scholarly journals A cardiac manifestation in patients with COVID-19: a case series

2020 ◽  
Vol 8 (1) ◽  
pp. 124
Author(s):  
Archita Ravindranath ◽  
Madhumati Ramaiah ◽  
Parvaiz Kadloor
Keyword(s):  
Case Series ◽  
Respiratory Illness ◽  
Prior History ◽  
Microvascular Damage ◽  
Hypoxic Injury ◽  
History Of ◽  
Artery Disease ◽  
Cardiac Manifestation ◽  
Cardiac Manifestations ◽  
Severe Acute Respiratory Illness

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus or the coronavirus 2019 (COVID-19) infection is a novel viral infection causing the 2020 pandemic affecting primarily the respiratory system in the form of influenza like illness, severe acute respiratory illness or asymptomatic respiratory illness and other systems. The cardiovascular system may also be affected, with or without a prior history of cardiovascular diseases. Myocardial injury is common among patients hospitalized with COVID-19 due to stress cardiomyopathy, hypoxic injury, ischemic injury due to cardiac microvascular damage or epicardial coronary artery disease and cytokine storm, however rhythm abnormalities is affected rarely in a transient or severe manner causing rhythm disturbances. The concerns about COVID‐19 may result in a delay in proper approach and prompt management in many emergent medical conditions, such as cardiovascular problems. Here, we describe our experience with 4 COVID-19 patients with varied cardiac manifestations presenting to our hospital during the months of September- October 2020.

Labyrinthitis ossificans: How accurate is MRI in predicting cochlear obstruction?

2009 ◽  
Vol 140 (5) ◽  
pp. 692-696 ◽  
Author(s):  
Brandon Isaacson ◽  
Timothy Booth ◽  
Joe W. Kutz ◽  
Kenneth H. Lee ◽  
Peter S. Roland
Keyword(s):  
High Resolution ◽  
Bacterial Meningitis ◽  
Cochlear Implant ◽  
Tertiary Care ◽  
Fibrous Tissue ◽  
Case Series ◽  
Prior History ◽  
Basal Turn ◽  
Labyrinthitis Ossificans ◽  
History Of

Objective: To determine the accuracy of preoperative MRI in predicting cochlear obstruction in pediatric patients with a history of bacterial meningitis. Methods: A case series with chart review was performed at a tertiary care multidisciplinary cochlear implant program. Forty-five children with hearing loss that resulted from bacterial meningitis were implanted from 1991 to 2006. Twenty-five children had preoperative MRI with high-resolution axial T2-weighted images to assess for cochlear patency. Results: Seventeen of 25 patients (68%) had surgical evidence of cochlear obstruction. Six patients (37.5%) required circummodiolar drill-outs, and one patient (6.25%) underwent placement of a double array cochlear implant. The nine remaining patients (56%) with cochlear obstruction required removal of fibrous tissue or drilling of the inferior basal turn, but did not require manipulation of the ascending basal turn to achieve full electrode insertion. The sensitivity, specificity, and positive and negative predictive value of MRI predicting intraoperative cochlear obstruction with 95 percent confidence intervals was 94.1 percent (71–99), 87.5 percent (47–99), 94.1 percent (71–99) and 87.5 percent (47–99), respectively. Conclusion: Preoperative high-resolution T2 MRI may be useful in predicting cochlear obstruction in patients with a prior history of bacterial meningitis.

scholarly journals Spontaneous Gallbladdre Perforation: A case series

2016 ◽  
Vol 18 (3) ◽  
pp. 31
Author(s):  
Sujit Kumar ◽  
Sanjay Negi ◽  
BN Patowary ◽  
Aditya Jalan ◽  
Sulabh Rajbhandari
Keyword(s):  
Rare Complication ◽  
Case Series ◽  
Biliary Colic ◽  
Gallbladder Perforation ◽  
Prior History ◽  
Aged Patients ◽  
Abdominal Radiographs ◽  
History Of ◽  
Abdominal Paracentesis ◽  
Fluid Levels

Background: Gallbladder is rarely injured as it is embedded in the liver and well protected by ribcage. Gallbladder perforation is a rare complication of acute calculus cholecystitis. Spontaneous gallbladder perforation is even rarer.Case Series: We present our experience of 4 cases of spontaneous gallbladder perforation. The patients were mostly males (3:1) with age ranging from 42-64 years. All the patients presented with abdominal pain, distension, ileus and fever ranging from 2-5 days duration. There was no prior history of biliary colic. Examination revealed abdominal tenderness and ileus. Abdominal radiographs showed multiple air-fluid levels and no pneumoperitoneum. Sonography and CT scan of abdomen revealed pericholecystic fluid, intra-abdominal collection with no evidence of gallstones. Provisional diagnosis was peritonitis in 3 and acute pancreatitis in one case. Image guided abdominal paracentesis yielded bilious fluid. In view of lack of clinical improvement and aspiration of bilious content all the patients were subjected to laparotomy. Gallbladder perforation in fundus region without stones and intra-abdominal bile collection was noted in all the patients. Cholecystectomy with peritoneal lavage and abdominal drainage was performed in all cases. Postoperative course was uneventful except wound infection in 2 cases. Histopathology report revealed features of acute cholecystitis in 2 and acute on chronic cholecystitis in the remaining 2 patients.Conclusion: Diagnosis of spontaneous gallbladder perforation should be suspected in middle aged patients who present with acute abdomen but does not have classical signs of peritonitis and in whom paracentesis has yielded bilious fluid.

Cardiac and cerebral manifestations of the antiphospholipid syndrome

2001 ◽  
Vol 21 (02) ◽  
pp. 60-65
Author(s):  
F. Jung ◽  
I. Scharrer
Keyword(s):  
Aortic Valve ◽  
Antiphospholipid Syndrome ◽  
The Other ◽  
Prior History ◽  
Review Of The Literature ◽  
Left Main ◽  
Vessel Occlusion ◽  
History Of ◽  
Artery Disease ◽  
Valvular Lesions

Summary Aim: To describe cardiac and cerebral manifestations in eight patients with the antiphospholipid syndrome and a review of the literature. Patients and Methods: We studied eight patients with the antiphospholipid syndrome (APS) with either cardiac or cerebral or both manifestations. All patients fulfilled the proposed classification criteria for the APS according to the SSC of the ISTH. One patient died and had an autopsy. Results: Five of the eight patients had coronary artery disease with either thrombotic coronary occlusions or high grade stenosis, of which three patients had an occlusion of the left main artery or LAD. As valvular lesions have been described in association with the APS it is to note that three patients had thickening either of the mitral valve or aortic valve and one patient had an aortic valve replacement. The other two patients presented with a history of cerebral infarction. One of these patients also had a prior history of myocardial infarction, whereas the other patient had a history of aortic valve endocarditis. Conclusion: The APS can be associated with cardiac and cerebral manifestations. Acute thrombotic vessel occlusion presents as one of the most frequent vascular manifestations. Also valvular lesions can be associated with the APS.

scholarly journals 1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S308-S308 ◽  
Author(s):  
Adam Pettigrew ◽  
Ripal Jariwala ◽  
Kristen Zeitler ◽  
Jose Montero ◽  
Sandra Gompf ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clostridium Difficile ◽  
Bloodstream Infection ◽  
Broad Spectrum ◽  
Case Series ◽  
Prior History ◽  
Broad Spectrum Antibiotics ◽  
History Of ◽  
Polymicrobial Bacteremia ◽  
Hospital Acquired

Abstract Background While Clostridium difficile gastrointestinal infection (CDI) is the most common hospital-acquired infectious disease, C. difficile bacteremia (CDB) is exceedingly rare and its risk factors, mortality rate, and modalities of treatment are not well defined. Methods We conducted a retrospective, IRB approved, chart review of adult patients with a diagnosis of CDB admitted to our institutions from 2011 through 2017. Variables catalogued included previous antibiotic and proton pump inhibitor (PPI) use, co-morbid conditions, prior history of CDI, diarrhea at the time of CDB, active malignancy, and gastrointestinal (GI) disruption (e.g., perforated viscous, GI bleeding, abdominal malignancy). Treatment courses and outcomes for CDB were also gleaned. Results Seven patients with CDB were identified, with ages ranging from 35 to 81 years (median 65 years). Six (85.7%) patients had evidence of GI disruption and three (42.9%) were noted to have active cancer. Three (42.9%) patients had previous CDI by testing and three (42.9%) had complaints of diarrhea at the time of diagnosis. Six (85.7%) patients had exposure to PPIs before CDB diagnosis, and five (71.4%) had prior antibiotic exposure in the past 30 days. Five (71.4%) patients had a polymicrobial bloodstream infection, with the majority of organisms being enteric in nature. In terms of CDB treatment, the majority of patients received intravenous (IV) metronidazole and/or IV vancomycin in addition to broad-spectrum antibiotics due to the polymicrobial nature of their infection. Three (42.9%) patients died during their hospitalization, only one who had polymicrobial bacteremia. Conclusion CDI is the most common cause of hospital acquired infection, although rarely causes bacteremia. Notable findings in our population included older age, concomitant malignancy, evidence of GI disruption, and prior exposure to PPIs and antibiotics. Antibiotics chosen to treat CDB were IV metronidazole and/or IV vancomycin, with other broad-spectrum antibiotics utilized due to polymicrobial bacteremia. CDB is associated with a high mortality rate and is commonly manifested as a polymicrobial bloodstream infection. This is one of the larger case series that adds to the scant literature characterizing patients diagnosed with CDB. Disclosures All authors: No reported disclosures.

Patients with Coronary Artery Disease Have an Increased Incidence of Aspirin Resistance: Association of PFA-100 Closure Time with Clinical Findings.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1859-1859 ◽  
Author(s):  
Andrew L. Frelinger ◽  
Matthew D. Linden ◽  
Mark I. Furman ◽  
Marsha L. Fox ◽  
Marc R. Barnard ◽  
...  
Keyword(s):  
Platelet Function ◽  
Aspirin Resistance ◽  
Clinical Findings ◽  
Prior History ◽  
Limited Data ◽  
Closure Time ◽  
Cyclooxygenase 1 ◽  
History Of ◽  
Artery Disease

Abstract Background: The occurrence of thrombotic events despite aspirin (ASA) therapy in patients with vascular disease has been termed ASA resistance. However, limited data are available correlating laboratory evidence of platelet function with clinical ASA resistance. The PFA-100 collagen/epinephrine (COL/EPI) cartridge can detect the ASA-induced inhibition of platelet cyclooxygenase 1 in a high shear flow environment that mimics in vivo arterial conditions. Aim: To investigate whether there is an association of PFA-100 test results with clinical ASA resistance. Methods: Peripheral blood was collected prior to angiography from 560 sequential ASA-treated patients (81 or 325 mg > 3 d). Patients receiving thienopyridines were not excluded but those receiving GPIIb-IIIa antagonists were. Patients with normal angiographic arteries ("No CAD", low probability of ASA resistance) were compared to those with angiographic CAD or a single prior CAD event and to those with multiple CAD events ("CAD" and "Repeat CAD" respectively, higher probability of ASA resistance). Citrate 3.8% anticoagulated blood was tested in the PFA-100 in duplicate using the COL/EPI test cartridge. Patients in the No CAD group were younger, more often female, and less often diabetic, hypertensive, and lipidemic than CAD or Repeat CAD patients. Results: A short (< 142 s) closure time (CT) in at least one of the duplicate PFA-100 COL/EPI cartridges occurred more frequently in CAD and Repeat CAD patients compared to No CAD patients (p < 0.05, Table). Conclusions: Failure of ASA to inhibit platelet function, as measured by the PFA-100, is associated with CAD, even in patients without prior history of CAD. The PFA-100, a shear-dependent system, may therefore be a useful test to assess the presence of ASA resistance. This test, unlike some tests for aspirin resistance, does not include ADP and therefore can be used in patients receiving thienopyridines (a frequent co-medication with aspirin). No CAD CAD Repeat CAD *p<0.05 vs. No CAD PFA-100 CT < 142 s (no. of patients) 4 45 26 PFA-100 CD ≥ 142 s (no. of patients) 79 251 155 Total (no. of patients) 83 296 181 % PFA-100 CT < 142 s 5% 15%* 14%*

scholarly journals Respiratory Presentation of Pediatric Patients in the 2014 Enterovirus D68 Outbreak

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Georgina Martin ◽  
Rachel Li ◽  
Victoria E. Cook ◽  
Matthew Carwana ◽  
Peter Tilley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Presentation ◽  
Hospital Admissions ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Respiratory Illness ◽  
Prior History ◽  
Medical Comorbidities ◽  
History Of ◽  
Enterovirus D68

Background. In the fall of 2014, a North American outbreak of enterovirus D68 resulted in a significant number of pediatric hospital admissions for respiratory illness throughout North America. This study characterized the clinical presentation and risk factors for a severe clinical course in children admitted to British Columbia Children’s Hospital during the 2014 outbreak.Methods. Retrospective chart review of patients with confirmed EV-D68 infection admitted to BCCH with respiratory symptoms in the fall of 2014. Past medical history, clinical presentation, management, and course in hospital was collected and analyzed using descriptive statistics. Comparison was made between those that did and did not require ICU admission to identify risk factors.Results. Thirty-four patients were included (median age 7.5 years). Fifty-three percent of children had a prior history of wheeze, 32% had other preexisting medical comorbidities, and 15% were previously healthy. Ten children (29%) were admitted to the pediatric intensive care unit. The presence of complex medical conditions (excluding wheezing) (P=0.03) and copathogens was associated with PICU admission (P=0.02).Conclusions. EV-D68 infection resulted in severe, prolonged presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of wheeze and preexisting medical comorbidities appear to be most severely affected, but the virus can also cause wheezing in previously well children.

scholarly journals Post-operative functional neurological symptom disorder after anesthesia

2020 ◽  
Author(s):  
Ryan S D'Souza ◽  
Matthew NP Vogt ◽  
Edwin Rho
Keyword(s):  
Neurological Symptom ◽  
Past History ◽  
Significant Proportion ◽  
Case Series ◽  
Pharmacologic Therapy ◽  
Prior History ◽  
General Anesthetic ◽  
Tertiary Referral Hospital ◽  
History Of ◽  
Functional Neurological Symptom Disorder

A rare manifestation during the post-anesthetic period may include the occurrence of functional neurological symptom disorder (FNSD). FNSD is described as neurological symptoms that are not consistently explained by neurological or medical conditions. We report a case series consisting of six patients who underwent a general anesthetic at a tertiary referral hospital and experienced FNSD in the immediate post-anesthetic period. Life-threatening causes were excluded based on benign physical exam findings and knowledge of past history. Five of six cases manifested with FNSD only in the immediate post-operative setting after exposure to anesthesia, and never otherwise experienced these symptoms during their normal daily lives. MEDLINE and Google Scholar were searched through October 2019 using a highly-sensitive search strategy and identified 38 published cases of post-anesthetic FNSD. Meta-analysis of pooled clinical data revealed that a significant proportion of patients were females (86%), reported a history of psychiatric illness (49%), reported a prior history of FNSD (53%), and underwent general anesthesia as the primary anesthetic (93%). The majority of patients were exposed to diagnostic studies (66% received radiographic tests and 52% received electroencephalogram) as well as pharmacologic therapy (57%). While no deaths occurred, many patients had unanticipated admission to the hospital (53%) or to the intensive care unit (25%). These data may help inform the anesthesia literature on presentation, risk factors, and treatment outcomes of FNSD in the context of anesthetic administration. We contemplate whether anesthetic agents may predispose a vulnerable brain to manifest with involuntary motor and sensory control seen in FNSD.

scholarly journals STABLE ANGINA

2009 ◽  
Vol 16 (01) ◽  
pp. 94-99
Author(s):  
SHAFIQUE AHMED ◽  
MUHAMMAD BILAL AHSAN ◽  
EHSAN ULLAH ◽  
Raees Abbas
Keyword(s):  
Coronary Artery ◽  
Stable Angina ◽  
Coronary Artery Stenosis ◽  
Case Series ◽  
Artery Stenosis ◽  
P Value ◽  
Significant Difference ◽  
History Of ◽  
Male Patients ◽  
Artery Disease

Objective: To see the frequency of coronary artery stenosis in the patients of stable angina having left bundle branchblock, and to see the effects of gender and age on this correlation. Design: Experimental case series. Setting: Bahawal Victoria Hospital,Bahawalpur. Period: June 2006 to May 2008. Methods: One hundred and forty one (141) patients of Stable Angina presenting with atypicalchest pain, both male and female of 30—70 years age, positive for LBBB and with normal Cardio-Thoracic Ratio, normal echocardiographyand negative for conventional risk factors and family history of Coronary Artery Disease were taken. All patients were angiographied .Results: A total of 141 patients were investigated through coronary angiogram to see the frequency of coronary artery stenosis in thesepatients. Ninety five (67.4%) patients proved to have coronary artery stenosis. The male patients showed higher frequency (87.4%) ofharboring coronary vessel blockade as compared to that (35.2%) in females (P value <0.0005). There was no relation between age and thefrequency of coronary stenosis (P value >0.05). Conclusions: There is significant difference (P value <0.0005) in coronary artery stenosisamong men and women having LBBB.

The Novel Use of Flexible Endoscopic Techniques in the Management of Pharyngocutaneous Fistulas

2021 ◽  
Author(s):  
Shivam Patel ◽  
Colin G. DeLong ◽  
Luis De Jesus Sanchez ◽  
Neerav Goyal ◽  
Eric M. Pauli
Keyword(s):  
Case Series ◽  
Spontaneous Resolution ◽  
Prior History ◽  
Pharyngocutaneous Fistula ◽  
The Novel ◽  
Endoscopic Techniques ◽  
Anterolateral Thigh ◽  
Successful Resolution ◽  
History Of ◽  
Reduced Rate

AbstractPharyngocutaneous fistula (PCF) is a complication of laryngectomies in 14 to 23% of patients. The rate of spontaneous resolution of small and low-output fistulas has been shown to be 65 to 94% in those who are radiation-naive, with a reduced rate of resolution in patients who were previously radiated as low as 33%. Two patients are presented who underwent total laryngopharyngectomy and anterolateral thigh free flap reconstruction at our institution eventually complicated with PCF. All the pertinent patient data were retrieved through chart review from the records of our institution. The cases presented had a prior history of radiation or chemoradiation complicating the spontaneous resolution of the PCF. Both patients had successful resolution of PCF with the flexible endoscopic techniques presented. This case series highlights the management of small PCFs using flexible endoscopic techniques including over-the-scope clips and Vicryl mesh plugs.

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