D-dimer trends predict COVID-19 patient's prognosis: A retrospective chart review study.

This is a retrospective study of patients admitted to Jackson Hospital, Montgomery, Alabama, with a diagnosis of COVID-19 from January 1, 2021, to February 15, 2022. The independent variables used in the models were patient sex, age, race, BMI category, daily D-dimer categories, categories of anticoagulation doses, bleeding episodes, and vaccination status. The three different categories of anticoagulation doses were considered for the purpose of the study which were Enoxaparin 40 mg daily vs Enoxaparin 80 mg daily vs Enoxaparin 1 mg/kg or equivalent daily. The study reviewed a total of 100 hospitalized patients. Intermediate-dose anticoagulation was found to be the optimal dose as only 14% patients died compared to a 36 and 50% death rate among those treated with low-dose and high-dose anticoagulation, respectively. The multivariate linear regression model predicting patient oxygen requirements revealed D-dimer and bleeding status to be statistically significant predictors with a p value of <0.01. For the patients who had a D-dimer value ≥2 µg/mL, the oxygenation requirement was predicted to be 31 L higher than those with a D-dimer <2 µg/mL (99% CI; p < 0.01). When mean D-dimer and corresponding oxygen requirements were calculated per hospitalization days category, the D-dimer levels and oxygen requirements were noted to follow the same trends indicating that both values tended to increase and decrease simultaneously. The study concludes daily D-dimer trends can predict COVID-19 patient survival or daily oxygen requirements indicating that D-dimer can be the miracle molecule for COVID-19 prognosis.

Cardiac performance is impaired in morbidly obese pregnant females.

AIM: To evaluate the effect of pregnancy on ventricular function in morbidly obese as compared to lean controls. MATERIAL AND METHODS: We serially studied 33 obese and non-obese pregnant females with echocardiography during each trimester of pregnancy and after delivery. Two well-validated, relatively load-independent indices of contractility (systolic shortening index and systolic velocity index) were assessed, along with more traditional echocardiographic parameters. ANOVA for repeated measures was used to compare data between sequential studies in the normal and obese pregnant groups. RESULTS: In lean controls, stroke volume increased and contractility was maintained during pregnancy as compared to pre-pregnancy levels. In contrast, both stroke volume and contractility declined significantly by the third trimester in morbidly obese females. CONCLUSION: There is a maladaptive left ventricular contractile response to pregnancy in morbidly obese patients.

Thyrotoxic Dysphagia in an 82-year-old male.

Dysphagia is a common problem in elderly patients and a rare manifestation of Graves' disease. We report a case of an 82-year-old male who presented with a 4-week history of dysphagia and weight loss. Workup for his dysphagia with upper endoscopy, MRI brain, electromyography, acetyl-cholinesterase receptor antibodies, and voltage-gated calcium channel antibodies were negative. Modified Barium swallow test showed oropharyngeal dysphagia. Thyroid function tests that revealed hyperthyroidism and antibodies to TSH-receptor were positive. Based on the above findings, we considered Graves' disease as the most likely diagnosis. Patient was treated with methimazole and beta-blockers and subsequently his dysphagia resolved. This paper highlights the importance to clinicians of considering thyrotoxicosis as possible diagnosis in an elderly patient presenting with unexplained dysphagia.

Tako tsubo cardiomyopathy (transient left ventricular apical ballooning): case report of a myocardial perfusion echocardiogram study.

We are reporting a case of Tako tsubo cardiomyopathy (transient left ventricular apical ballooning) in the Western population identified by a perfusion echocardiogram that demonstrated perfusion defect at baseline in the apical and adjacent walls that was incongruous to the wall-motion abnormality. The perfusion defect improved within 72 hours on a repeated study indicating that microvasculature disruption is a key feature of this enigmatic cardiomyopathy.

Childhood blood pressure predicts adult microalbuminuria in African Americans, but not in whites: the Bogalusa Heart Study.

BACKGROUND: Microalbuminuria is considered as a strong predictor of cardiovascular diseases. However, limited information is available for childhood blood pressure (BP) levels and microalbuminuria in adulthood. METHODS: This study examined 2,122 individuals enrolled in the Bogalusa Heart Study as children, aged 5 to 17 years, and as adults, aged 20 to 37 years, with an average follow-up period of 16 years. Microalbuminuria is defined as urinary albumin (in milligrams per liter) to creatinine (mmoles per liter) ratio at or above the 90th percentile specific for age, ethnicity, and sex or urinary albumin levels >/=30 mg/L. RESULTS: As children, African American boys had higher BP than white boys. As adults, African Americans had higher BP and urinary albumin/creatinine ratio than whites. After adjusting for age, sex, and body mass index (BMI), African Americans with microalbuminuria in adulthood by either measure had higher systolic (P =.03) and diastolic (P =.02) BP as adults, and higher diastolic (P <.01) as children than those without this condition. On the other hand, whites showed no such significant association. In a multivariate regression analysis, adjusting for sex, childhood BMI, and age, and current smoking status, childhood BP and rate of change in BP from childhood to adulthood were significant predictors of increased urine albumin excretion in African Americans, but not in whites. CONCLUSIONS: Elevated BP beginning in childhood is associated with microalbuminuria in adulthood in African Americans, but not in whites, suggesting that African Americans may be more susceptible than whites to BP-related renal damage.