Influence of the First-wave COVID-19 Pandemic on Emergency Acute Coronary Syndrome: a Multicenter Retrospective Study From a Non-epicenter Region

Background: The COVID-19 pandemic presented severe challenges to emergency practice of acute coronary syndrome (ACS). However, poor evidence was shown on ACS in a non-hot-spot region. We sought to clarify the influence of the first-wave COVID-19 pandemic on emergency ACS from a non-epicenter region.Methods: This retrospective multicenter study was conducted in emergency ACS patients during the pandemic (from 2020-01-23 to 2020-03-29) and the ones during the same period in 2019. Clinical characteristics, timeline parameters and treatment strategies were compared between different groups. Association of the pandemic with non-invasive therapy was further assessed.Results: Compared with 2019, ACS had a drop in admission (267 cases vs. 475 cases) and invasive therapy (140 cases vs. 318 cases). Also, process delays were detected including the period from symptom onset to first medical contact (S-to-FMC, 5h vs. 2.5h), the period from FMC to electrocardiogram (ECG) completed (8min vs. 4min) and the period from FMC to dual antiplatelet therapy (FMC-to-DAPT, 25min vs. 19min). Primary percutaneous coronary intervention (PPCI) decreased by 54.9% in STEMI and early invasive therapy decreased by 59.2% in NSTE-ACS. The proportion of invasive therapy in NSTE-ACS decreased more than in STEMI (16.9% vs. 10.1%) with longer process delay. The pandemic was associated with increased non-PPCI in STEMI (OR=1.707, 95%CI 1.082-2.692, P=0.021) and elevated medication in NSTE-ACS (OR=2.029, 95%CI 1.268-3.247, P=0.003), respectively. Conclusion: Even in a non-epicenter region, the first-wave COVID-19 pandemic caused a significant reduction of invasive therapy and evident process delays in emergency ACS.

Comparison of the effectiveness of non invasive and invasive therapy in the removal of viral warts of the foot skin

The aim of this review was to compare the effectiveness of natural and invasive therapy in the removal of viral warts of the foot skin. A research was conducted based on 25 studies on wart removal with salicylic acid, pyruvic acid and formic acid, retinoids, 5-fluorouracil, phenol, occlusion, lasers: CO2, KTP, Nd:Yag, Er:Yag, pulse-dye, cryotherapy, electrocoagulation and surgical method. When comparing natural and invasive treatments, similar effectiveness was concluded, and the presented studies did not show any advantage one over the other.

Shoulder transcutaneous electric nerve stimulation decreases heart rate via potentiating vagal tone

By enhancing vagal activity, auricle transcutaneous electric nerve stimulation (TENS) is developed as a non-invasive therapy for heart failure. Nevertheless, though shoulder TENS used for treating adhesive capsulitis could affect vagal tone, its potential impact on heart functions remains unclear. In this study, electrocardiogram (ECG) and heart rate (HR) of subjects in response to sham, right-sided, or left-sided shoulder TENS (TENS-S, TENS-R, and TENS-L, respectively; 5 min) were recorded and analyzed. During the stimulation period, TENS-R constantly and TENS-L transiently decreased the HR of subjects; both TENS-R and TENS-L increased powers of the low- and high-frequency spectra. While TENS-R exhibiting no effect, TENS-L increased the ratio of low/high-frequency power spectrum indicating TENS-R decreased the HR through potentiating cardiac vagal tone. Collectively, these results suggest TENS could be an early and non-invasive therapy for heart failure patients before considering implant devices or devices are not feasible; moreover, therapists/physicians need to carefully monitor the potential adverse events during treatment for patient safety.Trial registration: The study protocol was registered in ClinicalTrials.gov (NCT03982472; 11/06/2019).

Unusual case of immune haemolytic disease causing severe neonatal cholestasis in a newborn

Neonatal hyperbilirubinaemia is a very common entity witnessed in most of the newborns. Rarely are there events where the bilirubin levels reach extreme values mandating invasive therapy. Unconjugated hyperbilirubinaemia when solely present is easy to manage and diagnose the common aetiological factors associated with it. The issue arises when we come across a mixed picture of conjugated with unconjugated hyperbilirubinaemia and puts us in a dilemma as to what are we treating. Our case highlights a similar picture where we witnessed the highest documented levels of total bilirubin but to our surprise the major component of which was direct bilirubin. This report takes us through the differentials which were ruled out and our management strategies for solving this rare mystery.