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Rivera Boadla ME, Naeem A, Kumari S, Mazhar Uddin SM, Farooqui A, Maheshwari S, Seitllari A, Haq Z, Khan MH, Epstein DJ, Singh S, Hollander G, Kumar K. Third-Degree Heart Block in COVID-19 Pneumonia Complicated by Methicillin-Resistant Staphylococcus Aureus (MRSA) Bacteremia. A Case Report and Review of Literature. J Community Hosp Intern Med Perspect 2023; 13:76-79. [PMID: 38596545 PMCID: PMC11000843 DOI: 10.55729/2000-9666.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 04/11/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) burden has been identified to cause multiorgan damage. Respiratory compromise is still one of the most common presentations, but cardiac injuries like myocardial injury, ischemia, and conduction abnormalities are also becoming prevalent. We present a case of an 87-year-old male with a history of dementia, type 2 diabetes mellitus, hypertension, chronic kidney disease, and a left kidney transplant hospitalized for respiratory distress and generalized tonic-clonic seizures. He was bradycardic to 27 beats per minute, hypotensive with mean arterial pressure <60 mm Hg. An electrocardiogram (EKG) depicted a high-grade atrioventricular block (AV-block). The transvenous pacemaker was placed via femoral access and tested positive for COVID-19. Work-up was done to rule out possible causes of bradycardia, like hypothyroidism, ischemia, AV nodal blocking agents, and drug-induced bradycardia was negative. His hospital stay got complicated by methicillin-resistant staphylococcus aureus (MRSA) pneumonia leading to empyema and bacteremia. Unfortunately, being critically ill, the family opted for comfort measures, and he passed away. Our clinical vignette signifies cardiovascular complications in COVID-19 patients are associated with poor outcomes if not addressed. The conduction abnormalities in patients with intact cardiac structure and function are becoming more common in the setting of COVID infection. Assessment with serial EKGs and cardiac monitoring might be essential as patients can develop AV blocks at any point of the disease.
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Affiliation(s)
| | - Azka Naeem
- Maimonides Medical Center,
United States
| | - Sapna Kumari
- Ross University, School of Medicine,
United States
| | | | | | | | | | - Zara Haq
- Sindh Police Hospital, Karachi,
Pakistan
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Healthy Immunity on Preventive Medicine for Combating COVID-19. Nutrients 2022; 14:nu14051004. [PMID: 35267980 PMCID: PMC8912522 DOI: 10.3390/nu14051004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 02/06/2023] Open
Abstract
Immunomodulation is influenced by the consumption of nutrients, and healthy immunity is pivotal to defending an individual from a variety of pathogens. The immune system is a network of intricately regulated biological processes that is comprised of many organs, cellular structures, and signaling molecules. A balanced diet, rich in vitamins, minerals, and antioxidants, is key to a strengthened immune system and, thus, crucial to proper functioning of various physiological activities. Conversely, deficiencies of these micronutrients, involving impaired immunity, are linked to numerous health complications, along with a host of pathologies. Coronavirus disease 2019 (COVID-19) is a dangerous infectious disease caused by a β-form of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its genomic variants, which enter host cells upon binding to the angiotensin converting enzyme 2 receptors, and is associated with substantial morbidities and mortalities globally. Patients afflicted with COVID-19 display asymptomatic to severe symptoms, occurrences of which are multifactorial and include diverse immune responses, sex and gender differences, aging, and underlying medical conditions. Geriatric populations, especially men in comparison to women, regardless of their states, are most vulnerable to severe COVID-19-associated infections and complications, with fatal outcomes. Advances in genomic and proteomic technologies help one understand molecular events, including host–pathogen interactions and pathogenesis of COVID-19 and, subsequently, have developed a variety of preventive measures urgently, ranging from mask wearing to vaccination to medication. Despite these approaches, no unique strategy is available today that can effectively prevent and/or treat this hostile disease. As a consequence, the maintenance of a boosted immune system could be considered a high priority of preventive medicine for combating COVID-19. Herein, we discuss the current level of understanding underlining the contribution of healthy immunity and its relevance to COVID-19 molecular pathogenesis, and potential therapeutic strategies, in the management of this devastating disease.
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Liu Y, Chen Y, Chen J, Kuang Y, Tan N, Jiang K, Peng S, Hu C. Hemodynamic Characteristics of Patients with Myocardial Injury and Cardiogenic Shock Caused by Severe COVID-19-Related Pneumonia. Int J Gen Med 2021; 14:9647-9655. [PMID: 34934341 PMCID: PMC8684391 DOI: 10.2147/ijgm.s334442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023] Open
Abstract
Objective To observe hemodynamic characteristics in a series of patients with myocardial injury caused by severe COVID-19-related pneumonia. Materials and Methods We continuously collected clinical data from severe COVID-19-related pneumonia patients from the West Campus of Union Hospital in Wuhan and Dongguan People's Hospital in Dongguan to explore the prevalence of myocardial injury and hemodynamic characteristics after circulatory failure. Doppler ultrasound and PiCCO2 were used to evaluate the hemodynamics of each patient, and arterial blood gas analysis was performed at the same time. Pearson correlation analysis was used to clarify the relationship between the parameters. Results A total of 376 patients were observed during the study period. Eighty-seven patients had myocardial injury after admission, and the mean time of myocardial injury after admission was 6 (2, 30) days, from which 16 patients developed hemodynamic instability and 15 died of cardiogenic shock or combined with MODS. Cardiac echocardiography found that the LVEF of all patients was in the normal range and that diastolic function was slightly to moderately impaired. The PiCCO2 data showed that the GEF was significantly decreased in all patients. The dpmx was in normal range. EVLWI, SVRI and GEDI were significantly increased in most patients. Pearson correlation analysis showed that cTNI was significantly related to BNP at hemodynamic instability (r = 0.662, p = 0.005); GEF was related to EVLWI (r = -0.572, p = 0.021) and LAC (r = 0.692, p = 0.003); and EVLWI was affected by LVEF (r = -0.564, p = 0.023), LVDF (r = -0.734, p = 0.001) and PVPI (r = -0.524, p = 0.037). Conclusion Hemodynamic status after myocardial injury and cardiogenic shock caused by severe COVID-19-related pneumonia was characterized by cardiac preload and increased EVLWI, accompanied by a decline in GEF.
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Affiliation(s)
- Yongjun Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People's Republic of China
| | - Yuee Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People's Republic of China
| | - Jie Chen
- Department of Critical Care Medicine, Dongguan People's Hospital, Dongguan, Province Guangdong, 523059, People's Republic of China
| | - Yukung Kuang
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People's Republic of China
| | - Niandi Tan
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China
| | - Ke Jiang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China
| | - Shuihui Peng
- Department of Pharmacy Intravenous Admixture Services, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People's Republic of China
| | - Chunlin Hu
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People's Republic of China
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Hou SM, Jia CL, Hou MJ, Fernandes SL, Guo JC. A Study on Weak Edge Detection of COVID-19's CT Images Based on Histogram Equalization and Improved Canny Algorithm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5208940. [PMID: 34745326 PMCID: PMC8568529 DOI: 10.1155/2021/5208940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/11/2021] [Accepted: 10/04/2021] [Indexed: 01/01/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is a substantial threat to people's lives and health due to its high infectivity and rapid spread. Computed tomography (CT) scan is one of the important auxiliary methods for the clinical diagnosis of COVID-19. However, CT image lesion edge is normally affected by pixels with uneven grayscale and isolated noise, which makes weak edge detection of the COVID-19 lesion more complicated. In order to solve this problem, an edge detection method is proposed, which combines the histogram equalization and the improved Canny algorithm. Specifically, the histogram equalization is applied to enhance image contrast. In the improved Canny algorithm, the median filter, instead of the Gaussian filter, is used to remove the isolated noise points. The K-means algorithm is applied to separate the image background and edge. And the Canny algorithm is improved continuously by combining the mathematical morphology and the maximum between class variance method (OTSU). On selecting four types of lesion images from COVID-CT date set, MSE, MAE, SNR, and the running time are applied to evaluate the performance of the proposed method. The average values of these evaluation indicators are 1.7322, 7.9010, 57.1241, and 5.4887, respectively. Compared with other three methods, these values indicate that the proposed method achieves better result. The experimental results prove that the proposed algorithm can effectively detect the weak edge of the lesion, which is helpful for the diagnosis of COVID-19.
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Affiliation(s)
- Shou-Ming Hou
- School of Computer Science and Technology, Henan Polytechnic University, Jiaozuo 454000, China
| | - Chao-Lan Jia
- School of Computer Science and Technology, Henan Polytechnic University, Jiaozuo 454000, China
| | - Ming-Jie Hou
- CT Centre, Jiaozuo People's Hospital, Jiaozuo 454000, China
| | - Steven L. Fernandes
- Department of Computer Science, Design & Journalism, Creighton University, Omaha, Nebraska, USA
| | - Jin-Cheng Guo
- Department of Thoracic Surgery, Jiaozuo Second People's Hospital, Jiaozuo 454000, China
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Successful Treatment of Severely Hypotensive Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) with the Guidance of Invasive Hemodynamic Monitoring: A Report of Three Cases. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2021. [DOI: 10.5812/pedinfect.116282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak, it was assumed that infection rate in pediatric patients is lower than in adults and that infection is less severe in children than adult patients. Recently, there have been several reports and case series presenting critically-ill children with COVID-19, but still, severe hypotension is rare in pediatric patients with COVID-19. Case Presentation: We describe three pediatric cases with COVID-19 who presented with multi-system organ failure and severe hypotension treated with the guidance of the parameters of an invasive continuous hemodynamic monitoring device. We also compare their parameters with few articles on pediatric sepsis parameters. Conclusions: Although we usually start the treatment of hypotensive pediatric patients with hydration and epinephrine as an inotrope, in our cases, we required a different treatment plan according to the hemodynamic monitoring parameters, which indicates the value of the utilization of these devices in pediatric intensive care units
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Hallberg TC, Bjorklund AR, Slusher TM, Rodgers N. Sinus bradycardia in a toddler with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19. BMJ Case Rep 2021; 14:14/5/e242058. [PMID: 33975844 PMCID: PMC8118024 DOI: 10.1136/bcr-2021-242058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
This report documents a case of sinus bradycardia in a hospitalised 27-month-old girl with a history of moderate persistent asthma, recent suspected viral respiratory infection and suspicion for multisystem inflammatory syndrome in children (MIS-C). This patient developed profound sinus bradycardia during her hospitalisation despite an overall well clinical appearance and good outcome. Reports of bradycardia related to COVID-19 infection are few but growing in number. In this article, we discuss what has been observed in the literature about bradycardia in relation to COVID-19 and MIS-C. We also propose sinus bradycardia as a potential sign of MIS-C with recent respiratory symptoms, which would warrant close follow-up of such patients.
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Affiliation(s)
| | - Ashley Rebekah Bjorklund
- Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA.,Pediatrics, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Tina Marye Slusher
- Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA .,Pediatrics, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Nathan Rodgers
- Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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Gorini F, Chatzianagnostou K, Mazzone A, Bustaffa E, Esposito A, Berti S, Bianchi F, Vassalle C. "Acute Myocardial Infarction in the Time of COVID-19": A Review of Biological, Environmental, and Psychosocial Contributors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7371. [PMID: 33050220 PMCID: PMC7600622 DOI: 10.3390/ijerph17207371] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has quickly become a worldwide health crisis.Although respiratory disease remains the main cause of morbidity and mortality in COVID patients,myocardial damage is a common finding. Many possible biological pathways may explain therelationship between COVID-19 and acute myocardial infarction (AMI). Increased immune andinflammatory responses, and procoagulant profile have characterized COVID patients. All theseresponses may induce endothelial dysfunction, myocardial injury, plaque instability, and AMI.Disease severity and mortality are increased by cardiovascular comorbidities. Moreover, COVID-19has been associated with air pollution, which may also represent an AMI risk factor. Nonetheless,a significant reduction in patient admissions following containment initiatives has been observed,including for AMI. The reasons for this phenomenon are largely unknown, although a real decreasein the incidence of cardiac events seems highly improbable. Instead, patients likely may presentdelayed time from symptoms onset and subsequent referral to emergency departments because offear of possible in-hospital infection, and as such, may present more complications. Here, we aim todiscuss available evidence about all these factors in the complex relationship between COVID-19and AMI, with particular focus on psychological distress and the need to increase awareness ofischemic symptoms.
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Affiliation(s)
- Francesca Gorini
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (F.G.); (E.B.); (F.B.)
| | - Kyriazoula Chatzianagnostou
- Ospedale del Cuore G Pasquinucci Fondazione Toscana Gabriele Monasterio di Massa, via Aurelia Sud, 54100 Massa, Italy; (K.C.); (A.M.); (A.E.); (S.B.)
| | - Annamaria Mazzone
- Ospedale del Cuore G Pasquinucci Fondazione Toscana Gabriele Monasterio di Massa, via Aurelia Sud, 54100 Massa, Italy; (K.C.); (A.M.); (A.E.); (S.B.)
| | - Elisa Bustaffa
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (F.G.); (E.B.); (F.B.)
| | - Augusto Esposito
- Ospedale del Cuore G Pasquinucci Fondazione Toscana Gabriele Monasterio di Massa, via Aurelia Sud, 54100 Massa, Italy; (K.C.); (A.M.); (A.E.); (S.B.)
| | - Sergio Berti
- Ospedale del Cuore G Pasquinucci Fondazione Toscana Gabriele Monasterio di Massa, via Aurelia Sud, 54100 Massa, Italy; (K.C.); (A.M.); (A.E.); (S.B.)
| | - Fabrizio Bianchi
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (F.G.); (E.B.); (F.B.)
| | - Cristina Vassalle
- Ospedale del Cuore G Pasquinucci Fondazione Toscana Gabriele Monasterio di Massa, via Aurelia Sud, 54100 Massa, Italy; (K.C.); (A.M.); (A.E.); (S.B.)
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Gawałko M, Kapłon-Cieślicka A, Hohl M, Dobrev D, Linz D. COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications. IJC HEART & VASCULATURE 2020; 30:100631. [PMID: 32904969 PMCID: PMC7462635 DOI: 10.1016/j.ijcha.2020.100631] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/14/2020] [Accepted: 08/25/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a novel, highly transmittable and severe strain disease, which has rapidly spread worldwide. Despite epidemiological evidence linking COVID-19 with cardiovascular diseases, little is known about whether and how COVID-19 influences atrial fibrillation (AF), the most prevalent arrhythmia in clinical practice. Here, we review the available evidence for prevalence and incidence of AF in patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and discuss disease management approaches and potential treatment options for COVID-19 infected AF patients.
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Affiliation(s)
- Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.,Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | | | - Mathias Hohl
- Klinik für Innere Medizin III, Universität des Saarlandes, Homburg/Saar, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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