A Grover-Like Skin Rash: A Potential Indicator of Underlying Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection.

Transient acantholytic dermatosis, also known as Grover's disease, is an acquired dermatological condition characterised by the sudden emergence of pruritic, erythematous papules, or vesicles, primarily affecting the trunk. It is observed most commonly in men older than 50 years. Histology typically demonstrates a pattern of focal acantholysis within the epidermis, dyskeratotic cells including corps ronds and grains, and a variable perivascular lymphocytic infiltrate in the upper dermis. While its aetiology is not well understood, recognised triggers include excessive heat, sweating, sun exposure, and certain drugs, such as chemotherapy agents. More recently, isolated reports of Grover's disease and Grover-like skin eruptions have been described in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and following COVID-19 vaccination. We report the case of a 65-year-old man who presented to secondary care with a nine-day history of an intensely pruritic rash over his chest and back. On internal medical workup, he was found to have SARS-CoV-2 infection and rapidly deteriorated due to coronavirus disease 2019 (COVID-19)-associated pneumonia, necessitating a 10-day hospital admission for supportive care. Diagnostic workup of his skin lesions confirmed transient acantholytic dermatosis (Grover's disease), which resolved following a course of oral corticosteroids. This case underscores the rare but significant association between Grover's disease and COVID-19, contributing valuable insights to the evolving body of literature on cutaneous lesions associated with SARS-CoV-2 infection, and highlighting the importance of considering SARS-CoV-2 screening as part of the diagnostic workup for patients presenting with Grover-like skin eruptions.

Impact of the COVID-19 pandemic on acute coronary syndrome hospital admission and management in Slovenia.

AIMS: We evaluated the effects of the COVID-19 pandemic on hospital admission and quality of care for acute coronary syndrome. METHODS AND RESULTS: Data for all patients admitted to hospital care for acute coronary syndromes in Slovenia (nationwide cohort) between 2014 and 2021 were obtained by merging the national hospital database, national medicines reimbursement database and population mortality registry using unique identifying numbers. Using interrupted time series analysis, we assessed the impact of the COVID-19 pandemic on hospital admission rates and quality of care (in-hospital and 30-day mortality, reperfusion and secondary preventive medication uptake). Data were fitted to segmented regression models with March 2020 as the breakpoint. Data on 21 001 patients were included (7057 ST-elevation myocardial infarction (STEMI), 7649 non-ST elevation myocardial infarction (NSTEMI) and 6295 unstable angina). Hospital admissions for STEMI remained stable (92 patients; +1 patient per month, p=0.783), whereas the pandemic was associated with a significant reduction in NSTEMI (81 patients; -21 patients per month, p=0.015) and unstable angina admissions (47 patients; -28 patients per month, p=0.025). In patients with STEMI, the pandemic did not affect reperfusion rates (0.29%, (95% CI) -1.5% to 2.1%, p=0.755) or in-hospital mortality (0.1%, (95% CI) -0.9% to 1.1%, p=0.815), but was associated with a significant negative trend for secondary preventive medication uptake (-0.12%, (95% CI) -0.23% to -0.01%, p=0.034). CONCLUSION: In Slovenia, hospital admissions for STEMI remained stable throughout the COVID-19 pandemic, but NSTEMI and unstable angina admissions dropped significantly. While mortality and reperfusion rates were not affected, the pandemic was associated with a continual negative time trend for the uptake of secondary preventive medication.

Using CorMatrix for partial and complete (re)construction of arteriovenous fistulas in haemodialysis patients: (Re)construction of arteriovenous fistulas with CorMatrix.

INTRODUCTION: CorMatrix is an acellular extracellular matrix that acts as a biological scaffold and remodels into site-specific tissue. We used it for the (re)construction of arteriovenous fistulas. METHODS: In this prospective pilot case study, we used CorMatrix in six patients. We included patients who required vascular access reconstruction due to thrombosis of unsalvageable arteriovenous fistulas, patients with high-flow arteriovenous fistulas and patients with microvasculature in which autologous arteriovenous fistulas did not mature, requiring reconstruction with a graft. We sutured the CorMatrix plate into a tubular shape and then constructed arterial and venous anastomoses. RESULTS: There were no periprocedural complications, CorMatrix-related infections, bleeding or limb swelling after the procedures. CorMatrix was first punctured after 8-10 weeks. In five patients, a percutaneous angioplasty due to CorMatrix stenosis was performed; in one patient, a stent was placed due to refractory stenosis. We observed eight thromboses during the observation period (four in one patient). Perianastomotic stenosis of CorMatrix and interdialytic hypotension were the causes of the thrombosis in five patients, cephalic arch stenosis in two patients and thromboembolism to the brachial artery and arteriovenous fistula in one patient. Thrombendarteriectomy was successful in 87.5% of patients, and one patient required arteriovenous fistula reconstruction. After a median observation period of 12.5 (range 4-23) months, all arteriovenous fistulas were patent, with a median brachial artery flow of 1450 (range 700-1700) mL/min. CONCLUSION: Arteriovenous fistula (re)construction with CorMatrix seems to be feasible and safe, with a relatively high incidence of neointimal hyperplasia, predominantly at venous anastomoses, but additional clinical studies are needed.

Hemodialysis treatment of cardiorenal syndrome.

AIMS: We evaluated the impact of hemodialysis on mortality and hospital readmission in patients with cardiorenal syndrome. METHODS: All patients were NYHA IV functional class and underwent laboratory testing, echocardiography, and cardiac functional testing. Hemodialysis was indicated in patients with progressive decline of kidney function and consequent failure to titrate heart failure medication as well as in patients with hypervolemia that was resistant to conservative treatment with more than 4 annual hospitalizations due to heart failure and/or concomitant chronic kidney disease stage III - IV. Patients were treated with low-efficacy bicarbonate hemodialysis with permanent central venous catheter used as vascular access. RESULTS: Since 2004, 67 patients were started on hemodialysis because of cardiorenal syndrome. Hospital readmission rate due to heart failure decreased (1 year before dialysis vs. 1 year after dialysis: 0.79 ± 1.32 vs. 0.22 ± 0.65 hospitalizations per year, p = 0.001) together with the duration of annual hospital stay (11.4 ± 21.4 vs. 3.7 ± 10.4 days, p = 0.011). 1-, 2-, 3-, 4- and 5-year survival for our patients was 81%, 61%, 52%, 47%, and 39%, respectively. CONCLUSIONS: Chronic renal replacement therapy with hemodialysis and strict uremic, electrolyte, and volume control may be more beneficial for patients with advanced heart failure with preserved or reduced LVEF than ultrafiltration alone. We have observed better survival of terminal cardiorenal patients treated with hemodialysis than in the general NYHA IV population, with lower hospital readmission rate and less hospitalized days for heart failure.
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Ultrasound-guided percutaneous endovascular treatment of arteriovenous fistula/graft.

BACKGROUND: Ultrasound-guided percutaneous endovascular treatment of arteriovenous fistula (AVF) or graft failure is an alternative to radiologically-guided angioplastic methods. Its main advantages are that it can be used with open or percutaneous access, using no contrast media and no radiation. The aim of this study was to analyze the results of ultrasound-guided endovascular treatment of arteriovenous access failure. MATERIAL AND METHODS: Preoperative ultrasound was used to determine the degree of stenosis and the size of balloon used in angioplasty. Angioplasty was performed as open procedure or by using a 4 - 6 French percutaneous sheath. Indications for angioplasty were significant stenosis of native vein or polytetrafluoroethylene (PTFE) graft with or without AVF thrombosis. Stenosis was considered significant if it narrowed the lumen of AVF for more than 50% and changed the shape of the flow curve. Balloon inflation was controlled by ultrasound. Procedural success was assessed with repeated postprocedural ultrasound. RESULTS: In the period from August 2012 until August 2016, 228 ultrasound-guided open or percutaneous transluminal angioplasties (PTA) were performed (61% men, mean age 66.6 ± 12.0 years), success rate was 93%. In 19 (8%) cases, ultrasound-guided PTA was used in conjunction with surgical reconstruction of arteriovenous fistula/graft and in 27 (12%) cases with thromboendarterectomy. Main complications were recoil, phlebitic vein rupture, and guidewire false route in thrombotic vessels. The main cause of access failure was perianastomotic stenosis (25%). 46% of patients required repeated PTA after the first one (after a mean time of 20.8 ± 22.8 weeks, mean number of repeated PTA 2.1 ± 1.7). Repeated PTA was done intentionally as stepped dilatation or because of rethrombosis/restenosis. Ultrasound-guided stent placement was done in 8% of PTA. CONCLUSIONS: Ultrasound-guided endovascular treatment of arteriovenous fistula or graft is a feasible and safe method of reestablishing or maintaining a functional vascular access.
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Role of perfusion computed tomography in assessing submandibular gland radiochemotherapy-induced injury.

OBJECTIVE: We aimed to detect changes in the volume and perfusion parameters of the submandibular glands during and after radiochemotherapy. STUDY DESIGN: Twelve patients underwent computed tomography (CT) and perfusion CT before radiochemotherapy, after 40 Gy, after 70 Gy, and 3 months after radiochemotherapy. Submandibular gland volume, blood volume, permeability surface area product, and blood flow were quantified. RESULTS: Submandibular gland volumes during and after therapy were significantly lower compared with the baseline value (P < .001). Blood volume, blood flow, and permeability surface area product values showed statistically significant reduction during and 3 months after therapy. A significant linear correlation was found between changes in submandibular gland volume and of the perfusion parameter blood volume in the period between baseline and 3 months after therapy (P = .012; RP = -0.697). CONCLUSIONS: Changes in submandibular gland volume and dynamics of perfusion parameters imply that radiation-induced injury of submandibular glands develops early during radiochemotherapy.