Gender Disparities after Transcatheter Aortic Valve Replacement with Newer Generation Transcatheter Heart Valves: A Systematic Review and Meta-Analysis.

Previous studies have demonstrated gender disparities in mortality and vascular complications after transcatheter aortic valve replacement (TAVR) with early generation transcatheter heart valves (THVs). It is unclear, however, whether gender-related differences persist with the newer generation THVs. We aim to assess gender disparities after TAVR with newer generation THVs. The MEDLINE and Embase databases were thoroughly searched from inception to April 2023 to identify studies that reported gender-specific outcomes after TAVR with newer generation THVs (Sapien 3, Corevalve Evolut R, and Evolut Pro). The outcomes of interest included 30-day mortality, 1-year mortality, and vascular complications. In total, 5 studies (4 databases) with a total of 47,933 patients (21,073 females and 26,860 males) were included. Ninety-six percent received TAVR via the transfemoral approach. The females had higher 30-day mortality rates (odds ratio (OR) = 1.53, 95% confidence interval (CI) 1.31-1.79, p-value (p) < 0.001) and vascular complications (OR = 1.43, 95% CI 1.23-1.65, p < 0.001). However, one-year mortality was similar between the two groups (OR = 0.78, 95% CI 0.61-1.00, p = 0.28). The female gender continues to be associated with higher 30-day mortality rates and vascular complications after TAVR with newer generation transcatheter heart valves, while there was no difference in 1-year mortality between the genders. More data is needed to explore the causes and whether we can improve TAVR outcomes in females.

Electric Cardioversion vs. Pharmacological with or without Electric Cardioversion for Stable New-Onset Atrial Fibrillation: A Systematic Review and Meta-Analysis.

BACKGROUND: There is no clear consensus on the preference for pharmacological cardioversion (PC) in comparison to electric cardioversion (EC) for hemodynamically stable new-onset atrial fibrillation (NOAF) patients presenting to the emergency department (ED). METHODS: A systematic review and meta-analysis was conducted to assess PC (whether being followed by EC or not) vs. EC in achieving cardioversion for hemodynamically stable NOAF patients. PubMed, PubMed Central, Embase, Scopus, and Cochrane databases were searched to include relevant studies until 7 March 2022. The primary outcome was the successful restoration of sinus rhythm, and secondary outcomes included emergency department (ED) revisits with atrial fibrillation (AF), hospital readmission rate, length of hospital stay, and cardioversion-associated adverse events. RESULTS: A total of three randomized controlled trials (RCTs) and one observational study were included. There was no difference in the rates of successful restoration to sinus rhythm (88.66% vs. 85.25%; OR 1.14, 95% CI 0.35-3.71; n = 868). There was no statistical difference across the two groups for ED revisits with AF, readmission rates, length of hospital stay, and cardioversion-associated adverse effects, with the exception of hypotension, whose incidence was lower in the EC group (OR 0.11, 95% CI 0.04-0.27: n = 727). CONCLUSION: This meta-analysis suggests that there is no difference in successful restoration of sinus rhythm with either modality among patients with hemodynamically stable NOAF.

Steven-Johnson Syndrome: A Rare but Serious Adverse Event of Nivolumab Use in a Patient With Metastatic Gastric Adenocarcinoma.

Nivolumab is a humanized monoclonal anti-programmed cell death receptor-1 (PD-1) antibody that has been authorized for use in the treatment of advanced malignancies. Cutaneous reactions are the most common immune-related adverse events reported with anti-PD-1 agents, and they range broadly from mild localized reactions to rarely severe or life-threatening systemic dermatoses. The occurrence of Steven-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) with nivolumab use is an exceedingly rare phenomenon that was only documented in a handful of cases in the current literature, but it deserves careful attention as SJS/TEN may be associated with fatal outcomes. We present a case of nivolumab-induced SJS/TEN in a middle-aged female patient with metastatic gastric adenocarcinoma that was successfully treated with immunosuppressive therapy and supportive care. Prompt recognition of SJS/TEN with discontinuation of nivolumab is warranted when SJS/TEN is suspected clinically. Multidisciplinary management in a specialized burn unit is the key to improving outcomes of SJS/TEN.

Pericardial Metastasis From Recurrent Squamous Cell Carcinoma of Hypopharynx in a Living Patient.

Cardiac metastatic disease is a rare finding and is usually diagnosed incidentally postmortem; it has been commonly reported in patients with cancers of lung, esophagus, breast, and melanoma. We present a case of a 62-year-old male with a history of squamous cell carcinoma of the pyriform sinus who presented with shortness of breath for one day. He underwent tumor resection followed by chemotherapy and radiotherapy seven months before this presentation. Computed tomography (CT) of the chest revealed pericardial nodular soft tissue that was consistent with the diagnosis of metastatic carcinomatosis. Further imaging with a transthoracic echocardiogram (TTE) showed a likely metastatic pericardial mass. The patient had presented with shortness of breath three months prior to this admission and TTE had demonstrated pericardial effusion. However, pericardial fluid cytology was negative for malignancy, and the repeat TTE had revealed resolution of the pericardial effusion. On the current admission, CT of the neck demonstrated local recurrence of the tumor in the resection bed with scattered regional lymph nodes enlargement. Thus, we report a case of a recurrent laryngopharyngeal tumor with very rarely reported pericardial metastasis.

Community-Acquired Meningitis Complicated by Pyogenic Ventriculitis: A Case Report.

Ventriculitis is the inflammation of the ependymal lining of the ventricles in the brain which usually occurs as a complication of meningitis, intraventricular devices, intracranial surgery, or brain abscess. Common clinical features include fever, altered mental status, headache, and neck rigidity. Some commonly associated organisms are Streptococcus, gram-negative Bacillus, Staphylococcus, and Meningococcus. Here, we report the case of a 57-year-old female presenting with fever, headache, and altered mental status, along with positive physical examination findings of Kernig's and Brudzinski's signs without any focal neurological deficits. Cerebrospinal fluid analysis findings were consistent with bacterial infection with neutrophilic leukocytosis, high protein, and low glucose. The blood culture was positive for Streptococcus pneumoniae. Magnetic resonance imaging was negative for enhancement of the meninges but showed fluid-filled layering in the ventricles consistent with pyogenic ventriculitis. The patient improved clinically within three days of initiation of empiric antibiotics.

A Case of Campylobacter Fetus Subspecies Fetus Systemic Infection.

Campylobacter are gram-negative bacilli commonly known to cause gastro-intestinal infection; however, species like Campylobacter fetus subspecies fetus (C. fetus) have been documented to cause severe systemic illness, especially in immunocompromised hosts. It has been linked with severe sepsis, septic arthritis, endocarditis, and subdural abscess. We report a case of a 65-year-old male with a history of human immunodeficiency virus infection (HIV) and chronic hepatitis B presenting with high fevers, pain, and swelling in multiple joints. His blood cultures grew C. fetus. Synovial fluid analysis from the knee joint revealed leukocytes of 17,000 with 93% neutrophils, and gram stains and cultures from synovial fluid were negative. The patient improved with piperacillin-tazobactam and vancomycin which were transitioned to amoxicillin-clavulanic acid and azithromycin as the patient returned to baseline functional status.

Cardiac Arrest With Spontaneous Coronary Artery Dissection in a Young Female.

Spontaneous coronary artery dissection (SCAD) is a rare condition that has variable clinical presentations requiring a very high index of suspicion for diagnosis. We present here a case of a young female with SCAD who initially presented with chest pain and syncope, with progression to cardiac arrest.

The first reported case of Creutzfeldt-Jakob disease from Nepal.

Creutzfeldt-Jakob disease (CJD) can also be diagnosed in a resource-limited setting through good clinical analysis. The diagnosis of CJD should be considered in patients with rapidly evolving neurological signs associated with cognitive disturbances even in countries with limited available sophisticated tools and where CJD was never reported before.

Extra Hepatic Portal Vein Obstruction with Solitary Left Kidney: A Case Report.

Extra Hepatic Portal Vein Obstruction in individual with solitary left kidney is rare occurence. Though there is no etiological association between Extra Hepatic Portal Vein Obstruction and solitary left kidney but the solitary left kidney decides the modality of treatment. Eighteen year lady referred to our institute with menorrhagia for 5 years and ultrasonography finding of splenomegaly and atretic right kidney. Investigations revealed Extra Hepatic Portal Vein Obstruction with multiple cavernoma formation with oesophagogastric varices with right renal agenesis. She successfully underwent splenectomy with devascularisation. Patient with Extra Hepatic Portal Vein Obstruction present mainly with recurrent episodes of variceal bleeding, splenomegaly and hypersplenism. Splenectomy and esophagogastric devascularisation is an effective modality of treatment for patient with Extra Hepatic Portal Vein Obstruction with solitary kidney. Keywords: cavernoma; modified Hassab's operation; Portal vein; unilateral renal agenesis.