Theophylline in Treatment of COVID-19 Induced Sinus Bradycardia

This is a retrospective case series of two patients with laboratory-confirmed coronavirus 2 (SARS-CoV-2) infection, presented to the University of Arkansas for Medical Sciences in January 2021. Medical records of these patients were reviewed using the EPIC electronic health record system. Clinical, laboratory, and treatment data were reviewed against periods of bradycardia in each patient. Both of the patients presented with dizziness and presyncope related to sinus bradycardia in which they received treatment with 1 mg of IV atropine and theophylline 200 mg orally. We share these two cases of theophylline treatment in COVID-19 induced sinus bradycardia. The first patient was a 39-year-old female, with a past medical history of polycystic ovarian syndrome, who presented to the emergency department with lightheadedness and dizziness. Two weeks prior to her presentation, she was tested positive for COVID-19 infection that was treated with azithromycin, dexamethasone and aspirin. Upon presentation, her ECG showed sinus bradycardia at a rate of 48 bpm. The second patient, a 21-year-old female with no significant past medical history, presented with presyncope. Three weeks prior to her presentation, she tested positive for COVID-19 infection that was treated symptomatically at her home. Upon presentation, her ECG showed junctional rhythm at a heart rate of 51 bpm.

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Unmasking of Neurosarcoidosis

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1260 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A618-A618

Author(s):

Sharini Venugopal ◽

Binita Neupane ◽

Mahesh Nepal ◽

Luis F Chavez

Keyword(s):

Diabetes Insipidus ◽

Medical History ◽

Case Reports ◽

Rare Complication ◽

Case Series ◽

Primary Hypothyroidism ◽

Past Medical History ◽

Water Excretion ◽

History Of ◽

Glucocorticoid Deficiency

Abstract Introduction: Central diabetes insipidus is a rare complication of neurosarcoidosis. In patients with concomitant adrenal insufficiency (AI), the symptoms of Diabetes Insipidus (DI) can be masked. Case: A 55-year-old female with past medical history of sarcoidosis presented to the hospital with hematemesis, nausea and dizziness. She has a past medical history of cardiac sarcoidosis that was revealed on a PET scan done before 10 years for which she was being treated with methotrexate and prednisone. She was off prednisone for a year prior to hospitalization. She underwent an upper endoscopy that showed diffusely erythematous gastric mucosa in the antrum. She was also hypotensive on admission, and she received packed red blood transfusions after which her sodium increased from 145mmol/L to 165mmol/L (Normal: 135-145mmol/L) in 48 hours. Further workup revealed persistent hypernatremia and urine osmolality was 75mOsm/kg H2O. (Normal: 50-1200mOsm/kg H2O). She was also hypoglycemic and hypotensive requiring multiple fluid boluses throughout her hospitalization. This prompted us to perform a random cortisol that came back at 2.1ug/dl (Normal: 3-23ug/dl) and 1.8ug/dl on two occasions. Cortisol Stimulation test was subsequently ordered, but was done only at 30 minutes, and Cortisol increased from 1.8ug/dl to 6.3ug/dl. Free thyroxine was 0.5 ng/dl (Normal: 0.9-1.8 ng/dl) and her TSH was 7.58uIU/ml (Normal: 0.55-4.78uIU/ml). MRI of the brain revealed extensive areas of extra-axial supra-sellar/infundibular nodular homogeneous intense enhancement that is most consistent with neuro-sarcoid. She was started on prednisone 40 mg daily, Desmopressin 0.05 mg twice daily, and levothyroxine as well. Her sodium level normalized and was 137mmol/L at discharge. She followed up later with outpatient Endocrinology and reported around 90lbs weight gain and no more episodes of nausea or vomiting or epistaxis or lightheadedness. Conclusion: The involvement of the hypothalamic-pituitary axis in sarcoidosis is extremely rare and attributes to < 1% of patients with a sellar mass. Small case series have shown that hypogonadism is the most common endocrine abnormality followed by DI. Our patient had a long-standing history of sarcoidosis with her pituitary dysfunction unmasked only on admission for other causes. She did not manifest any symptoms of DI or AI. There have been case reports where the symptoms of DI are masked due to underlying glucocorticoid deficiency. There have been theories that glucocorticoid deficiency impairs renal water excretion by both ADH (Anti-diuretic hormone) dependent and ADH independent pathways. Another notable feature in our case is that our patient presented with primary hypothyroidism. In fact, sarcoidosis has been commonly implicated in auto-immune polyglandular syndromes type 3, which can present with auto-immune thyroiditis more so in females.

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An unusual suspect for heart failure

Acute Medicine Journal ◽

10.52964/amja.0797 ◽

2020 ◽

Vol 19 (1) ◽

pp. 42-42

Author(s):

Christianne Tan ◽

◽

Hitesh C Patel ◽

Justin Mariani ◽

◽

...

Keyword(s):

Heart Failure ◽

Medical History ◽

Clinical Examination ◽

Venous Pressure ◽

Heart Sounds ◽

Past Medical History ◽

Jugular Venous Pressure ◽

Significant Past Medical History ◽

Chest Auscultation ◽

History Of

A 71-year old retired missionary presented with a 2- week history of increasing dyspnoea, orthopnoea, and peripheral oedema. The patient had no previous significant past medical history. On clinical examination, his heart sounds were dual and his jugular venous pressure was elevated to 7cm. On chest auscultation there were bilateral crepitations at his lung bases.

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An unusual Cause of Periorbital Swelling in a Young Female

Acute Medicine Journal ◽

10.52964/amja.0420 ◽

2015 ◽

Vol 14 (2) ◽

pp. 93-94

Author(s):

Ursula Griffiths ◽

◽

Darshan Kumar ◽

Micheal Trimble ◽

Siddhesh Prabhavalkar ◽

...

Keyword(s):

Medical History ◽

Skin Rash ◽

Young Female ◽

Past Medical History ◽

Significant Past Medical History ◽

Neck Stiffness ◽

History Of ◽

Periorbital Swelling

A 16 year old female was admitted with a one week history of headache and swelling of both upper eyelids. Other symptoms included nausea, tiredness, dizziness and photophobia with no symptoms of skin rash, or neck stiffness. She had been previously very well with no significant past medical history.

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Airway Safety in a Patient with Submandibular Swelling

Journal of Perioperative Practice ◽

10.1177/175045891702700305 ◽

2017 ◽

Vol 27 (3) ◽

pp. 59-61

Author(s):

S De Silva

Keyword(s):

Emergency Department ◽

General Practitioner ◽

Medical History ◽

Past Medical History ◽

Significant Past Medical History ◽

History Of ◽

Regular Medication

A fifty-eight year old gentleman (CH) with a five-day history of toothache presented to the emergency department (ED) with increasing pain with associated submandibular swelling over the last 24-hours. He was an unkempt gentleman who had not consulted his general practitioner or dentist in many years, was unaware of any significant past medical history and was not on any regular medication. He was an obese gentleman with a BMI of 56.

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Novel coronavirus 19 (COVID-19) associated sinus node dysfunction: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa132 ◽

2020 ◽

Vol 4 (FI1) ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Graham Peigh ◽

Marysa V Leya ◽

Jayson R Baman ◽

Eric P Cantey ◽

Bradley P Knight ◽

...

Keyword(s):

Respiratory Failure ◽

Medical History ◽

Sinus Bradycardia ◽

Sinus Node ◽

Case Series ◽

Sinus Node Dysfunction ◽

Past Medical History ◽

Hypoxic Respiratory Failure ◽

Novel Coronavirus ◽

New Onset

Abstract Background Novel coronavirus-19 disease (COVID-19) is associated with significant cardiovascular morbidity and mortality. To date, there have not been reports of sinus node dysfunction (SND) associated with COVID-19. This case series describes clinical characteristics, potential mechanisms, and short-term outcomes of COVID-19 patients who experience de novo SND. Case summary We present two cases of new-onset SND in patients recently diagnosed with COVID-19. Patient 1 is a 70-year-old female with no major past medical history who was intubated for acute hypoxic respiratory failure secondary to COVID-19 pneumonia and developed new-onset sinus bradycardia without a compensatory increase in heart rate in response to relative hypotension. Patient 2 is an 81-year-old male with a past medical history of an ascending aortic aneurysm, hypertension, and obstructive sleep apnoea who required intubation for COVID-19-induced acute hypoxic respiratory failure and exhibited new-onset sinus bradycardia followed by numerous episodes of haemodynamically significant accelerated idioventricular rhythm. Two weeks following the onset of SND, both patients remain in sinus bradycardia. Discussion COVID-19-associated SND has not previously been described. The potential mechanisms for SND in patients with COVID-19 include myocardial inflammation or direct viral infiltration. Patients diagnosed with COVID-19 should be monitored closely for the development of bradyarrhythmia and haemodynamic instability.

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

Transplantology ◽

10.3390/transplantology2020022 ◽

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.

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Vestibular neuritis caused by severe acute respiratory syndrome coronavirus 2 infection diagnosed by serology: Case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x211013261 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110132

Author(s):

Alexandra Halalau ◽

Madalina Halalau ◽

Christopher Carpenter ◽

Amr E Abbas ◽

Matthew Sims

Keyword(s):

Case Report ◽

Severe Acute Respiratory Syndrome ◽

Medical History ◽

Cranial Nerve ◽

Respiratory Illness ◽

Vestibular Neuritis ◽

Past Medical History ◽

Significant Past Medical History ◽

Eighth Cranial Nerve ◽

Male Physician

Vestibular neuritis is a disorder selectively affecting the vestibular portion of the eighth cranial nerve generally considered to be inflammatory in nature. There have been no reports of severe acute respiratory syndrome coronavirus 2 causing vestibular neuritis. We present the case of a 42-year-old Caucasian male physician, providing care to COVID-19 patients, with no significant past medical history, who developed acute vestibular neuritis, 2 weeks following a mild respiratory illness, later diagnosed as COVID-19. Physicians should keep severe acute respiratory syndrome coronavirus 2 high on the list as a possible etiology when suspecting vestibular neuritis, given the extent and implications of the current pandemic and the high contagiousness potential.

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Past medical history of tumors other than meningioma is a negative prognostic factor for tumor recurrence in meningiomas WHO grade I

Acta Neurochirurgica ◽

10.1007/s00701-021-04780-9 ◽

2021 ◽

Author(s):

Annamaria Biczok ◽

Philipp Karschnia ◽

Raffaela Vitalini ◽

Markus Lenski ◽

Tobias Greve ◽

...

Keyword(s):

Medical History ◽

Tumor Recurrence ◽

Clinical History ◽

Study Endpoint ◽

Past Medical History ◽

Who Grade ◽

Increased Risk ◽

History Of ◽

Meningioma Recurrence ◽

The Impact

Abstract Background Prognostic markers for meningioma recurrence are needed to guide patient management. Apart from rare hereditary syndromes, the impact of a previous unrelated tumor disease on meningioma recurrence has not been described before. Methods We retrospectively searched our database for patients with meningioma WHO grade I and complete resection provided between 2002 and 2016. Demographical, clinical, pathological, and outcome data were recorded. The following covariates were included in the statistical model: age, sex, clinical history of unrelated tumor disease, and localization (skull base vs. convexity). Particular interest was paid to the patients’ past medical history. The study endpoint was date of tumor recurrence on imaging. Prognostic factors were obtained from multivariate proportional hazards models. Results Out of 976 meningioma patients diagnosed with a meningioma WHO grade I, 416 patients fulfilled our inclusion criteria. We encountered 305 women and 111 men with a median age of 57 years (range: 21–89 years). Forty-six patients suffered from a tumor other than meningioma, and no TERT mutation was detected in these patients. There were no differences between patients with and without a positive oncological history in terms of age, tumor localization, or mitotic cell count. Clinical history of prior tumors other than meningioma showed the strongest association with meningioma recurrence (p = 0.004, HR = 3.113, CI = 1.431–6.771) both on uni- and multivariate analysis. Conclusion Past medical history of tumors other than meningioma might be associated with an increased risk of meningioma recurrence. A detailed pre-surgical history might help to identify patients at risk for early recurrence.

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Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100718794851 ◽

2018 ◽

Vol 40 (1) ◽

pp. 98-104 ◽

Cited By ~ 5

Author(s):

Johanna Marie Richey ◽

Miranda Lucia Ritterman Weintraub ◽

John M. Schuberth

Keyword(s):

Risk Factors ◽

Hormone Replacement ◽

Case Series ◽

Foot And Ankle ◽

Retrospective Case ◽

Level Of Evidence ◽

Ankle Surgery ◽

History Of ◽

Low Incidence ◽

Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

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