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Widespread uptake of the coronavirus disease 2019 (COVID-19) vaccinations has become the world's championed defense against the global pandemic. Four vaccines have been either approved or authorized for emergency use by the FDA, and at this time, over 13 billion doses of these vaccines have been administered around the world. Unfortunately, uncommon and sometimes unforeseen side effects such as small-vessel vasculitis have been reported. In this case report, we present a 74-year-old woman with a history of hypertension, type 2 diabetes mellitus, and hypothyroidism who developed microscopic polyangiitis (MPA) following the second dose of the Pfizer-BioNTech mRNA vaccine for COVID-19. The diagnosis of MPA was confirmed by a kidney biopsy. The autoimmune condition progressed to pericardial effusion and eventual cardiac tamponade, which is occasionally seen in the disease. In this patient's case, we suspect there to be a temporal association between mRNA COVID-19 vaccination and the development of MPA. Direct causation has not been determined.
RESUMEN
INTRODUCTION: The purpose of this study was to determine whether alcohol use disorder (AUD) patients undergoing reverse shoulder arthroplasty (RSA) have increased: 1) lengths of stay (LOS); 2) complications; and 3) costs. METHODS: The study identified 19,168 patients in the study (n = 3198) and control (n = 15,970) cohort. In-hospital LOS, 90-day complications, and costs were assessed. RESULTS: AUD patients had significantly longer LOS (3- vs. 2-days, p < 0.0001), higher9 0-day medical complications (49.59 vs. 14.81%; p < 0.0001), and 90-day costs of care ($18,763.25 vs. $16,035.49, p < 0.0001). CONCLUSIONS: The study is useful as it can allow healthcare professionals to adequately counsel these patients.
RESUMEN
Influenza virus can disseminate from the lungs to the heart in severe infections and can induce cardiac pathology, but this has been difficult to study due to a lack of small animal models. In humans, polymorphisms in the gene encoding the antiviral restriction factor IFN-induced transmembrane protein 3 (IFITM3) are associated with susceptibility to severe influenza, but whether IFITM3 deficiencies contribute to cardiac dysfunction during infection is unclear. We show that IFITM3 deficiency in a new knockout (KO) mouse model increases weight loss and mortality following influenza virus infections. We investigated this enhanced pathogenesis with the A/PR/8/34 (H1N1) (PR8) influenza virus strain, which is lethal in KO mice even at low doses, and observed increased replication of virus in the lungs, spleens, and hearts of KO mice compared with wild-type (WT) mice. Infected IFITM3 KO mice developed aberrant cardiac electrical activity, including decreased heart rate and irregular, arrhythmic RR (interbeat) intervals, whereas WT mice exhibited a mild decrease in heart rate without irregular RR intervals. Cardiac electrical dysfunction in PR8-infected KO mice was accompanied by increased activation of fibrotic pathways and fibrotic lesions in the heart. Infection with a sublethal dose of a less virulent influenza virus strain (A/WSN/33 [H1N1]) resulted in a milder cardiac electrical dysfunction in KO mice that subsided as the mice recovered. Our findings reveal an essential role for IFITM3 in limiting influenza virus replication and pathogenesis in heart tissue and establish IFITM3 KO mice as a powerful model for studying mild and severe influenza virus-induced cardiac dysfunction.
Asunto(s)
Cardiopatías/genética , Subtipo H1N1 del Virus de la Influenza A/inmunología , Gripe Humana/genética , Proteínas de la Membrana/genética , Miocardio/patología , Animales , Modelos Animales de Enfermedad , Ecocardiografía , Electrocardiografía , Fibrosis , Predisposición Genética a la Enfermedad , Corazón/diagnóstico por imagen , Corazón/virología , Cardiopatías/diagnóstico , Cardiopatías/patología , Cardiopatías/virología , Humanos , Subtipo H1N1 del Virus de la Influenza A/patogenicidad , Gripe Humana/complicaciones , Gripe Humana/inmunología , Gripe Humana/virología , Proteínas de la Membrana/inmunología , Ratones , Ratones Noqueados , Índice de Severidad de la Enfermedad , Replicación Viral/genética , Replicación Viral/inmunologíaRESUMEN
Historically, most patients with the lumbar spinal stenosis have been older than 66 yr when initially diagnosed; however, with a growing awareness of this entity, it is increasingly being identified at an earlier age. A 5-yr retrospective review of hospital records was initiated to determine the frequency of lumbar spinal stenosis in a population of patients of <51 yr of age. Of 2751 patients admitted with this diagnosis, 268 (9.8%) were <51 yr of age.
