ABSTRACT
Background: Covid-19 infected patients without any risk factors and family history of a thrombotic event can be still at risks of developing thrombotic and/or other Covid-19-related complications, and therefore, there is a substantial need to study such cases. Case presentation: In this study, we present a 60-years-old Covid-19 patient with mild symptoms who was admitted to the hospital with simultaneous arterial and venous thrombotic event, with chief complaint of chest pain and vague abdominal pain. The patient was diagnosed with Covid-19 two weeks before admission to the ICU. A 12-lead electrocardiogram revealed pathologic Q-wave ST-segment elevation and T-wave inversion in II, III, aVF, and T inversion in V5 and V6. Quantitative troponin was elevated which confirmed inferior ST-elevation MI. Abdominal color Doppler sonography and CT scan with contrast demonstrated an absent flow in the portal vein and thrombosis. A chest CT scan illustrated a normal pattern. We started IV unfractionated heparin (UFH), dual antiplatelet, beta-blocker, statin, intravenous nitrate, and angiotensin-converting enzyme inhibitor. Coronary angiography showed the right coronary artery was totally cut off at the proximal part.Here we report three main un-common characteristics associated with our patient compared to other similar studies. First, the thrombotic event in our case occurred without pulmonary involvement and the patient only had a flu-like symptom two weeks before admission. The second main difference is that the patient's arterial and venous thrombotic events had simultaneously happened, which is not common in most cases. Patient presented simultaneous portal vein thrombosis and recent ST-segment elevation Myocardial Infarction (MI). Finally, both MI and portal vein thrombosis symptoms were subtle and confusing, which could cause misdiagnosis. A post two-weeks color Doppler sonography follow-up showed portal vein thrombosis recanalization and myocardial perfusion scan had no viability and reversible ischemia in RCA territory. Conclusions: This report addresses that a cautious diagnosis of Covid-19 at the time of admission can play a vital role in preventing cardiovascular events; where even asymptomatic to mildly infected patients could be still at higher risks of developing clinical complications (e.g., thrombotic events).
ABSTRACT
BACKGROUND: The treatment of onychomycosis is a challenge and infections are typically more severe and difficult to treat in toenails than in fingernails. OBJECTIVES: The current study aimed to investigate the fungicidal effect of ultraviolet radiation on the growth of dermatophytes isolated from nails. PATIENTS AND METHODS: Samples from patients with clinical manifestations of onychomycosis were inoculated onto Sabouraud dextrose agar and incubated at 30°C for 14 days. Isolated species were identified by specific laboratory examinations; UV-A, UV-B, and UV-C light were used to irradiate two strains of Trichophyton mentagrophytes and T. rubrum. Colony count, size and growth rate of the isolated fungi were evaluated under laboratory conditions. RESULTS: Trichophyton rubrum type 1 was less sensitive to UV-A and UV-C, and more sensitive to UV-B than type 2. T. mentagrophytes type 2 was slightly responsive to UV-A therapy, although no decrease in colony count was observed. Increased doses of UV-B and UV-C irradiation decreased the counts. The effect of radiation on colony size was dependent on the dose and type of irradiation. CONCLUSIONS: UV-A, UV-B, and UV-C light seem to be effective in decreasing colony growth of the most prevalent fungi, which caused onychomycosis in the current study samples. Further studies are needed to determine the efficacy of ultraviolet light therapy, identify possible side effects, and establish appropriate dosages for the antifungal effect of this therapy.
