Catastrophic Concomitant Arterial and Venous Thrombosis in a Mild COVID-19-Positive Patient.

Since its first discovery in late 2019, coronavirus disease 2019 (COVID-19) has been a global burden associated with significant morbidity and mortality. COVID-19 has been correlated with the development of hypercoagulable state that predisposes the patients to a higher risk of thromboembolism. Current evidence suggests higher incidence of thrombosis, particularly venous thrombosis, among hospitalized COVID-19 patients, mostly with critical illness. On the other hand, there is currently no data regarding the incidence of vivid thrombosis in ambulatory patients with mild COVID-19 and the incidence of concomitant arterial and venous thrombosis in COVID-19 is extremely rare. Herein, we describe catastrophic outcomes of concomitant lower limb arterial and venous thrombosis in a patient with mild COVID-19. This report highlights the occurrence of concomitant arterial and venous thrombosis in ambulatory setting and that this phenomenon resulted in catastrophic clinical consequences.

The prognostic value of neutrophil-to-lymphocyte ratio across all stages of coronary artery disease.

The natural history of coronary heart disease (CAD) commonly begins with atherosclerosis, progressing to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and eventually, heart failure. Despite advancements in preventive and therapeutic strategies, there is room for further cardiovascular risk reduction. Recently, inflammation has emerged as a potential therapeutic target. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker which predicts poor prognosis in several conditions such as metabolic syndrome, sepsis, malignancy and CAD. In atherosclerosis, a high NLR predicts plaque vulnerability and severe stenosis. This is consistent with observations in CCS, where an elevated NLR predicts long-term major adverse cardiac events (MACEs). In ACS patients, high NLR levels are associated with larger infarct sizes and poor long-term outcomes. Possible reasons for this include failure of fibrinolysis, ischemia-reperfusion injury and in-stent restenosis, all of which are associated with raised NLR levels. Following myocardial infarction, an elevated NLR correlates with pathological cardiac remodeling which propagates chronic heart failure. Finally, in heart failure patients, an elevated NLR predicts long-term MACEs, mortality, and poor left ventricular assist device and transplant outcomes. Further studies must evaluate whether the addition of NLR to current risk-stratification models can better identify high-risk CAD patients.

The effect of external counterpulsation on intrinsic myocardial function evaluated by speckle tracking echocardiography in refractory angina patients: a randomized controlled trial.

External Counterpulsation (ECP) is one of the therapeutic options in patients with refractory angina inadequately controlled by medical, interventional, or surgical therapy. The 2D Speckle Tracking Echocardiography (2D-STE) method is considered superior in assessing clinical improvement. We would like to evaluate any improvement of myocardial intrinsic function using 2D-STE in patients underwent standard ECP protocol (35 sessions). We conducted a double-blind randomized controlled trial. Patients with refractory angina who could not be revascularized conventionally were randomized into two groups: (1) the ECP group (300 mmHg) and (2) the Sham/control group (75 mmHg). ECP standard therapy was given for 35 sessions (1 h/day/session). The 2D-STE data, including longitudinal strain and post systolic index (PSI) were obtained before and after therapy. 43 subjects were analyzed, with 22 subjects in ECP group and 21 control subjects (Sham group). A homogenous baseline strain was found either globally (12.42 ± 4.55 vs 12.00 ± 4.92 [- %]; P = 0.774) or segmentally/regionally (12.63 (0.01-25.16) vs 12.43 (0.01-27.20) [- %]; P = 0.570). There was no statistically significant improvement between groups in the left ventricle longitudinal strain globally (P = 0.535) and segmentally/regionally (P = 0.434). PSI parameters showed improvement in the ECP group (P = 0.049), and segments with PSI ≥ 20% seemed to improve longitudinal strains in the ECP group after therapy (P = 0.042). In conclusion, 35 ECP therapy sessions did not improve either global or segmental/regional left ventricular mechanical function in patients with refractory angina. However, the mechanical function of myocardial segments with PSS tends to improve after ECP therapy.

[Weismann-Netter and Stuhl toxopachyosteosis. Apropos of 30 cases]. / La toxopachyostéose de Weismann-Netter et Stuhl. A propos de 30 observations.

Toxopachyosteosis, a rare bone disease, was described in 1954 by Weissmann-Netter and Stuhl. This congenital osteopathy, which may be familial, is defined by an anteroposterior curvature (toxon = arc) and thickening (pachus = thick) of the shafts of both leg bones. Other bones may be affected. Short stature and delayed walking are other important special features of the disease. It is most often diagnosed late and by chance because of the minimal functional consequences of the deformities. Sequelae of vitamin D-deficient rickets are the main differential diagnosis. The aim of this study undertaken by the Bone and Calcium/Phosphorus Metabolism Section of the Société Française de Rhumatologie (French Society of Rheumatology) was an overall assessment of the disease. The authors report 30 cases of toxopachyosteosis and evaluate their main characteristics on the basis of data from the literature.

[A case of Weismann-Netter and Stuhl toxopachyosteosis with new bone sites]. / Une observation de toxopachyostéose de Weismann-Netter et Stuhl avec localisations osseuses nouvelles.

A case of Weismann-Netter-Stuhl toxopachyosteosis in a 63-year-old man is reported. Bone deformities had been present since the age of 18 months. Tibio-fibular dysmorphism was severe. Radiological evaluation revealed other lesions encountered more rarely: bilateral femoral incurvature and exostoses, bilateral coxa vara, radio-ulnar incurvature and flattening of the last ribs. Two other previously undescribed lesions were seen in this patient; bradymetacarpism of the last four rays of the left hand and dysmorphic lengthening of the left patella. This case illustrates the widespread nature and unusual extent of bone lesions in the context of toxopachyosteosis.

[Study of bone repercussion in 33 cases with anorexia nervosa which 8 with fracture osteoporosis]. / Etude du retentissement osseux dans 33 cas d'anorexie mentale dont 8 avec une osteoporose fracturaire.

A national survey has regrouped 33 cases of anorexia nervosa (AN) with osseous investigations, in particular an absorptiometry of the lumbar spine. 2 groups have been defined: 25 patients without fracture (F-) and 8 patients with osteoporotic fractures (F+), including 5 cases with 12 vertebral fractures and 5 with non vertebral fractures: 31/33 have a low lumbar bone mineral content (BMC). The lumbar BMC of the F+ is significantly lower than the F-: -4.1 +/- 1.6 DS versus -2.2 +/- 1.2 DS (p less than 0.001). 5 F+ patients are under the fracture threshold (FT), (O F-), 2 F+ are on the same level as the FT, and the last F+ has a lumbar BMC 15% above the FT, but an osteoporotic wrist fracture and a very low femoral neck BMC (0.64 g/m2, normal 1.06 +/- 0.15). F+ are older (35.2 year old versus 23.6, p less than 0.001), owing the fact that the duration of the AN (+ 9.2 years, p less than 0.005) and of the amenorrhea (+ 9.8 years, p less than 0.001) are longer, although the AN began at the same age in the 2 groups. The minimum weight, the body mass index, the percentage of loss of weight are similar in the 2 groups. Phosphocalcic biological studies, which show rather high osteocalcinemia and hydroxyprolinuria (hyperremodeling), with rather high serum 1-25 OH vitamin D, do not differ between the 2 groups. Endocrinologic evaluations, with a constant hypooestradiolemia of hypothalamic origin, low somatomedinemia and normal cortisolemia, are not different between the 2 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Osteoporosis, arachnoid cyst and conus medullaris compression]. / Ostéoporose, kyste arachnoïdien et compression du cône terminal.

The authors report the case of a 75-year-old woman with an osteoporotic vertebral crush fracture of L1, without detectable vertebral necrosis, with signs of conus medullaris compression. The outcome at 2 years was satisfactory with complete recovery of neurological impairment after laminectomy from T12 to L2 and evacuation of a compressive arachnoid cyst overlying L1. This rare case is remarkable because of the presence of an arachnoid cyst. The role of the latter in the pathogenesis and progression of the neurological lesions is discussed.

[Spondylodiscitis disclosing bacterial endocarditis. Apropos of a case. Review of the literature]. / Spondylodiscite révélatrice d'une endocardite bactérienne. A propos d'une observation. Revue de la littérature.

The authors report a case of infectious spondylodiscitis revealing a staphylococcal endocarditis in a patient with a Carpentier aortic heterograft. This case, along with 60 descriptions from the literature, has enabled them to specify the characteristics of occurrence of endocarditis during a spondylodiscitis. The clinical factors in favor of this association are: a pre-existing cardiopathy, an oral port of entry, occurrence of other rheumatoid manifestations, even more the presence of complications of endocarditis. The laboratory factors in favor of an association are: discovery of an inflammatory anemia, of circulating immune complexes, of a cryoglobulinemia, of a rheumatoid factor, of hematuria. But it is mostly the demonstration of streptococcus in blood cultures and other samples that should be an indication to search for an endocarditis, the course of which dominates the prognosis.