Left Coronary Artery to Pulmonary Trunk Fistula: Two Case Reports With Literature Review.

Coronary artery fistulas (CAFs) are abnormal communication between coronary arteries and the pulmonary trunk or with adjacent heart structures. Coronary pulmonary artery fistulas (CPAFs) can be congenital or acquired. Mostly, CAFs are found as incidental findings on angiographic evaluation. The management of CPAFs varies from case to case depending on size, anatomical location, patient's clinical presentation, and presence of coronary steal phenomenon. We present two cases of CPAFs; one of them had coronary steal phenomena at a young age with no past medical history of coronary artery disease, and the patient underwent transcatheter coil embolization to close the fistula. In other cases, a fistulous connection between the left anterior descending (LAD) and the pulmonary trunk was found incidentally on computed tomography (CT) of the heart and based on a small-sized fistula and symptomatic improvement, the patient was discharged with conservative management. CPAFs are rare cardiac anomalies but can give rise to severe hemodynamic complications, so this should be a part of the initial differential diagnosis if the patient does not have significant coronary artery disease. Percutaneous closure or surgical correction is indicated if the patients are symptomatic or have secondary complications.

Myopericarditis Following the Third Dose of COVID-19 mRNA Vaccination: A Case Report.

Coronavirus disease 2019 (COVID-19) mRNA vaccine-related cases of pericarditis and myocarditis have been reported infrequently. Most of the patients usually present within a week of the vaccine, and on average, most of the cases were reported after the second dose of vaccine within two to four days. Chest pain was the most common presentation, and fever and shortness of breath were the other commonly reported symptoms. The patients can have positive cardiac markers and electrocardiogram (EKG) changes, and the cases can be mistaken for cardiac emergencies. We present a 17-year-old male patient with sudden onset substernal chest pain for two days who got the third dose of the Pfizer-BioNTech mRNA vaccine within 24 hours prior. EKG was remarkable for diffuse ST elevations, and troponins were elevated. Later, the cardiac magnetic resonance imaging confirmed the findings of myopericarditis. The patient was treated with colchicine and non-steroidal anti-inflammatory drugs (NSAIDs), completely recovered, and is doing fine to date. This case hights that post-vaccine myocarditis can be mistaken and early diagnosis and management can prevent unnecessary interventions.

Household COVID-19 secondary attack rate and associated determinants in Pakistan; A retrospective cohort study.

BACKGROUND: COVID-19 household transmissibility remains unclear in Pakistan. To understand the dynamics of Severe Acute Respiratory Syndrome Coronavirus disease epidemiology, this study estimated Secondary Attack Rate (SAR) among household and close contacts of index cases in Pakistan using a statistical transmission model. METHODOLOGY: A retrospective cohort study was conducted using an inclusive contact tracing dataset from the provinces of Punjab and Khyber-Pakhtunkhwa to estimate SAR. We considered the probability of an infected person transmitting the infection to close contacts regardless of residential addresses. This means that close contacts were identified irrespective of their relationship with the index case. We assessed demographic determinants of COVID-19 infectivity and transmissibility. For this purpose based on evolving evidence, and as CDC recommends fully vaccinated people get tested 5-7 days after close contact with a person with suspected or confirmed COVID-19. Therefore we followed the same procedure in the close contacts for secondary infection. FINDINGS: During the study period from 15th May 2020 to 15th Jan 2021, a total of 339 (33.9%) index cases were studied from 1000 cases initially notified. Among close contact groups (n = 739), households were identified with an assumed mean incubation period of 8.2+4.3 days and a maximum incubation period of 15 days. SAR estimated here is among the household contacts. 117 secondary cases from 739 household contacts, with SAR 11.1% (95% CI 9.0-13.6). All together (240) SAR achieved was 32.48% (95% CI; 29.12-37.87) for symptomatic and confirmed cases. The potential risk factors for SAR identified here included; old age group (>45 years of age), male (gender), household members >5, and residency in urban areas and for index cases high age group. Overall local reproductive number (R) based on the observed household contact frequencies for index/primary cases was 0.9 (95% CI 0.47-1.21) in Khyber Pakhtunkhwa and 1.3 (95% CI 0.73-1.56) in Punjab. CONCLUSIONS: SAR estimated here was high especially in the second phase of the COVID-19 pandemic in Pakistan. The results highlight the need to adopt rigorous preventive measures to cut the chain of viral transmission and prevent another wave of COVID-19.

Prevalence and Associated Factors of Depression among Patients with HIV/AIDS in Lahore, Pakistan: Cross-Sectional Study.

BACKGROUND: Depression is defined as a psychiatric disorder characterized by depressed mood, lack of concentration, diminished energy, disturbed sleep, and low self-esteem. Depression is more prevalent in HIV/AIDS patients than the general population. There is no published study available that reveals the present status of depression among HIV patients in Pakistan. As such, the present study was conducted to determine the prevalence and associated factors of depression among HIV/AIDS patients attending the HIV clinic of Jinnah Hospital, Lahore, Pakistan. METHODS: A hospital-based cross-sectional study was carried out from February to March 2019 in Lahore. Data were collected from 158 HIV/AIDS patients using a pretested, standardized, structured interviewer-administered questionnaire. Nonprobability convenience sampling was used to recruit the study participants. Depression was evaluated using the Patient Health Questionnaire. SPSS version 23 was used to analyze the data. Binary logistic regression models were used to determine the various factors associated with depression. AORs with 95% CIs were used to assess the magnitude of associations between depression and associated factors. RESULTS: The mean age of the study participants was 35.03 years±9.123. Prevalence of depression among HIV/AIDS patients was 32.2%. Living in a rural area (AOR 5.60, 95% CI 2.20, 14.15), fear of stigma and discrimination (AOR 3.505, 95% CI 1.364, 9.008), having worked abroad (AOR 3.017, 95% CI 1.134, 8.031), and history of substance abuse (AOR 4.147, 95% CI 1.673, 10.28) were significantly associated with depression. CONCLUSION: The prevalence of depression among HIV/AIDS patients is very high in Pakistan. Therefore, it is suggested that guidelines formulated to screen and treat depression among HIV patients.

Molecular epidemiology and genotype distribution of hepatitis C in Pakistan; a multicenter cross-sectional study.

Pakistan has second highest burden of hepatitis C virus (HCV) infected patients in the World. Little is known about the molecular epidemiology and risk factors for prevailing HCV genotypes in Pakistan. Considering this a multicenter cross-sectional study was conducted at 23different viral hepatitis control and prevention centers. A total of 175,897 patients were registered and screened for HCV, out of which 73,180 (41.6%) were found positive on Architect screening test. The screened positive patients were sequentially tested on RT-PCR; where 41,241 (56.35%) were detected positive. Molecular characterization results showed genotype 3 (73.9%) as the most prevalent type, followed by genotype 1 (9.7%), and genotype 4 (0.3%) was isolated for the first time in Pakistan. On regression analysis; risk factors associated with genotype 3 and 1 included; age group of 30-50 years, rural residence, exposure to >10 injections, barber shaving, circumcision by barbers, and low literacy rate. Phylogenetic analysis based on genotypes identified in this study and sequences isolated from Pakistan in last 10 years demonstrated that genotype 3 and 1 are endemic locally in Punjab province. The high prevalence rate of HCV is a threat for a generalized epidemic and genetic recombination with such variability of genotypes identified here is an alarming condition. More focused attention and resources should be spent in awareness of the population to prevent the spread of HCV among high risk population.