scholarly journals Early Disseminated Lyme Carditis Inducing High-Degree Atrioventricular Block

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Connor C. Kerndt ◽  
John A. Bills ◽  
Zaid J. Shareef ◽  
Alexander M. Balinski ◽  
Daniel F. Summers ◽  
...  
Keyword(s):  
Erythema Migrans ◽  
The United States ◽  
Outdoor Exposure ◽  
Clinical Suspicion ◽  
Adverse Outcomes ◽  
Av Block ◽  
Lyme Carditis ◽  
High Degree ◽  
Electrocardiogram Ecg

Lyme disease is the most common tick-borne illness in the United States due to Borrelia burgdorferi infection. This case demonstrates a 20-year-old male patient presenting with complaints of annular skin rash, malaise, fever, and lightheadedness after significant outdoor exposure. Physical exam revealed multiple large targetoid lesions on the back and extremities. The rash had raised borders and centralized clearing consistent with erythema migrans chronicum. Electrocardiogram (ECG) revealed a high-degree atrioventricular (AV) block. The patient was started on intravenous ceftriaxone due to clinical suspicion for Lyme carditis. ELISA and Western blot tests were reactive for Lyme IgM and IgG, confirming the diagnosis. The AV block resolved by hospital day four and the patient was discharged with outpatient follow-up. Early identification of disease allowed for effective treatment with no adverse outcomes or sequelae.

The Transfusion Services Committee—Responsibilities and Response to Adverse Transfusion Events

Hematology ◽  
2005 ◽  
Vol 2005 (1) ◽  
pp. 483-490 ◽  
Author(s):  
Ira A. Shulman ◽  
Sunita Saxena
Keyword(s):  
Performance Improvement ◽  
Review Process ◽  
High Volume ◽  
The United States ◽  
Adverse Outcomes ◽  
Data Driven ◽  
Medicaid Program ◽  
And Performance ◽  
To Receive

Abstract Healthcare institutions in the United States must review blood transfusion practices and adverse outcomes in order to receive payments from the Centers for Medicare/Medicaid program, but it is not required for a specific committee to be assigned to oversee the review process. Regardless of the group or individuals responsible, the review process must include a program of quality assessment and performance improvement that is ongoing, hospital-wide, and data-driven, reflects the complexity of the hospital’s organization and services, and involves all hospital departments and services (including those contracted). To be most effective, the performance improvement activity should be prioritized around high-risk, high-volume activities and/or in problem-prone areas. Even if a hospital elects not to receive payments from Medicare, it must still comply with applicable sections of the Code of Federal Regulations pertaining to transfusion services such as the follow up of adverse outcomes of transfusion.

scholarly journals Cardiac Abnormalities Seen in Pediatric Patients During the SARS‐CoV2 Pandemic: An International Experience

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Bradley C. Clark ◽  
Joan Sanchez‐de‐Toledo ◽  
Carles Bautista‐Rodriguez ◽  
Nadine Choueiter ◽  
Diego Lara ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
The United States ◽  
Left Ventricular ◽  
Medical Community ◽  
Healthy Children ◽  
Av Block ◽  
Coronary Abnormalities ◽  
Cardiac Manifestations ◽  
Inflammatory Syndrome

Abstract Background During the SARS‐CoV2 pandemic, there has been increase in hyperinflammatory presentation in previously healthy children with a variety of cardiac manifestations. Our objective is to describe the cardiac manifestations found in an international cohort of 55 pediatric cases with multi‐system inflammatory syndrome (MIS‐C) during the SARS‐CoV2 pandemic. Methods and Results We reviewed data on previously healthy pediatric patients (≤18 years) with structurally normal hearts who presented at hospitals in the United States, United Kingdom, Spain and Pakistan with MIS‐C and had consultation with a pediatric cardiologist. Data collected included demographics, clinical presentation, laboratory values, electrocardiographic abnormalities, echocardiographic findings and initial therapies. A total of 55 patients presented with MIS‐C. Thirty‐five patients (64%) had evidence of decreased left ventricular function, 17 (31%) had valvulitis, 12 (22%) with pericardial effusion and 11 (20%) with coronary abnormalities. Twenty‐seven (49%) required ICU admission and 24 (44%) had evidence of shock. Eleven patients (20%) fulfilled complete Kawasaki disease criteria and had lower NT pro‐BNP, D‐dimer and ferritin levels compared with those who did not fulfill criteria. Electrophysiologic abnormalities occurred in 6 patients and included complete atrioventricular (AV) block, transient AV block and ventricular tachycardia. Conclusions We describe the first international cohort of pediatric patients with MIS‐C during the SARS‐CoV2 pandemic with a range of cardiac manifestations. This paper brings awareness and alertness to the global medical community to recognize these children during the pandemic and understand the need for early cardiology evaluation and follow‐up.

Steroid-Induced Osteonecrosis in Dermatology

2015 ◽  
Vol 19 (4) ◽  
pp. 358-360 ◽  
Author(s):  
Dominik Alex Nowak ◽  
Jensen Yeung
Keyword(s):  
Relevant Literature ◽  
Clinical Suspicion ◽  
Oral Steroid ◽  
Pubmed Search ◽  
High Degree

Background: Steroid-induced osteonecrosis is unpredictable and highly morbid. Methods: MEDLINE (Ovid) and PubMed search for relevant literature. Results: Oral steroid doses typically considered to be associated with the condition are >20 mg of prednisone (or equivalent) per day or >2 g within a period of 2 to 3 months. Symptoms may be vague. Conclusions: Dermatologists must exercise a high degree of clinical suspicion and warn patients about steroid-related risks and conditions for follow-up.

scholarly journals Treating Lyme carditis high‐degree AV block using a temporary–permanent pacemaker

2018 ◽  
Vol 24 (3) ◽  
pp. e12599 ◽  
Author(s):  
Chang Wang ◽  
Sanoj Chacko ◽  
Hoshiar Abdollah ◽  
Adrian Baranchuk
Keyword(s):  
Permanent Pacemaker ◽  
Av Block ◽  
Lyme Carditis ◽  
High Degree

scholarly journals Lyme Carditis: A Case Report and Review of Management

2018 ◽  
Vol 53 (4) ◽  
pp. 263-265 ◽  
Author(s):  
Sheheryar Muhammad ◽  
Robert J. Simonelli
Keyword(s):  
Heart Rate ◽  
Case Report ◽  
Erythema Migrans ◽  
Acute Onset ◽  
Unknown Etiology ◽  
Type I ◽  
Av Block ◽  
Presumptive Diagnosis ◽  
Lyme Carditis ◽  
Mobitz Type

Purpose: A case report of a patient who presented with an acute onset, fluctuating atrioventricular (AV) block and was diagnosed with Lyme carditis is presented. Summary: A 55-year-old man with progressively worsening generalized malaise, flu-like symptoms, dyspnea on exertion, and near syncope was admitted with bradycardia (heart rate was between 20 and 30 beats per minute upon admission). He endorsed having several tick bites after which he developed erythema migrans on his arm and abdomen. An electrocardiogram (ECG) revealed a second-degree AV block, fluctuating between Mobitz type I and Mobitz type II heart block, with a P-R interval of 300 ms. A presumptive diagnosis of Lyme carditis was made based on a confirmed history of tick exposure, presence of erythema migrans, and AV block. The patient was started on ceftriaxone. On day 3 of hospitalization, patient’s heart rate was between 50 and 60 beats per minute. A diagnosis of Lyme disease was confirmed based on serologic testing. A repeat ECG revealed a first-degree AV block with a P-R interval of 300 ms. On day 5 of hospitalization, a peripherally inserted central catheter line was placed and the patient was discharged to his home on a 28-day course of ceftriaxone. Patient’s heart rate was 65 beats per minute on discharge day. Conclusion: Considering Lyme carditis as a differential diagnosis in patients with an AV block of an unknown etiology can result in a timely diagnosis and treatment of Lyme carditis.

scholarly journals Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block

Healthcare ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 119 ◽  
Author(s):  
Cynthia Yeung ◽  
Adrian Baranchuk
Keyword(s):  
Lyme Disease ◽  
Risk Stratification ◽  
Atrioventricular Block ◽  
Systematic Approach ◽  
Av Block ◽  
Diagnosis And Management ◽  
Favorable Prognosis ◽  
Lyme Carditis ◽  
High Degree ◽  
Risk Stratification Score

Lyme carditis (LC) is a manifestation of the early disseminated stage of Lyme disease and often presents as high-degree atrioventricular (AV) block. High-degree AV block in LC can be treated with antibiotics, usually resolving with a highly favorable prognosis, thus preventing the unnecessary implantation of permanent pacemakers. We present a systematic approach to the diagnosis and management of LC that implements the Suspicious Index in Lyme Carditis (SILC) risk stratification score.

scholarly journals SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes

Circulation ◽  
2021 ◽  
Author(s):  
Nathaniel Moulson ◽  
Bradley J. Petek ◽  
Jonathan A. Drezner ◽  
Kimberly G. Harmon ◽  
Stephanie A. Kliethermes ◽  
...  
Keyword(s):  
Cardiac Involvement ◽  
Diagnostic Yield ◽  
Collegiate Athletes ◽  
The United States ◽  
Adverse Outcomes ◽  
Cardiac Complications ◽  
Primary Screening ◽  
Competitive Athletes ◽  
Clinical Surveillance

Background: Cardiac involvement among hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is common and associated with adverse outcomes. The objective of this study was to determine the prevalence and clinical implications of SARS-CoV-2 cardiac involvement in young competitive athletes. Methods: In this prospective multicenter observational cohort study with data from 42 colleges/universities, we assessed the prevalence, clinical characteristics, and outcomes of SARS-CoV-2 cardiac involvement among collegiate athletes in the United States. Data were collected from September 1, 2020 to December 31, 2020. The primary outcome was the prevalence of definite, probable, or possible SARS-CoV-2 cardiac involvement based on imaging definitions adapted from the Updated Lake Louise Criteria. Secondary outcomes included the diagnostic yield of cardiac testing, predictors for cardiac involvement, and adverse cardiovascular events or hospitalizations. Results: Among 19,378 athletes tested for SARS-CoV-2 infection, 3018 (mean age 20 years [SD,1 year]; 32% female) tested positive and underwent cardiac evaluation. A total of 2820 athletes underwent at least one element of cardiac 'triad' testing [12-lead electrocardiography (ECG), troponin, and/or transthoracic echocardiography(TTE)] followed by cardiac magnetic resonance (CMR) if clinically indicated. In contrast, primary screening CMR was performed in 198 athletes. Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG (21/2999,0.7%), cardiac troponin (24/2719,0.9%), and TTE (24/2556,0.9%). Definite, probable, or possible SARS-COV-2 cardiac involvement was identified in 21/3018 (0.7%) athletes, including 15/2820 (0.5%) who underwent clinically indicated CMR (n=119) and 6/198 (3.0%) who underwent primary screening CMR. Accordingly, the diagnostic yield of CMR for SARS-COV-2 cardiac involvement was 4.2 times higher for a clinically indicated CMR (15/119,12.6%) versus a primary screening CMR (6/198,3.0%). After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (OR:3.1,95% CI:1.2,7.7) or at least one abnormal triad test (OR:37.4,95% CI:13.3,105.3). Five (0.2%) athletes required hospitalization for non-cardiac complications of SARS-CoV-2. During clinical surveillance (median follow-up 113 days [IQR=90,146]), there was one (0.03%) adverse cardiac event likely unrelated to SARS-CoV-2 infection. Conclusions: SARS-CoV-2 infection among young competitive athletes is associated with a low prevalence of cardiac involvement and a low risk of clinical events in short term follow-up.

scholarly journals Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block

2018 ◽  
Author(s):  
Cynthia Yeung ◽  
Adrian Baranchuk
Keyword(s):  
Lyme Disease ◽  
Risk Stratification ◽  
Atrioventricular Block ◽  
Systematic Approach ◽  
Diagnosis And Treatment ◽  
Av Block ◽  
Diagnosis And Management ◽  
Lyme Carditis ◽  
High Degree ◽  
Risk Stratification Score

Lyme carditis (LC) is a manifestation of the early disseminated stage of Lyme disease and often presents as high-degree atrioventricular (AV) block. High-degree AV block in LC can be treated with antibiotics, usually resolving with highly favourable prognosis, thus preventing the unnecessary implantation of permanent pacemakers. We present a systematic approach to the diagnosis and management of LC that implements the Suspicious Index in Lyme Carditis (SILC) risk stratification score.

Development and validation of risk stratification models for adult spinal deformity surgery

2019 ◽  
Vol 31 (4) ◽  
pp. 587-599 ◽  
Author(s):  
Ferran Pellisé ◽  
Miquel Serra-Burriel ◽  
Justin S. Smith ◽  
Sleiman Haddad ◽  
Michael P. Kelly ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
The United States ◽  
Adverse Outcomes ◽  
High Rate ◽  
Prognostic Models ◽  
Time To Event ◽  
European Continent ◽  
Event Risk ◽  
Risk Estimates

OBJECTIVEAdult spinal deformity (ASD) surgery has a high rate of major complications (MCs). Public information about adverse outcomes is currently limited to registry average estimates. The object of this study was to assess the incidence of adverse events after ASD surgery, and to develop and validate a prognostic tool for the time-to-event risk of MC, hospital readmission (RA), and unplanned reoperation (RO).METHODSTwo models per outcome, created with a random survival forest algorithm, were trained in an 80% random split and tested in the remaining 20%. Two independent prospective multicenter ASD databases, originating from the European continent and the United States, were queried, merged, and analyzed. ASD patients surgically treated by 57 surgeons at 23 sites in 5 countries in the period from 2008 to 2016 were included in the analysis.RESULTSThe final sample consisted of 1612 ASD patients: mean (standard deviation) age 56.7 (17.4) years, 76.6% women, 10.4 (4.3) fused vertebral levels, 55.1% of patients with pelvic fixation, 2047.9 observation-years. Kaplan-Meier estimates showed that 12.1% of patients had at least one MC at 10 days after surgery; 21.5%, at 90 days; and 36%, at 2 years. Discrimination, measured as the concordance statistic, was up to 71.7% (95% CI 68%–75%) in the development sample for the postoperative complications model. Surgical invasiveness, age, magnitude of deformity, and frailty were the strongest predictors of MCs. Individual cumulative risk estimates at 2 years ranged from 3.9% to 74.1% for MCs, from 3.17% to 44.2% for RAs, and from 2.67% to 51.9% for ROs.CONCLUSIONSThe creation of accurate prognostic models for the occurrence and timing of MCs, RAs, and ROs following ASD surgery is possible. The presented variability in patient risk profiles alongside the discrimination and calibration of the models highlights the potential benefits of obtaining time-to-event risk estimates for patients and clinicians.

Cerebellotrigeminal Dermal Dysplasia (Gómez-López-Hernández Syndrome)

2018 ◽  
Vol 16 (05) ◽  
pp. 362-368 ◽  
Author(s):  
Federica Sullo ◽  
Agata Polizzi ◽  
Stefano Catanzaro ◽  
Selene Mantegna ◽  
Francesco Lacarrubba ◽  
...  
Keyword(s):  
De Novo ◽  
Chromosomal Rearrangements ◽  
Number Of Patients ◽  
Wide Range ◽  
Visual Problems ◽  
Neurodevelopmental Abnormalities ◽  
Clinical Triad ◽  
High Degree ◽  
Motor Handicap

Cerebellotrigeminal dermal (CTD) dysplasia is a rare neurocutaneous disorder characterized by a triad of symptoms: bilateral parieto-occipital alopecia, facial anesthesia in the trigeminal area, and rhombencephalosynapsis (RES), confirmed by cranial magnetic resonance imaging. CTD dysplasia is also known as Gómez-López-Hernández syndrome. So far, only 35 cases have been described with varying symptomatology. The etiology remains unknown. Either spontaneous dominant mutations or de novo chromosomal rearrangements have been proposed as possible explanations. In addition to its clinical triad of RES, parietal alopecia, and trigeminal anesthesia, CTD dysplasia is associated with a wide range of phenotypic and neurodevelopmental abnormalities.Treatment is symptomatic and includes physical rehabilitation, special education, dental care, and ocular protection against self-induced corneal trauma that causes ulcers and, later, corneal opacification. The prognosis is correlated to the mental development, motor handicap, corneal–facial anesthesia, and visual problems. Follow-up on a large number of patients with CTD dysplasia has never been reported and experience is limited to few cases to date. High degree of suspicion in a child presenting with characteristic alopecia and RES has a great importance in diagnosis of this syndrome.

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