation, right ventricle (RV) hypertrophy, first-degree atrioventricular block and right bundle branch block. Transthoracic echocardiography (TTE) showed reduced left ventricular (LV) volume with preserved EF (diastolic volume= 37 ml, EF=88%), severe right atrial and RV dilation with flattening of the interventricular septum, estimated pulmonary artery systolic pressure (PASP) of 124 mmHg, and moderate calcific aortic stenosis (peak aortic velocity 3.3 m/s, mean gradient 25 mmHg, valve area 1.1 cm2). Right and left heart catheterization showed severe pre-capillary PH (mean pulmonary pressure 60 mmHg, mean wedge 11 mmHg, pulmonary vascular resistance 14.41 WU), a severe aortic valve stenosis (aortic valve area 0.68 cmq and peak-to-peak gradient 25 mmHg, slight reduction of cardiac index 2.04 l/min/mq) and no significant coronary artery disease. The degree of aortic stenosis was considered as moderate-severe by integrating data of transesophageal echocardiography (planimetric area 1cm2) and assessment of calcium score (1615 Agatson units). Pneumological causes, chronic thromboembolic PH, rheumatologic diseases, HIV infection, paraneoplastic origin and veno-occlusive disease were all ruled out as potential PH causes and a diagnosis of Idiopathic pulmonary arterial hypertension (IPAH) was finally made. The Heart Team established the best therapeutic option was a transcatheter aortic valve replacement (TAVI) allowing better haemodynamic tolerability of PH therapy. The patient underwent TAVI and was started on PH therapy;a complete atrio-ventricular block developed after the procedure, requiring permanent pacemaker (PM) implantation. Unfortunately, few days later, the patient died following pacemaker's lead dislocation. Conclusion: PH has a diverse aetiology, and prognosis is generally poor, especially in patients with severe comorbidities. (Figure Presented).

6.
Europace ; 24(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1912823

ABSTRACT

The proceedings contain 629 papers. The topics discussed include: digitalized ECG measure of p-wave duration predicts incident heart failure;diagnostic value of Peguero Lo Presti Electrocardiografic index for diagnosis of left ventricle hypertrophy in correlation with cardiovascular magnetic resonance;electrocardiography: an useful tool for prediction of the diagnosis and severity of pulmonary embolism;association between excessive supraventricular ectopic activity and future diagnosis of atrial fibrillation in patients with cryptogenic stroke;low-level vagus nerve stimulation during cardiac surgery: smart neuromodulation;a polymorphism in histidine-rich calcium binding protein as second hit in phospholamban cardiomyopathy;genetic predisposition according to the age at the onset of atrial fibrillation;familial clustering of unexplained heart failure - a Danish nationwide cohort study;and fever following covid-19 vaccination in subjects with Brugada syndrome: incidence and management.

7.
Journal of Urology ; 207(SUPPL 5):e1037-e1038, 2022.
Article in English | EMBASE | ID: covidwho-1886528

ABSTRACT

INTRODUCTION AND OBJECTIVE: To report IPSS, QoL and treatment failure rate up to 79-months for the MT02 study with implantation of the temporary implantable nitinol device (iTind;Medi- Tate Ltd®, Israel) in men with lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). METHODS: Three out of nine international centers consented to continue the international prospective multicenter study on patients with LUTS due to BPO (IPSS ≥10, Qmax <12ml/sec, and prostate volume <75ml) beyond 36 months following implantation of iTind. Out of the originally enrolled 81 patients, 50 were followed-up at sites in Italy, Switzerland, and Belgium. Due to Covid-19 the originally planned follow-up scheme was amended: Each patient was assessed once during a timeframe of 50-79 months post-operatively by IPSS and IPSS-QoL, change in medication and adverse events via a telephone call. Patients were analyzed in three groups according to their follow-up time point (clustered into groups from 48-59 months, 60-71 months, and 72-83 months). RESULTS: Fifty to 79 months results were available for 42 patients. Four patients were lost to follow-up and two patients deceased from reasons unrelated to the iTind device. Only two patients had treatment failures (one patient underwent TURP, the other ThuLEP), while no patient required any additional medication. IPSS average results were 12.63±8.84 (50-59m, N=24), 8.85±5.54 (60-71m, N =13) and 9.20 ±5.85 (72-79m, N=5). QoL average results were 2.21±1.69 (50-59m, N=24), 1.85±0.99 (60-71m, N=13) and 1.80±1.10 (72-79m, N=5). IPSS (-8.88, -10.31, and -9.60) and IPSSQoL (-2.04, -1.85 and -1.80) improved significantly for all groups vs. baseline, respectively (p <0.0001). Functional data is shown in Figure 1. No late post-operative complications were observed between 50 and 79 months. CONCLUSIONS: iTind for treatment of LUTS secondary to BPO is an effective and safe procedure providing significant and effective reduction in symptoms and quality of life durable up to 79 months (6.6 years) with only 4% of treatment failures after 3-year follow-up. (Figure Presented).

8.
Journal of Urology ; 207(SUPPL 5):e667-e668, 2022.
Article in English | EMBASE | ID: covidwho-1886524

ABSTRACT

INTRODUCTION AND OBJECTIVE: The SARS-CoV-2 (COVID) pandemic threatened access to healthcare, raising concerns that patients were going underdiagnosed and undertreated. The aim of our study was to understand the impact of the COVID pandemic on diagnosis and surgical management of common urological conditions. METHODS: Using a large multi-center electronic health record network (TRINETx) consisting of 46 healthcare organizations, we conducted an epidemiological study investigating the number of patients newly diagnosed with common urological conditions and those undergoing urologic surgeries at yearly intervals from March 1st, 2016 to March 1st, 2021. Relevant international classification of diseases (ICD) codes used to identify urologic conditions are elaborated on in Table 1. Current procedural terminology (CPT) codes used to identify surgeries are detailed in Figure 1. We then determined the percentage of newly diagnosed patients who underwent surgery for each specific year. RESULTS: We saw a decrease in number of all urologic surgeries being performed during the initial year of the pandemic (Figure 1). From March 2020-2021, there was a >20% decrease in surgical case load for benign prostatic hyperplasia procedures (-29.5%), prostate biopsies (-30.1%), incontinence procedures (-33.6%), and vasectomies (-22.8%), compared to the preceding year. Radical cystectomies and orchiectomies saw the lowest decrease, -5.9% and -8.6%, respectively. A similar trend was seen in the number of individuals newly diagnosed with urologic conditions and percentage of patients undergoing surgical intervention. The lowest drops were seen with ureteral stent placements (-5.0%) and prostate biopsies (-3.1%). CONCLUSIONS: The number of people receiving urologic diagnoses and surgical case load for urologic procedures significantly reduced during the first year of the COVID pandemic. Providers should be aware of this healthcare disparity, and greater efforts made to identify these missed patients moving forward.

9.
Journal of Urology ; 207(SUPPL 5):e269-e270, 2022.
Article in English | EMBASE | ID: covidwho-1886491

ABSTRACT

INTRODUCTION AND OBJECTIVE: SARS-CoV-2 utilizes two integral membrane proteins ACE2 and TMPRSS2 for viral replication. It has been established TMPRS22 specifically is found in high concentrations throughout the prostate found to be linked to prostatic disease progression. This project examined the histopathological, ultrastructural, and immunofluorescent elements of prostatic tissue from men infected by SARS-CoV-2. METHODS: We evaluated prostate tissue in men with worsening lower urinary tract symptoms who underwent HoLEP procedure after SARS-CoV-2 infection. Biopsied tissue was visualized by transmission electron microscopy (TEM), immunofluorescence, and viral presence was confirmed by quantitative polymerase chain reaction (RT-PCR). RESULTS: Multiple coronavirus-like spiked viral particles ranging from 73.3mm to 109mm were visualized by TEM (Figure). Histochemical and immunofluorescence concurrently showed presence of distinct hyalinization, fibrosis, and presence of spike protein (Figure 2). RT-PCR confirmed the identity of the viral bodies as SARS-CoV-2 (Figure 3). CONCLUSIONS: This study provides evidence that SARSCoV- 2 not only enters prostatic tissue but may persist beyond initial infection period. In addition to establishing the persistence of SARSCoV- 2 particles in prostatic tissue, this report suggests the importance of discerning the relationships between COVID-19, lower urinary tract symptom severity, and prostatic hyperplasia. (Figure Presented).

10.
International Journal of Pharmaceutical and Clinical Research ; 14(5):208-217, 2022.
Article in English | EMBASE | ID: covidwho-1880308

ABSTRACT

Background: cardiovascular disease comprising of mostly ischemic heart disease and stroke are leading cause of death worldwide. WHO estimates that India accounts for just over a fifth of these deaths. A thorough autopsy under expert supervision and histomorphological examination of heart plays an essential part to confirm the cause of death. Aims and objectives: This study was conducted to study the spectrum of histopathological changes in ischemic heart disease. Material and methods: A retrospective study of 252 cases of formalin fixed heart specimen was undertaken in the Department of Pathology, Chhattisgarh Institute of Medical Sciences, Bilaspur, Chhattisgarh. Out of 252 specimen, 32 specimen of heart showed autolytic changes and hence their histomorphological findings were not included in the study. A detailed gross and microscopic examination was performed, and findings were correlated with available clinical data to establish the cause of death. Result: Atherosclerosis was the most common lesion found in 124 cases (64%) followed by medial hypertrophy in 56 cases (28%) and intimal hyperplasia in 46 cases (23%). Other frequent findings were disruption of myocardial architecture 44 cases (22%) and patchy interstitial fibrosis 47 cases (23.5%). Also seen was presence of collateral formation in 39 cases (19.5%) and recanalization in 22 cases (11%). Microthrombi in circulation was seen in 27 cases (13.5%). These cases could have been the undiagnosed covid patients. Fibromuscular dysplasia was seen in 12 cases (6%) and thickening of pericardial fat in 10 cases (5%). Fibrous cap formation was seen in 7 cases (3.5%) and transmural inflammation in 12 cases (6%). Other less common findings were presence of Lines of Zhan in 7 cases (3.5%), Giant cell arteritis in 2 cases (1%) and dissection of aorta in 2 cases (1%). Conclusion: Atherosclerosis was found out to be the most common lesion responsible for causing mortality.

11.
Medicina ; 82(1):61-65, 2022.
Article in English | GIM | ID: covidwho-1864094

ABSTRACT

Coronavirus disease 2019 (COVID-19) produces a significant burden to severely ill patients affected by acute respiratory failure. The aim of this study was to describe echocardiographic findings in a series of mechanically ventilated patients with moderate and severe acute respiratory distress syndrome (ARDS) due to COVID-19. This was a single center, descriptive and cros s-sectional study of prospectively collected data. Patients had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and moderate or severe ARDS. Initial echocardiogram was performed within 7 days of intensive care unit admission and every 15 days until mechanical ventilation ended, 28 days or death. Time spent by the physician for each study was measured. Multiple echographic measurements were acquired;33 patients were analyzed. Total number of echocardiograms performed was 76. The median imaging time required to complete a standard study was 13 [10-15] minutes. Chronic structural abnormalities were present in 16 patients (48%), being LV hypertrophy the main finding in 11 patients (33%). The most frequent acute or dynamic finding was RV enlargement (43%) when considering all echocardiograms performed from admission to day 28 of follow-up. Other findings were: pulmonary hypertension (15%), new or dynamic left ventricle (LV) regional wall motion abnormalities (15%), new or dynamic LV global contractility deterioration (6%) and hypercontractility (12%).

12.
Modern Pathology ; 35(SUPPL 2):1302, 2022.
Article in English | EMBASE | ID: covidwho-1857148

ABSTRACT

Background: The acute autopsy findings associated with COVID-19, due to the novel coronavirus SARS-CoV-2, are well documented. However, the long term sequelae of COVID-19 are still being elucidated. One significant sequela of patients who survive COVID-19 is pulmonary hypertension. Indeed, several groups have reported pathologic pulmonary hypertensive changes in patients who have undergone lung transplantation. The purpose of this study was to determine the frequency of pulmonary hypertensive changes at autopsy as well as identify associated factors. Design: We retrospectively examined 22 autopsies from patients who died of COVID-19 at our institution. Demographic information collected included age, sex, ethnicity, pre-existing medical conditions, BMI, whether the patient was on a ventilator, as well as treatment. All H&E lung autopsy slides were examined, in addition to MOVAT and VVG stained slides where appropriate. Small arteries (<100 microns in diameter) were evaluated for the presence/absence of medial hypertrophy, intimal thickening, recanalized thrombi, and plexiform lesions according to the Heath and Edwards grade. The COVID-19 autopsy lungs were also evaluated for the presence/absence of diffuse alveolar damage, pneumonia as well as thrombi. Results: Pathologic findings consistent with pulmonary hypertension were identified in 6 of the 22 COVID-19 lungs identified. Two patients had both medial hypertrophy as well as intimal thickening (Heath and Edwards grade 2), whereas four patients had only medial hypertrophy (Heath and Edwards grade 1). Of the six patients with pulmonary hypertensive changes, 4/6 patients also had pulmonary vascular thrombi, 5/6 patients had previously been on the ventilator, 3/6 patients had pneumonia by pathologic examination, and 4/6 patient had DAD by pathologic examination. None of the six patients had known pulmonary hypertension prior to their terminal hospital admission. Conclusions: In our retrospective review of COVID-19 autopsy lungs, 27% of lungs demonstrated pathologic features suggestive of pulmonary hypertension. As expected, most patients had early (Grade 1, medial hypertrophy) pulmonary hypertensive changes. Vascular thrombi, history of ventilation, pneumonia and DAD were all commonly associated with pathologic pulmonary hypertension. Movat and/or VVG stains are useful to help identify these pathologic changes. We hypothesize there will be an increase in pulmonary hypertension in long-term survivors of COVID-19.

13.
Journal of Neurological Surgery, Part B Skull Base ; 83(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1815668

ABSTRACT

Objective: Sarcoidosis is a systemic granulomatous disease identified by noncaseating granulomas that can have central nervous system (CNS) involvement but rarely presents with primary CNS involvement. Neurosarcoidosis can present with or without systemic disease and can present with mass effect, endocrinopathies, and neuropathic symptoms. We report on an unusual case of neurosarcoidosis involving a pituitary adenoma. Case report: A 45-year-old African American man presented to ophthalmology clinic with a chief complaint of worsening field of vision. Magnetic resonance imaging (MRI) showed a 3.8-cm macroadenoma containing cystic and calcified components with optic chiasm compression, near-complete opacification of the maxillary sinuses, and mucosal thickening in the frontal sinuses. Due to the COVID-19 pandemic, follow-up was delayed for 4 months while the vision loss progressed to near blindness in his right eye. After thorough evaluation, the patient was found to have near-complete right sided blindness, diffuse lymphadenopathy. After interdisciplinary discussions surgery was recommended. The patient underwent endoscopic transsphenoidal resection of the pituitary tumor and concurrent endoscopic sinus surgery. During the approach sinus mucosa was grossly inflamed. Frozen section of the sinus mucosa revealed granulomatous disease. The suprasellar mass had both soft contents which could be suctioned and fibrotic tumor with dense septations. Final pathology showed a pituitary adenoma with non-necrotizing granulomas within in the pituitary adenoma. Post-operatively, the patient was started on steroids and reported gradual improvement in his visual fields. At 3-months post-operative, MRI showed significant reduction in macroadenoma with a 1.5 cm residual tumor remaining in the sella and a decompressed optic chiasm which retracted inferiorly without any evidence of other intercranial anomalies. Literature review: Sarcoidosis occurs mostly in African Americans and Northern European women in their 3rd and 4th decades and can affect any part of the body such as the lymphatic systems, skin, lungs, and liver. Sarcoidosis is estimated to be prevalent in up to 80 per 100,000 people. CNS involvement occurs in 5 to 15% of patients with systemic sarcoidosis and can present with cranial neuropathy such as 7th nerve palsy, anticonvulsant refractory seizures, visual changes, and headaches. Pituitary involvement occurs 0.5% of patients with sarcoidosis and can present with endocrine and water metabolism dysfunction while sinonasal sarcoidosis can occur in up to 4%. Sinonasal sarcoidosis most usually presents as chronic crusting rhinitis, nasal obstruction, anosmia, and epistaxis and can show clinically as mucosal hypertrophy and external nose deformity in ~10% of these patients. Discussion and Conclusion: Symptomatic pituitary mass as the initial presentation of sarcoidosis is extremely rare. This case of primary neurosarcoidosis is unusual with its initial presentation mimicking non-functional pituitary macroadenoma with optic chiasm compression and associated vision loss. Primary presentation of neurosarcoidosis as a pituitary mass is rare but should be included in the differential diagnosis of a patient presenting with a combination of a macroadenoma, chronic sinusitis, and lymphadenopathy.

14.
Biochemical and Cellular Archives ; 21(2):1-2, 2021.
Article in English | EMBASE | ID: covidwho-1812557
15.
Journal of the American College of Cardiology ; 79(15):S334-S335, 2022.
Article in English | EMBASE | ID: covidwho-1796602

ABSTRACT

Clinical Information Patient Initials or Identifier Number: SP Relevant Clinical History and Physical Exam: A 30-year-old female was referred to our centre with chief complaint of orthopnea. The patient had received medical attention elsewhere and was treated empirically for asthma, COVID pneumonia and antitubercular treatment. On examination the patient had a bounding pulse on right upper limb and an impalpable pulse on left upper limb, weak pulses in bilateral carotid and lower limbs. Further examination revealed a right upper limb blood pressure of 230/120 mm of Hg. [Formula presented] [Formula presented] Relevant Test Results Prior to Catheterization: The chest roentgenogram of the patient revealed bat-wing pulmonary edema with cardiomegaly. ECG revealed left ventricular hypertrophy with strain pattern and echocardiography revealed left ventricular dysfunction with ejection fraction of 35%. CT aortogram revealed wall thickening with fusiform dilatation of distal thoracic, proximal abdominal aorta, and stenosis of left subclavian, celiac artery at ostium and bilateral renal arteries at ostium. The patient also had a raised ESR (40 mm/hr). Interventional Management Procedural Step: The procedure was done under local anesthetic from a right femoral artery access with 7 French sheath. A coronary angiogram was done first which revealed normal epicardial coronaries. Pull back gradient was then taken across thoracic and abdominal aorta which revealed a gradient of 20 mmHg. Next, renal angiogram was taken in individual renal arteries which revealed significant ostial stenosis of bilateral renal arteries. The lesions were serially dilated with 1.5 mm, 2.5 mm and 4 mm diameter coronary balloons. After dilatation Invatec Hippocampus 5x15 mm stent was placed in right renal artery and a 6x14 mm Boston scientific vascular SD stent placed in left renal artery. Post stenting angiography showed a good flow with relief of stenosis. [Formula presented] [Formula presented] [Formula presented] Conclusions: Although, there is controversy regarding role of angioplasty in treatment of hypertension in atheromatous renal artery stenosis, no consensus exists in Takayasu arteritis with renal artery stenosis due to a lack of randomised controlled trials. Our case represents an interesting case where the patient had a dramatic relief of hypertension and heart failure after bilateral renal angioplasty in Takayasu arteritis.

16.
European Heart Journal Cardiovascular Imaging ; 23(SUPPL 1):i473, 2022.
Article in English | EMBASE | ID: covidwho-1795308

ABSTRACT

Objective. Cases of pulmonary embolism are observed in the course of COVID-19. Right ventricular enlargement is a negative prognostic factor of pulmonary embolism. The cardiothoracic ratio is a routine parameter in the cardiac assessment in chest radiology. Purpose. The aim of the study was to determine the usefulness of the radiological cardiothoracic ratio (CTR) as a predictor of right ventricular enlargement in patients with suspected pulmonary embolism during COVID-19. Material and method. The study group consisted of 61 patients with confirmed COVID-19, suspected of pulmonary embolism based on physical examination and laboratory tests (age: 67.18 ± 12.47 years). Computed tomography angiography (CTA) of pulmonary arteries and chest radiograph in AP projection with cardiothoracic ratio assessment were performed in all patients. Right ventricular enlargement was diagnosed by the ratio of right ventricular to left ventricular (RV/LV) dimensions in pulmonary CTA with 2 cut-off points: ≥0.9 and ≥1.0. Heart's silhouette enlargement was found when CTR on the chest radiograph in the projection AP >0.55. Results. The mean values of RV/LV and CTR in the studied group were 0.96 ± 0.23 and 0.57 ± 0.05. Pulmonary embolism was diagnosed in 45.9%. Right ventricular enlargement was documented in 44.3% or 29.5% depending on the adopted criterion RV/LV ≥0.9 or RV/LV ≥1.0. Heart's silhouette enlargement was found in 60.6%. Patients with confirmed pulmonary embolism (PE+) had significantly higher RV/LV ratio and CTR than patients with excluded pulmonary embolism (PE-) (RV/LV: PE+ 1.08 ± 0.24, PE- 0.82 ± 0.12;CTR: PE+ 0.60 ± 0.05, PE- 0.54 ± 0.04;p < 0.05). The correlation analysis showed a statistically significant positive correlation between RV/LV ratio and CTR (r = 0.59, p < 0.05). Based on the ROC curves, CTR values were determined as the optimal cut-off points for the prediction of right ventricular enlargement (RV/LV ≥0.9 or RV/LV ≥1.0), being 0.54 and 0.55, respectively. The sensitivity, specificity, and accuracy of the CTR criterion >0.54 as a predictor of RV/LV ratio ≥0.9 was 0.412, 0.963, and 0.656, respectively, while the CTR criterion >0.55 as a predictor of RV/LV ratio ≥1.0 was 0.488, 0.833, and 0.590, respectively. Conclusions. In patients with suspected pulmonary embolism during COVID-19, radiographic cardiothoracic ratio may be a predictor of right ventricular enlargement, especially a negative predictor of right ventricular enlargement in case of lower CTR values.

17.
Erciyes Medical Journal ; : 9, 2022.
Article in English | Web of Science | ID: covidwho-1771853

ABSTRACT

Objective: The coronavirus disease 2019 (COVID-19) has placed huge strains on medical systems. Therefore, it is essential to determine the predictors of the long hospital stay. We sought to investigate whether alterations in left ventricular (LV) geometry in COVID-19 patients are associated with the length of stay (LoS) and a long hospital stay. Materials and Methods: 108 consecutive hospitalized COVID-19 patients were incorporated in the study and 89 patients remained for statistical analysis. All participants underwent standard two-dimensional (2D) and Doppler echocardiographic examinations. Patients were classified according to LV geometry characteristics namely normal geometry (NG), concentric remodeling, concentric hypertrophy and eccentric hypertrophy. Results: Multiple binary logistic regression model adjusted for clinical and laboratory variables yielded significant and independent association of LV mass index (LVMI) (OR: 1.12, 95% CI: 1.06-1.19, p<0.001), 10 g/m(2) increase in LVMI (OR: 3.63, 95% CI: 2.00-6.59, p<0.001), LV geometry patterns (OR: 2.92, 95% CI: 1.46-5.34, p=0.002), and altered geometric patterns compared to NG (OR: 3.97, 95% CI: 1.08-14.5, p=0.037) with long hospital stay. Correlation analysis of LVMI and LoS demonstrated significant and moderate correlation (rho=0.58, p<0.001). Conclusion: LVMI and LV geometric patterns independently predict long hospital stays in COVID-19 patients. The significant correlation between LoS and LVMI underlies the significance of LV geometry in this infection.

18.
Journal of the American College of Cardiology ; 79(9):407, 2022.
Article in English | EMBASE | ID: covidwho-1768620

ABSTRACT

Background: Transthyretin cardiac amyloidosis (ATTR-CM) is important comorbidity associated with severe aortic stenosis (AS). Multiple studies have shown that ATTR-CM was present in 10-15% of all cases with severe AS. The purpose of this quality improvement project is to raise awareness of ATTR-CM in patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS amongst the healthcare providers and patients. Methods: We retrospectively reviewed all TAVR cases performed at our institution in 2019 (Total cases 87). We screened for the presence of predefined high-risk features for ATTR-CM based on prior literature (Presence of diastolic dysfunction, left ventricular hypertrophy on echocardiogram, low voltage-mass ratio, low limb lead voltage on EKG, arrhythmia/bundle branch block, or systemic symptoms of amyloidosis). We subsequently contacted the patients to discuss our clinical suspicion of ATTR-CM and offered clinical referral to a cardiac amyloid specialist. Results: Of the total of 87 patients who underwent TAVR in 2019, 12 patients were deceased at chart review. We have identified 50 patients (66.7%) who had high-risk features of ATTR-CM. A total of 17 patients (34% of 50 patients) agreed to be referred to cardiac amyloid specialist. Six patients (12%) were tested with 99m Technetium Pyrophosphate imaging, and all were negative for ATTR-CM. Eleven patients (22%) are still pending testing. Six patients did not wish for referral due to personal reasons. We were not able to reach 15 patients via phone (30%). In addition, we have found additional 12 patients who were deceased (Total mortality count of 24, 27.5%) in two years. Conclusion: Our project has increased awareness within structural cardiologists as we have implemented a prospective screening process within our institution. While we expected to diagnose ATTR-CM in 10% of severe AS who underwent TAVR, we had multiple difficulties contacting them, coordinating referrals due to the COVID-19 pandemic and higher 2-year mortality. We are hypothesizing whether the higher 2-year mortality is secondary to undetected ATTR-CM. We are planning for screening and timely referral for patients who underwent TAVR more recently.

19.
Journal of the American College of Cardiology ; 79(9):2229, 2022.
Article in English | EMBASE | ID: covidwho-1768639

ABSTRACT

Background: A 35-year-old G1P1 woman with a history of bioprosthetic mitral valve (MVR) and aortic valve (AVR) replacements and a tricuspid valve annuloplasty for presumed rheumatic heart disease who presented at 35 weeks gestational age with COVID-19 ARDS and shock. Case: The patient arrived with ARDS requiring intubation and distributive shock. Transthoracic echocardiogram (TTE) revealed a small left ventricular (LV) cavity with LV hypertrophy, MVR with mean gradient of 14 mmHg, and a mid-peaking transaortic gradient of 96 mmHg consistent with fixed obstruction. This gradient was likely due to LV outflow tract obstruction (LVOTO) from the combination of a small LV cavity and septal angulation of the MVR struts rather than AVR dysfunction. The patient underwent emergent cesarean section. Decision-making: The maternal and fetal risks of ARDS and distributive shock were primary considerations in undergoing cesarean section. Decisions regarding management thereafter were driven by three elements of her clinical presentation - anticipated peripartum hemodynamic shifts, multivalvular disease, and ARDS. The increased plasma volume from postpartum autotransfusion risked worsening her ARDS but also potentially benefited the LVOTO through increased preload. The effect of lower postpartum cardiac output and heart rate on valvular obstruction in series also had to be considered. To balance these hemodynamic demands, after delivery, her vasopressors were switched from norepinephrine to phenylephrine, and she was judiciously diuresed. A postpartum TTE demonstrated improved transmitral gradients (mean 5 mmHg) but ongoing LVOTO. Higher filling pressures than otherwise ideal in ARDS were tolerated given persistent gradients. She was liberated from hemodynamic and ventilator support and transferred out of ICU care. Though she died of infectious complications weeks later, close collaboration between the critical care, obstetrical, and cardiovascular teams were essential to her care. Conclusion: Care of the peripartum patient with cardiovascular disease, especially valvular disease, must take into consideration both their cardiac pathology and expected peripartum hemodynamic shifts.

20.
European Heart Journal, Supplement ; 23(SUPPL F), 2021.
Article in English | EMBASE | ID: covidwho-1766449

ABSTRACT

The proceedings contain 200 papers. The topics discussed include: an ultra-rare case of Hutchinson-Gilford progeria syndrome with severe aortic regurgitation due to bicuspid aortic valve in a 9-year-old girl;pulse dose corticosteroid improves clinical outcome in pulmonary hypertension patient: a potential of immense affordability and availability medication in suburban area;infected femoral artery pseudoaneurysm with klebsiella pneumoniae bacteremia in injected drug abuser: a case report;cardiac complications in immunocompromised patient : a case report;cardiac arrest in COVID-19 patient presenting with takotsubo cardiomyopathy;cardiac amyloidosis: a great pretender of left ventricular hypertrophy with systemic manifestation;and managing acute decompensated heart failure with exacerbation of chronic obstructive pulmonary disease in rural area: a case report.

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