scholarly journals Characteristics and outcome of patients with COVID-19 complicated by Takotsubo cardiomyopathy: case series with literature review

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001360 ◽  
Author(s):  
Shruti Hegde ◽  
Rizwan Khan ◽  
Magdi Zordok ◽  
Michael Maysky
Keyword(s):  
High Risk ◽  
Mortality Rate ◽  
Takotsubo Cardiomyopathy ◽  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Case Series ◽  
High Risk Group ◽  
Hospital Death ◽  
Retrospective Case ◽  
Improved Outcomes

BackgroundCardiac involvement with COVID-19 is increasingly being recognised. Clinical characteristics and outcomes of patients with COVID-19 complicated by secondary Takotsubo cardiomyopathy (TC) is poorly understood.MethodsThis retrospective case series was conducted between March and April 2020 at four hospitals of Steward Health Care Network of Massachusetts, USA. Seven patients out of 169 who had echocardiogram were identified to have features of TC. Demographic, clinical, laboratory, management and outcome were gathered from their electronic medical records. We also reviewed all the published cases of COVID-19 and TC in the literature to recognise their common clinical characteristics, risk factors and outcomes.ResultsIn our series of seven patients, three typical, two inverted, one biventricular and one global TC were recognised. Three were females and four were males. The mean age was 71±11 years. In-hospital death was observed in 57% of patients. Patients who belonged to the high-risk group and had high-risk echocardiographic features in our series had a 100% mortality rate.ConclusionsCOVID-19 complicated by TC has a high mortality rate. Early identification of patients with COVID-19 who are at higher risk for developing secondary TC is important for the prevention of complications, and thus improved outcomes.

scholarly journals Clinical Characteristics, Treatments and Outcomes of 18 Lung Transplant Recipients with COVID-19

2021 ◽  
Vol 2 (2) ◽  
pp. 229-245
Author(s):  
René Hage ◽  
Carolin Steinack ◽  
Fiorenza Gautschi ◽  
Susan Pfister ◽  
Ilhan Inci ◽  
...  
Keyword(s):  
Lung Transplant ◽  
Clinical Laboratory ◽  
Invasive Mechanical Ventilation ◽  
Case Series ◽  
Outcome Data ◽  
Transplant Recipients ◽  
Retrospective Case ◽  
Laboratory Findings ◽  
Case Series Study ◽  
Lung Transplant Recipients

We report clinical features, treatments and outcomes in 18 lung transplant recipients with laboratory confirmed SARS-CoV-2 infection. We performed a single center, retrospective case series study of lung transplant recipients, who tested positive for SARS-CoV-2 between 1 February 2020 and 1 March 2021. Clinical, laboratory and radiology findingswere obtained. Treatment regimens and patient outcome data were obtained by reviewing the electronic medical record. Mean age was 49.9 (22–68) years, and twelve (67%) patients were male. The most common symptoms were fever (n = 9, 50%), nausea/vomiting (n = 7, 39%), cough (n = 6, 33%), dyspnea (n = 6, 33%) and fatigue (n = 6, 33%). Headache was reported by five patients (28%). The most notable laboratory findings were elevated levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). Computed Tomography (CT) of the chest was performed in all hospitalized patients (n = 11, 7%), and showed ground-glass opacities (GGO) in 11 patients (100%), of whom nine (82%) had GGO combined with pulmonary consolidations. Six (33%) patients received remdesivir, five (28%) intravenous dexamethasone either alone or in combination with remdesivir, and 15 (83%) were treated with broad spectrum antibiotics including co-amoxicillin, tazobactam-piperacillin and meropenem. Four (22%) patients were transferred to the intensive care unit, two patients (11%) required invasive mechanical ventilation who could not be successfully extubated and died. Eighty-nine percent of our patients survived COVID-19 and were cured. Two patients with severe COVID-19 did not survive.

scholarly journals Long-Term Follow-Up of Denosumab Discontinuers with Multiple Vertebral Fractures in the Real-World: A Case Series

2021 ◽  
Author(s):  
Liana Tripto-Shkolnik ◽  
Yair Liel ◽  
Naama Yekutiel ◽  
Inbal Goldshtein
Keyword(s):  
Real World ◽  
Vertebral Fractures ◽  
Clinical Laboratory ◽  
Case Series ◽  
High Risk Group ◽  
Imaging Data ◽  
Long Term Follow Up ◽  
Multiple Vertebral Fractures

AbstractDenosumab discontinuation is associated with rapid reversal of bone turnover suppression and with a considerable increase in fracture risk, including a risk for multiple vertebral fractures (MVF). Long-term follow-up of patients who sustained MVF after denosumab discontinuation has not been reported. This case-series was aimed to provide a long-term follow-up on the management and outcome of denosumab discontinuers who initially presented with multiple vertebral fractures. Denosumab discontinuers were identified from a computerized database of a large healthcare provider. Baseline and follow-up clinical, laboratory, and imaging data were obtained from the computerized database and electronic medical records. The post-denosumab discontinuers MVF patients consisted of 12 women aged 71±12. Osteoporotic fractures were prevalent before denosumab discontinuation in 6 of the patients. The majority received bisphosphonates before denosumab. MVF occurred 134±76 days after denosumab discontinuation. The patients were followed for a median of 36.5 (IQR 28.2, 42.5) months after MVF. Two patients passed-away. Two patients suffered recurrent vertebral fractures. Following MVF, patients were treated inconsistently with denosumab, teriparatide, oral, and intravenous bisphosphonates, in various sequences. Two patients underwent vertebroplasty/kyphoplasty. This long-term follow-up of real-world patients with MVF following denosumab discontinuation reveals that management is inconsistent, and recurrent fractures are not uncommon. It calls for clear management guidelines for patients with MVF after denosumab discontinuation and for special attention to this high-risk group.

scholarly journals Lung Ultrasound Patterns and Clinical-Laboratory Correlates during COVID-19 Pneumonia: A Retrospective Study from North East Italy

2021 ◽  
Vol 10 (6) ◽  
pp. 1288
Author(s):  
Riccardo Senter ◽  
Federico Capone ◽  
Stefano Pasqualin ◽  
Lorenzo Cerruti ◽  
Leonardo Molinari ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Clinical Laboratory ◽  
Imaging Modality ◽  
Case Series ◽  
Severity Index ◽  
Disease Stage ◽  
Retrospective Case ◽  
North East ◽  
High Flow Oxygen ◽  
B Lines

Background and Aim. Lung ultrasound (LUS) is a convenient imaging modality in the setting of coronavirus disease-19 (COVID-19) because it is easily available, can be performed bedside and repeated over time. We herein examined LUS patterns in relation to disease severity and disease stage among patients with COVID-19 pneumonia. Methods. We performed a retrospective case series analysis of patients with confirmed SARS-CoV-2 infection who were admitted to the hospital because of pneumonia. We recorded history, clinical parameters and medications. LUS was performed and scored in a standardized fashion by experienced operators, with evaluation of up to 12 lung fields, reporting especially on B-lines and consolidations. Results. We included 96 patients, 58.3% men, with a mean age of 65.9 years. Patients with a high-risk quick COVID-19 severity index (qCSI) were older and had worse outcomes, especially for the need for high-flow oxygen. B-lines and consolidations were located mainly in the lower posterior lung fields. LUS patterns for B-lines and consolidations were significantly worse in all lung fields among patients with high versus low qCSI. B-lines and consolidations were worse in the intermediate disease stage, from day 7 to 13 after onset of symptoms. While consolidations correlated more with inflammatory biomarkers, B-lines correlated more with end-organ damage, including extrapulmonary involvement. Conclusions. LUS patterns provide a comprehensive evaluation of patients with COVID-19 pneumonia that correlated with severity and dynamically reflect disease stage. LUS patterns may reflect different pathophysiological processes related to inflammation or tissue damage; consolidations may represent a more specific sign of localized disease, whereas B-lines seem to be also dependent upon generalized illness due to SARS-CoV-2 infection.

scholarly journals Deferiprone as adjunctive treatment for patients with invasive mucormycosis: A retrospective case series

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Maria N. Chitasombat ◽  
Pimjai Niparuck
Keyword(s):  
Mortality Rate ◽  
Treatment Strategies ◽  
Case Series ◽  
Hematologic Malignancies ◽  
Adjunctive Treatment ◽  
Combination Regimen ◽  
Retrospective Case ◽  
Day Range

Mucormycosis is a life-threatening disease requiring multimodal treatment with antifungals and surgery. The mortality rate remains high, prompting consideration of alternative treatment strategies. Deferiprone has in vitro activity against Mucorales, but its efficacy has never been evaluated in humans. Here, we retrospectively analyzed patients with confirmed mucormycosis who received deferiprone from 2011 to 2017. Five patients had hematologic malignancies and one was diabetic. The sites of infection included sinus-orbit-cerebral (67%), lung (17%), and disseminated infection (17%). Surgery was performed in 83% of cases and achieved local control for 33% of patients. A combination regimen of polyenes plus echinocandins was administered with stepdown treatment using posaconazole. The median duration of antifungal treatment was 86 days (range: 46-435 days) days. Deferiprone was given as adjunctive treatment with a median dose and duration of 100 mg/kd/day (range: 86.2-100 mg/kg/day) and 25 days (range: 15-215 days), respectively. Overall, deferiprone was well-tolerated. Successful outcomes were observed at 12-week follow-up for 67% of patients. The mortality rate at 180- day follow-up was 50%. Adjunctive therapy with deferiprone showed safety and tolerability.

scholarly journals Acute bacterial nephritis. A descriptive study of an underdiagnosed entity

2020 ◽  
Vol 80 (3) ◽  
pp. 1-10
Author(s):  
Pedro Antonio Madero-Morales ◽  
Rigoberto Pallares-Méndez ◽  
Rodrigo Romero-Mata ◽  
Guillermo Vizcarra-Mata ◽  
Andrés Guillén-Lozoya
Keyword(s):  
Acute Pyelonephritis ◽  
Clinical Characteristics ◽  
Clinical Course ◽  
Case Series ◽  
Therapy Response ◽  
Time Frame ◽  
Clinical Findings ◽  
Imaging Features ◽  
Imaging Studies ◽  
Retrospective Case

Background: Acute bacterial nephritis is an infectious process diagnosed through imaging studies. The clinical course of the disease has been shown to be more aggressive than acute pyelonephritis. It continues to be underdiagnosed, thus there are few studies on the entity in the literature. Objective: To describe the clinical characteristics and imaging features of acute bacterial nephritis, as well as its clinical course. Design: A descriptive, retrospective case series was conducted. Materials and methods: Thirty-two cases of acute bacterial nephritis in patients admitted to the hospital within the time frame of 2009 to 2016 were reviewed. The patients’ clinical characteristics upon admission were registered, as well as inpatient clinical progression, culture results, and antibiotic therapy response. The imaging studies were re-evaluated and the diagnostic consistency with either the focal or multifocal disease presentation was confirmed. Results: Cases predominated in women (n=29, 90.62%) and the most frequently associated comorbidities were diabetes (n=16, 50%) and obesity (n=9, 28.25%). The most important clinical findings upon admission were fever (n=15, 46.87%) and leukocytosis (n=27, 84.38%). Escherichia coli was the most commonly isolated bacterium (63.63%). Both acute focal bacterial nephritis and acute multifocal bacterial nephritis were observed in 46.87% (n=15) and 53.13% (n=17) of the patients, respectively. Imaging studies were required for all diagnoses. Conclusion: Fever and leukocytosis are the main findings in acute bacterial nephritis. Imaging studies are necessary for making the diagnosis, given that acute pyelonephritis and acute bacterial nephritis cannot be clinically differentiated.

scholarly journals Clinical Analysis of restrictive strabismus secondary to ophthalmic surgery

2021 ◽  
Author(s):  
Lili Guo ◽  
Zhihua Zhao ◽  
Zequn Miao ◽  
Qianru Ouyang ◽  
Xin Xu ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Case Series ◽  
Strabismus Surgery ◽  
Ocular Motility ◽  
Ophthalmic Surgery ◽  
Retrospective Case ◽  
Eye Muscle ◽  
Lateral Ligaments ◽  
Surgical Methods ◽  
Restrictive Strabismus

Abstract Background: This study aimed to report the clinical characteristics and surgical methods of restrictive strabismus secondary to ophthalmic surgery. Methods: This retrospective case series covered 14 restrictive strabismus cases secondary to ophthalmic surgery. After evaluation of the clinical history and the basic ophthalmological findings, the following parameters were examined: squint angles (prism with alternative cover test, Krimsky’s test or Maddox cross), ocular motility, duction test and the forced duction test. All paitients underwent surgery, the strabismus surgery included the excision of adhesions and scar tissue, adhesiolysis, medial and lateral ligaments separated, repositioning of extraocular muscles (according to the degree of deviations). We described the clinical characteristics and evaluated the surgical results in strabismus eyes. Results: All patients were satisfied with the results of surgery, obtained anatomical reduction and partial functional recovery. In nine cases with preoperative diplopia, eight cases had no diplopia after surgery and one patient’s diplopia disappeared after the secondary surgery. The other five cases without preoperative diplopia, but had restricted ocular motility, which improved significantly than before surgery. Conclusions: Orbital surgery, trauma, conjunctival surgery, strabismus surgery and so on, can lead to secondary restrictive strabismus surgery. Strabismus surgical treatments including the full removal of the muscles around the scar, adhesiolysis, medial and lateral ligaments separated, eye muscle surgery, can provide excellent results and patient’s satisfaction.

scholarly journals Multiple Myeloma, Clinical Characteristics, and Increased COVID-19 Risk Using Real-World Data

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3778-3778
Author(s):  
Emily I. Liu ◽  
Nathan W. Sweeney ◽  
Jennifer M. Ahlstrom
Keyword(s):  
At Risk ◽  
Multiple Myeloma ◽  
High Risk ◽  
Clinical Characteristics ◽  
Medical Condition ◽  
Severe Case ◽  
High Risk Group ◽  
Smoking History ◽  
Medical Conditions ◽  
Real World Data

Abstract Background: A question that was commonly investigated during the COVID-19 pandemic was which clinical characteristics would make one more susceptible to contracting COVID-19? This was especially a concern for those who were considered "high risk" as they would be more prone to suffering from more severe COVID-19 symptoms and at times even death. In this abstract, we investigated which clinical characteristics of multiple myeloma (MM) cancer patients could make them more prone to contracting COVID-19. We also investigated which of these conditions make patients more at risk for experiencing more severe COVID-19 symptoms (PMID: 32950467, PMID: 32353254). Knowing what medical conditions that would make a patient more at risk for contracting or experiencing a more severe case of COVID-19 has been a concern for many, especially for those who suffer from more severe health conditions such as cancer. Methods: MM patient data and demographics were collected through HealthTree ® Cure Hub for Multiple Myeloma. We analyzed medical conditions including hypertension, heart condition, neuropathy condition, and BMI. We also looked into lung condition, kidney condition, diabetes, stroke, smoking history, drug use history, HIV, and Mediterranean descent but did not include in the figure due to small population sizes. We determined whether a patient had to be hospitalized, admitted to the ICU, needed oxygen therapy, or needed a D-dimer test as a severe COVID-19 case. Multivariable logistic regressions were performed to quantify the risk for contracting COVID-19 for patients with specific medical conditions and which medical conditions made COVID-19 positive patients more at risk for experiencing a more severe case of COVID-19. Results: Out of the 962 patients that were involved in this study, we found that patients who were overweight were 2% more likely to contract COVID-19 than those who were not overweight. Other medical conditions did not increase the risk of contracting COVID-19. Furthermore, there were 35 patients that were involved in investigating how certain medical conditions may affect the severity of COVID-19 symptoms. We found that overweight patients were 12% more likely to suffer from more severe COVID-19 than those not overweight. Patients who suffered from neuropathy conditions were 3% more likely to experience a more severe COVID-19 case than those who do not have that condition. It is important to note that these results were not statistically significant, although are still informative. Conclusion: Our results show that MM patients who are overweight have a greater tendency to not only contract COVID-19 but experience a more severe case of COVID-19. Somewhat surprisingly, we found that patients who experience neuropathy, common among MM patients, had a higher tendency to experience a more severe case of COVID-19. We speculate whether MM patients, a high-risk group due to their immunocompromised state, took extra care to follow safety recommendations and caution to avoid contracting COVID-19. A logical next step would be to compare medical condition interactions to examine whether patients with more than one condition experience additive or synergistic risk, as well as comparing out results to other high-risk groups. These findings, although not statistically significant, may help MM patients identify which of their own medical conditions may put them more at risk for contracting COVID-19 and thus take precautionary measures. Figure 1 Figure 1. Disclosures Ahlstrom: Takeda: Other: Patient Advisory; Pfizer: Other: Patient Advisory; Janssen: Other: Patient Advisory; Bristol Myers Squibb: Other: Patient Advisory.

scholarly journals Declining Mortality Rate of Hospitalised Patients in the Second Wave of the COVID-19 Epidemics in Italy: Risk Factors and the Age-Specific Patterns

Life ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 979
Author(s):  
Antonella D’Arminio Monforte ◽  
Alessandro Tavelli ◽  
Francesca Bai ◽  
Daniele Tomasoni ◽  
Camilla Falcinella ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clinical Laboratory ◽  
Flow Diagram ◽  
Hospital Death ◽  
Relative Reduction ◽  
Risk Of Death ◽  
Background Mortality ◽  
Hospitalised Patients ◽  
Vaccination Campaigns ◽  
Second Wave

Background: Mortality rate from COVID-19 in Italy is among the world’s highest. We aimed to ascertain whether there was any reduction of in-hospital mortality in patients hospitalised for COVID-19 in the second-wave period (October 2020–January 2021) compared to the first one (February–May 2020); further, we verified whether there were clusters of hospitalised patients who particularly benefitted from reduced mortality rate. Methods: Data collected related to in-patients’ demographics, clinical, laboratory, therapies and outcome. Primary end-point was time to in-hospital death. Factors associated were evaluated by uni- and multivariable analyses. A flow diagram was created to determine the rate of in-hospital death according to individual and disease characteristics. Results: A total of 1561 patients were included. The 14-day cumulative incidence of in-hospital death by competing risk regression was of 24.8% (95% CI: 21.3–28.5) and 15.9% (95% CI: 13.7–18.2) in the first and second wave. We observed that the highest relative reduction of death from first to second wave (more than 47%) occurred mainly in the clusters of patients younger than 70 years. Conclusions: Progress in care and supporting therapies did affect population over 70 years to a lesser extent. Preventive and vaccination campaigns should focus on individuals whose risk of death from COVID-19 remains high.

Integrated Analysis of Immune-Related Genes in High-Risk Neuroblastoma

2020 ◽  
Author(s):  
FengLing Shao ◽  
Zhenni Wang ◽  
Shan Wang
Keyword(s):  
High Risk ◽  
Risk Score ◽  
Clinical Characteristics ◽  
Roc Analysis ◽  
Risk Group ◽  
High Risk Group ◽  
Data Sets ◽  
Qrt Pcr ◽  
Kaplan Meier ◽  
Immune Related Genes

Abstract BackgroundDue to the extremely high mortality rate of children with high-risk Neuroblastoma (NB), there is an urgent need for new indicators to further classify children in the high-risk group for more precise treatment. The purpose of our research is to explore the immune-related genes in NB in the high-risk group, and to further identify and develop a prognostic nomogram based on immune IRG signatures. MethodsThrough bioinformatics analysis to explore the abnormal expression of immune-related genes in the high-risk group. Cox regression and the least absolute shrinkage and selection operator (LASSO) analysis were conducted to identify the immune and overall survival (OS) related mRNA. The accuracy of the risk score is evaluated by Kaplan-Meier method and receiver operating characteristics (ROC) analysis, which is used to build a nomogram in combination with other clinical characteristics.. Quantitative real-time polymerase chain reaction (qRT-PCR) was conducted to detect the accuracy of our results. ResultsA total of 127 common differentially expressed immune genes were found between the high-risk group and the non-high-risk group of the two data sets. Four immune-related genes (IRG) related to prognosis were identified and a risk score was established. Kaplan–Meier survival analysis and time-dependent ROC analysis showed that the 4-IRG risk score has satisfactory predictive potential and achieved consistency in the verification of external data sets. Subsequently, the risk score combined with clinical characteristics draws a nomogram. The reliability of the results was verified on 29 cases of NB tissues by qRT-PCR. ConclusionsOverall, we have developed a powerful multi-gene classifier that can effectively classify NB patients into low- and high-risk groups with poor prognosis, and draw a nomogram for children in the high-risk group. This feature can help select high-risk patients who need more aggressive adjuvant target therapy or immunotherapy.

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