scholarly journals Acute cardiac side effects after COVID-19 mRNA vaccination, a case series

2021 ◽  
Author(s):  
Noemi F. Freise ◽  
Milena Kivel ◽  
Olaf Grebe ◽  
Christian Meyer ◽  
Bahram Wafaisade ◽  
...  
Keyword(s):  
Chest Pain ◽  
Side Effects ◽  
Clinical Information System ◽  
Case Reports ◽  
Case Series ◽  
Clinical Information ◽  
Cardiac Symptom ◽  
Cardiac Side Effects ◽  
Cardiac Symptoms ◽  
Magnetic Resonance Imaging Mri

Abstract Background: Since development and approval of the world´s first mRNA vaccines, created under pressure of the global pandemic caused by SARS-CoV-2, potential side effects have naturally been a much-debated topic. Vaccination may be one, if not the only way out of the pandemic claiming more than 4 million deaths worldwide to date. Potential side effects from vaccination have long been controversial, and case reports of fatal side effects have been published. Therefore, data are needed to identify persons being at high risk for potential side effects. Until September 30, 2021, 1.243 cases of myocarditis after vaccination with BNT162b2 Comirnaty© in young adults were registered by the Paul-Ehrlich-Institute in Germany alone. The exact pathophysiology and the risk factors for myocarditis following vaccination remain unclear. We present a case series of eight patients with cardiac symptom shortly after SARS-CoV-2 mRNA vaccination (BNT162b6, Biontech, Comirnaty© or mRNA-1237 Moderna, Spikevax©).Patients and Methods: Eight patients between 13-56 years of age, vaccinated with mRNA vaccine either BNT162b2 or mRNA-1273 between January and August 2021 developed cardiac side effects shortly after either their first or second vaccination. Clinical data were retrieved from the clinical information system and analyzed. To support diagnosis of myocarditis or pericarditis, cardiac magnetic resonance imaging (MRI) was performed shortly after onset of symptoms and investigated further in severe cases. Symptoms were defined as dyspnea, chest pain, cardiac arrhythmia as determined by electrocardiography.Results: Eight patients (five males and three females) developed cardiac symptoms compatible with myocarditis according to CDC criteria shortly after SARS-CoV-2 mRNA vaccination. Three patients (two males, one female) required hospitalization due to severe chest pain and elevated troponin levels. All patients recovered fully within seven days after symptom onset Conclusion: Our data suggest that cardiac adverse events such as myocarditis or pericarditis shortly after SARS-CoV-2 mRNA vaccination are rare but possible and occur particularly in male patients.

scholarly journals Voriconazole versus Itraconazole for the Initial and Step-Down Treatment of Histoplasmosis: A Retrospective Cohort

2020 ◽  
Author(s):  
Michael Joshua Hendrix ◽  
Lindsey Larson ◽  
Adriana M Rauseo ◽  
Sasinuch Rutjanawech ◽  
Alexander D Franklin ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Proportional Hazards ◽  
Histoplasma Capsulatum ◽  
Case Reports ◽  
Case Series ◽  
Clinical Information ◽  
Cox Proportional Hazards ◽  
Heaviside Function ◽  
Step Down

Abstract Background Itraconazole is the preferred azole for histoplasmosis in the current Infectious Diseases Society of America guidelines. Voriconazole is increasingly used as treatment for histoplasmosis; it has in-vitro activity against Histoplasma capsulatum and has shown success in case reports and small case series but may have a lower barrier to resistance. No comparative studies have been published. Methods We constructed a single-center retrospective cohort of adult patients diagnosed with histoplasmosis from 2002 to 2017. Individual charts were reviewed to gather clinical information including demographics, clinical features, immune status, treatments, and mortality. Patients were categorized based on initial choice of azole, either as initial treatment or as step-down therapy from amphotericin B. Initial therapies with other azoles were excluded. Mortality was compared using a multivariable Cox proportional hazards with Heaviside function at 42 days. Results We identified 261 cases of histoplasmosis from 2002 to 2017. After excluding patients not treated with itraconazole or voriconazole, 194 patients remained. 175 (90%) patients received itraconazole and 19 (10%) received voriconazole. There were no significant demographic differences between patient populations receiving either azole as their initial azole treatment. Death at 180 days occurred in 41 patients (23.4%) in the itraconazole group and 6 patients (31.6%) in the voriconazole group. Patients on voriconazole had a statistically significant increase in mortality during the first 42 days after initiation of treatment when compared to patients receiving itraconazole (HR 4.30 [95% CI 1.3-13.9, p 0.015]) when controlled for other risk factors. Conclusion Voriconazole in histoplasmosis was associated with increased mortality in the first 42 days compared to itraconazole.

Amiodarone neurotoxicity: the other side of the medal

Open Medicine ◽  
2014 ◽  
Vol 9 (3) ◽  
pp. 437-442 ◽  
Author(s):  
Giuliana Galassi ◽  
Eleni Georgoulopoulou ◽  
Alessandra Ariatti
Keyword(s):  
Side Effects ◽  
Brain Magnetic Resonance Imaging ◽  
P100 Latency ◽  
Sensorimotor Polyneuropathy ◽  
Mechanisms Of Toxicity ◽  
Cardiac Side Effects ◽  
Patients At Risk ◽  
Laboratory Examinations ◽  
Magnetic Resonance Imaging Mri

AbstractThe efficacy of amiodarone is tempered by its toxicity, with 50% of long-term users discontinuing the drug. The non-cardiac side effects of amiodarone may involve central and peripheral nervous system. We studied two patients treated with amiodarone for 46 and 15 months respectively. Both patients exhibited progressive distal extremity weakness, impaired perception, loss of deep reflexes. Electrophysiology identified a widespread, sensorimotor polyneuropathy with features of axonal loss and demyelination. Visual evoked potentials (VEPs) showed prolonged P100 latency bilaterally in absence of visual symptoms or brain magnetic resonance imaging (MRI) abnormalities. Extensive laboratory examinations excluded known causes of peripheral neuropathies. At 21 months after amiodarone withdrawal, P100 latency of case 1 VEPs returned to normal, whereas polyneuropathy continued to progress. In the second patient neuropathy has worsened similarly over 2 years whereas P100 latency of VEPs recovered to normal within 7 months after withdrawal of amiodarone. These findings may suggest different mechanisms of toxicity, which could be due to amiodarone pharmacokinetic and its metabolite effects on the peripheral nerves, as opposed to the optic nerve. We emphasize that use of amiodarone needs monitoring of patients at risk of development side effects.

A Lethal Side Effect of Treatment by Macitentan

2020 ◽  
Author(s):  
Oumaima Naour
Keyword(s):  
Chest Pain ◽  
Side Effects ◽  
Side Effect ◽  
Acute Myocarditis ◽  
Human Case ◽  
Double Outlet Right Ventricle ◽  
St Segment Elevation ◽  
Cardiac Side Effects ◽  
St Segment ◽  
Pulmonary Arterial

Pulmonary arterial hypertension is a progressive and ultimately fatal disease despite the availability of a number of new therapies, including endothelin receptor antagonists. Many side effects have been reported with the use of these drugs, such as hepatotoxicity, peripheral edema, anemia and other digestive reactions. Cardiac side effects have been rarely mentioned. We report the case of a 17-year-old girl with Eisenmenger syndrome secondary to double outlet right ventricle and sub-pulmonary ventricular septal defect, Macitentan treatment has been started, three days later, she presented a ST segment elevation in septo-apico- lateral territory which shortly complicated with cardiogenic shock and death. A coronary arteritis or acute myocarditis of toxic origin was the two evoked diagnoses. This is the first human case in the medical literature describing a relationship between initiation of Macitentan and the onset of this event. This case highlights a lethal side effect of Macitentan, which should prompt patients to notify their doctors of any symptoms suggestive of coronary or myocardial injury (chest pain, dyspnea, heart failure symptoms), and implementation of electrocardiogram in combination with a control in any patient who develops chest pain on Macitentan.

Abstract 15334: Increased Physical Activity is Associated With Lower Prevalence of Cardiac Symptoms in Adolescents: An Analysis of the Heartbytes Screening Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Abhinav Nair ◽  
Max Weiss ◽  
Sean Dikdan ◽  
Jennifer Wellings ◽  
Drew Johnson ◽  
...  
Keyword(s):  
Physical Activity ◽  
Chest Pain ◽  
Physical Activity Level ◽  
Activity Level ◽  
Exertional Dyspnea ◽  
Cardiac Symptom ◽  
Cardiac Symptoms ◽  
Weekly Physical Activity ◽  
Cv Disease ◽  
The Relationship

Background: The ACC/AHA currently recommend performing a 14-point cardiovascular (CV) evaluation when screening healthy student-athletes for CV disease. This includes a focused history to assess for cardiac symptoms including exertional chest pain, dyspnea, fatigue, palpitations, and syncope. Though the presence of these symptoms may suggest underlying CV disease, additional factors including hours of weekly physical activity may influence the prevalence of reported symptoms. The relationship between physical activity level and the prevalence of cardiac symptoms has not been fully studied in an adolescent population. Methods: We analyzed the results of 10683 consecutive athlete screenings (median age 15 years) from HeartBytes, a data registry of pre-participation youth CV screenings utilizing the 14-point AHA evaluation. Cardiac symptoms and hours of weekly physical activity were self-reported. Weekly activity level was reported as less than 2 hours, between 2 and 5 hours, between 5 and 10 hours, or as greater than 10 hours. A chi-squared analysis for independence was performed to evaluate the relationship between physical activity level and each cardiac symptom. Results: Chest pain was reported in 5.1% of athletes, and increasing hours of physical activity was associated with less reported pain ( X 2 = 73.01, p <.001). Exertional dyspnea was reported in 11.7% of individuals, and increasing activity was associated with less reported dyspnea ( X 2 = 120.53, p <.001). Easy fatigability was reported in 7.5% of individuals, with more activity associated with less reported fatigue ( X 2 = 376.61, p <.001). Palpitations were reported in 5.1% of those screened, with increasing activity was associated with less reported palpitations ( X 2 = 95.34, p <.001). Finally, syncope was reported in 1.1% of athletes, though there was no relationship between activity level and syncope ( X 2 = 5.53, p = 0.24). Conclusion: Increased physical activity is associated with lower rates of reported chest pain, exertional dyspnea, easy fatigability, and palpitations in adolescents. Further studies are needed to clarify the relationship in youth athletes between symptoms and CV health.

111 Epileptic seizures in multiple sclerosis

2018 ◽  
Vol 89 (6) ◽  
pp. A44.1-A44
Author(s):  
Stephen Walsh ◽  
Joel Corbett ◽  
K Meng Tan ◽  
Simon Broadley
Keyword(s):  
Multiple Sclerosis ◽  
Demyelinating Disease ◽  
Age Of Onset ◽  
Case Reports ◽  
Case Series ◽  
Clinical Information ◽  
Epileptic Seizures ◽  
Disease Course ◽  
Number Of Patients ◽  
Significant Difference

IntroductionEpileptic seizures have been described in association with multiple sclerosis (MS) in both anecdotal case reports and case series. The recent identification of specific antibodies to myelin oligodendrocyte glycoprotein (MOG) protein in a small number of patients with demyelinating disease which may resemble neuromyelitis optica or acute disseminated encephalopathy, which may involve seizures, raises the possibility that anti-MOG antibody related demyelination may account for the association of epilepsy with MS.MethodsWe have undertaken a retrospective review of cases of MS diagnosed at the Gold Coast MS clinic over a 10 year period. All cases were systematically asked if they had ever had an epileptic seizure either via a patient completed questionnaire or at a clinic visit. Demographic and clinical information were also recorded. These data have been analysed using descriptive statistics and appropriate tests for significant differences between those with epilepsy and those without.Results428 cases with complete data were identified. Those with a history of epilepsy were slightly younger (median (range); 44.5 (27–64) years vs 4715–88 years), but this difference was not statistically significantly different. The gender ratio was the same for both groups (9/12 (75%) for those with epilepsy and 326/416 (78%)). There was no significant difference in age of onset, disease course, relapse frequency or level of disability. Although numbers are small, seizure appear to occur most frequently earlier in the disease course and are rarely an ongoing issue.ConclusionThese data support earlier work indicating that epilepsy occurs in people with MS who are younger. This fits with the notion that seizures arise in the context of the inflammatory stage of multiple sclerosis rather than the degenerative phase. Further work needs to be undertaken to assess any association with anti-MOG antibodies and epileptic seizures in demyelinating disease.

scholarly journals A case series of efavirenz induced gynaecomastia

2021 ◽  
Vol 8 (7) ◽  
pp. 984
Author(s):  
Balakrishna Teli ◽  
Sneha Biradar ◽  
Sheshan V. S.
Keyword(s):  
Side Effects ◽  
Hiv Infection ◽  
Side Effect ◽  
Case Reports ◽  
Case Series ◽  
Drug Adherence ◽  
Resource Limited Settings ◽  
Highly Active ◽  
Resource Limited ◽  
Haart Therapy

The prognosis of HIV infection has significantly changed following the introduction of highly active anti-retroviral therapy by reducing AIDS related morbidity and mortality. At the same time, HAART is documented for its side effects. Gynaecomastia is a less documented side effect of a commonly used ART drug efavirenz. There are only few case reports of HAART-induced gynaecomastia in resource limited settings. Initially gynaecomastia related to HAART in HIV patients was thought due to lipodystrophy and was termed as pseudogynaecomastia. Later, few case reports of efavirenz related gynaecomastia were published after ruling out other causes of gynaecomastia. All other causes of gynaecomastia were ruled out in our patients too. The incidence of gynaecomastia is increasing in men with HIV on HAART therapy, proper identification and management will promote better drug adherence. The present study presented a series of two cases that developed ultrasound confirmed gynaecomastia following efavirenz containing HAART.

scholarly journals Gemcitabine-Induced Cardiotoxicity in Patients Receiving Adjuvant Chemotherapy for Pancreatic Cancer: A Case Series

2018 ◽  
Vol 11 (1) ◽  
pp. 221-227 ◽  
Author(s):  
Salma Alam ◽  
Chidi Illo ◽  
Yuk Ting Ma ◽  
Pankaj Punia
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Chemotherapy ◽  
Cardiac Failure ◽  
Case Reports ◽  
Case Series ◽  
Standard Of Care ◽  
Cardiac Side Effects ◽  
Early Withdrawal ◽  
Pancreatic Cancers ◽  
Patients With Diabetes

Gemcitabine is not considered a cardiotoxic agent generally; so far only very few case reports have been reported in the literature on different aspects of cardiac side effects. Here we report a case series of 3 patients who developed congestive cardiac failure, when treated with gemcitabine monotherapy in the adjuvant setting for pancreatic cancers. Adjuvant chemotherapy with gemcitabine has been the standard of care for pancreatic cancer patients after successful surgery since the results of the CONKO-001 and ESPAC3 study were published. Gemcitabine was administered on days 1, 8, and 15 of a 28-day cycle at 1,000 mg/m2. All 3 patients developed symptoms suggestive of cardiac failure with a drop in ejection fraction on echocardiography, and responded to conservative treatment for heart failure after withdrawal of gemcitabine therapy. Early withdrawal of gemcitabine chemotherapy is recommended in addition to a need for studies required to evaluate the mechanism of cardiotoxicity. As per available literature, patients with diabetes and having received a total dose greater than 15,000 mg/m2 are generally at a higher risk and require close surveillance.

Case Reports of Acne and Homeopathy

2018 ◽  
Vol 25 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Lawrence C. Nwabudike
Keyword(s):  
Side Effects ◽  
Classical Method ◽  
Remission Rate ◽  
Case Reports ◽  
Acne Vulgaris ◽  
Case Series ◽  
Individual Characteristics ◽  
Severe Acne ◽  
Long Term Follow Up ◽  
The Aesthetic

Background: Acne vulgaris is a self-limiting disorder of the pilosebaceous unit. The aesthetic aspect of the disorder may provoke depression and diminish the quality of life. A number of agents are used for acne treatment, e.g., retinoids, antibiotics, benzoic acid, azelaic acid, and hormones. These agents have side-effects, sometimes severe ones. Case Reports: Presented are 2 cases of severe acne treated with individualized homeopathic medicines. Both patients were treated using the classical method of homeopathy, i.e., a single medicine based on the patient's individual characteristics was prescribed. The cases were documented photographically at onset and during the course of treatment. Both patients went into remission following treatment, and long-term follow-up suggested that the therapy remained efficacious long after cessation of treatment. No significant side effects were noted. Conclusions: Homeopathic medicines may be useful as stand-alone treatment of patients with severe acne vulgaris. A case series suggested a remission rate of more than 80% using individualized homeopathic treatment. The treatment remained efficacious long after cessation and is not accompanied by significant side-effects. It is to be hoped that this presentation will stimulate research interest into homeopathic medicines as stand-alone or adjunct treatments of acne.

scholarly journals OnabotulinumtoxinA for trigeminal neuralgia: a review of the available data

2015 ◽  
Vol 73 (10) ◽  
pp. 877-884 ◽  
Author(s):  
Pedro A. Kowacs ◽  
Marco A. T. Utiumi ◽  
Fábio A. Nascimento ◽  
Elcio J. Piovesan ◽  
Helio A. G. Teive
Keyword(s):  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Case Reports ◽  
Therapeutic Option ◽  
Case Series ◽  
Neurosurgical Procedures ◽  
Open Label ◽  
Randomized Controlled ◽  
Pain Syndromes ◽  
Proven Efficacy

Trigeminal neuralgia (TN) patients may develop side effects from centrally acting drugs, have contraindications for neurosurgical procedures, or experience relapse during conventional therapies. OnabotulinumtoxinA (BoNT/A) has been reported to be effective for TN, although this finding has been challenged. An overview of the available evidence based on a narrative/qualitative analysis of the literature is presented. About 90% of patients who receive BoNT/A show an improvement, a higher figure than that reported for the placebo effect of BoNT/A for other headaches. Tolerability of BoNT/A is good, and its few side-effects are transient. The articles reviewed were mainly case reports, case series and open-label trials; however, randomized controlled trials have endorsed the efficacy of BoNT/A for TN. This evidence, together with a better understanding of the analgesic mechanisms of BoNT/A and its proven efficacy in treating other pain syndromes, supports the use of this toxin as a therapeutic option for TN.

scholarly journals A Case of Coronary Vasospasm after Repeat Rituximab Infusion

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Calvin Ke ◽  
Amit Khosla ◽  
Margot K. Davis ◽  
Cameron Hague ◽  
Mustafa Toma
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
Coronary Artery ◽  
Side Effects ◽  
Cardiac Risk ◽  
Coronary Vasospasm ◽  
Cardiac Side Effects ◽  
Multiple Exposures ◽  
St Segment ◽  
Multiple Cycles

Coronary artery vasospasm (CAV) can be triggered by medication reactions. CAV occurring after multiple exposures to rituximab has not been previously described. A 61-year-old woman with no cardiac risk factors was treated with the sixth cycle of gemcitabine, cisplatin, dexamethasone, and rituximab therapy. Fifteen minutes after rituximab infusion commenced, she developed typical cardiac chest pain with ST segment elevations on electrocardiogram. Angiogram revealed evidence of coronary vasospasm. The patient was successfully treated with amlodipine. This case underlines the importance of monitoring cardiac side effects of rituximab therapy, even after multiple cycles.

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