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Desai R, Mondal A, Prasad A, Vyas A, Jain A, Rupareliya C, Shah M, Paul T, Kumar G, Sachdeva R. Concurrent Cardio-Cerebral Infarctions in COVID-19: A Systematic Review of Published Case Reports/Series. Curr Probl Cardiol 2023; 48:101814. [PMID: 37209804 PMCID: PMC10193814 DOI: 10.1016/j.cpcardiol.2023.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Twelve CCI patients were studied with confirmed or suspected COVID-19 infection. The majority of these patients were males (83.3%) with a median age of 55 years from three geographical locations, constituting the Middle East (7), Spain (3), and the USA (1). In 6 patients, IgG/IgM was positive for COVID-19, 4 with high pretest probability and 2 with positive RT-PCR. Type 2 DM, hyperlipidemia, and smoking were the primary risk factors. Right-sided neurological impairments and verbal impairment were the most common symptoms. Our analysis found 8 (66%) synchronous occurrences. In 58.3% of cases, neuroimaging showed left Middle Cerebral Artery (MCA) infarct and 33.3% right. Carotid artery thrombosis (16.6%), tandem occlusion (8.3%), and carotid stenosis (1%) were also reported in imaging. Dual antiplatelet therapy (DAPT) and anticoagulants were conservative therapies (10). Two AMI patients had aspiration thrombectomy, while three AIS patients had intravenous thrombolysis/tissue plasminogen activator (IVT-tPA), 2 had mechanical thrombectomy (MT), and 1 had decompressive craniotomy. Five had COVID-19-positive chest X-rays, whereas 4 were normal. four of 8 STEMI and 3 NSTEMI/UA patients complained chest pain. LV, ICA, and pulmonary embolism were further complications (2). Upon discharge, 7 patients (70%) had residual deficits while 1 patient unfortunately died.
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Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA.
| | - Avilash Mondal
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA
| | | | - Ankit Vyas
- Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX
| | - Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA
| | - Chintan Rupareliya
- Department of Vascular Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Manan Shah
- Department of Neurocritical Care, Department of Neurology and Neurosurgery, Medical College of Georgia at Augusta University, Augusta, GA
| | - Timir Paul
- Division of Cardiology, University of Tennessee Health Sciences Center at Nashville, Saint Thomas Heart Institute, Nashville, TN
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA
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2
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Badescu MC, Sorodoc V, Lionte C, Ouatu A, Haliga RE, Costache AD, Buliga-Finis ON, Simon I, Sorodoc L, Costache II, Rezus C. Direct Oral Anticoagulants for Stroke and Systemic Embolism Prevention in Patients with Left Ventricular Thrombus. J Pers Med 2023; 13:jpm13010158. [PMID: 36675819 PMCID: PMC9866081 DOI: 10.3390/jpm13010158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/17/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
In recent years, direct oral anticoagulants (DOAC) have accumulated evidence of efficacy and safety in various clinical scenarios and are approved for a wide spectrum of indications. Still, they are currently used off-label for left ventricular thrombus owing to a paucity of evidence. For the same reason, there is a lack of guideline indication as well. Our work is based on an exhaustive analysis of the available literature and provides a structured and detailed update on the use of DOACs in patients with left ventricle thrombus. The safety and efficacy of DOACs were analyzed in particular clinical scenarios. As far as we know, this is the first paper that analyzes DOACs in this approach.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Victorita Sorodoc
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- II Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
- Correspondence: (V.S.); (C.L.)
| | - Catalina Lionte
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- II Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
- Correspondence: (V.S.); (C.L.)
| | - Anca Ouatu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Raluca Ecaterina Haliga
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- II Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Oana Nicoleta Buliga-Finis
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Ioan Simon
- Department of Surgery, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Laurentiu Sorodoc
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- II Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Irina-Iuliana Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
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Suzuki K, Sakamoto SI, Hiromoto A, Motoji Y, Amitani R, Yamaguchi T, Ishii Y. Case of left ventricular thrombus managed with thrombectomy with left ventricular reconstruction in a patient who had coronavirus disease 2019 infection. J Cardiothorac Surg 2023; 18:8. [PMID: 36611152 PMCID: PMC9823256 DOI: 10.1186/s13019-023-02108-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Intracardiac thrombus is relatively rare in patients with coronavirus disease 2019 (COVID-19). However, if it occurs, thrombotic complications are likely to develop. In this case, we performed a successful thrombectomy on a patient who developed left ventricular thrombus after COVID-19 infection without complications. CASE PRESENTATION A 52-year-old man sought medical care due to fever, dyspnea, and abnormalities in the taste and smell that persisted for 2 weeks. The patient was diagnosed with COVID-19 and was treated with remdesivir, baricitinib, and heparin. Three weeks after hospitalization, electrocardiogram revealed angina pectoris, and cardiac catherization showed left anterior descending coronary artery stenosis. In addition, global hypokinesis and a thrombus at the left ventricular apex were observed on echocardiography. Left ventricular reconstruction concomitant with coronary artery bypass grafting was performed. A thrombus in the left ventricle was resected via left apical ventriculotomy, and the bovine pericardium was covered and sutured on the infarction site to exclude it. The patient was extubated a day after surgery and was transferred to another hospital for recuperation after 20 days. He did not present with complications. CONCLUSIONS Thrombotic events could be prevented via thrombectomy with left ventricular reconstruction using an intraventricular patch to exclude the residual thrombus.
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Affiliation(s)
- Kenji Suzuki
- grid.459842.60000 0004 0406 9101Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-Ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Shun-Ichiro Sakamoto
- grid.459842.60000 0004 0406 9101Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-Ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Atsushi Hiromoto
- grid.459842.60000 0004 0406 9101Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-Ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Yusuke Motoji
- grid.459842.60000 0004 0406 9101Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-Ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Ryosuke Amitani
- grid.459842.60000 0004 0406 9101Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-Ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Takako Yamaguchi
- grid.459842.60000 0004 0406 9101Department of Nursing, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimach, Nakahara-ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Yosuke Ishii
- grid.410821.e0000 0001 2173 8328Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602 Japan
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Iqbal P, Menik Arachchige S, Ali Y, Qamar MS, Jaouni HW, Abdussalam ALM. First case of concomitant cytomegalovirus (CMV) viremia in non-immunocompromised COVID-19 patient and ICU management strategy in Qatar with literature review. Clin Case Rep 2022; 10:e05783. [PMID: 35498350 PMCID: PMC9043710 DOI: 10.1002/ccr3.5783] [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: 09/05/2021] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/03/2022] Open
Abstract
COVID‐19 has created one of the world's worst pandemics and is associated with various life‐threatening complications and infections, possibly due to various internal and external host factors. Cytomegalovirus (CMV) coinfection is one of those infections. We present a challenging case of severe COVID‐19 infection managed in our ICU care facility with concomitant CMV infection. We aim to highlight the significance of early diagnosis and prompt management for a better outcome.
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Affiliation(s)
- Phool Iqbal
- Medical Intensive Care Department Hamad Medical Corporation Doha Qatar
| | | | - Yousra Ali
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | | | - Hani Walid Jaouni
- Medical Intensive Care Department Hamad Medical Corporation Doha Qatar.,Clinical Medicine Weill Cornell Medicine Qatar Ar-Rayyan Qatar
| | - Ahmed Lutfe Mohamad Abdussalam
- Medical Intensive Care Department Hamad Medical Corporation Doha Qatar.,Clinical Medicine Weill Cornell Medicine Qatar Ar-Rayyan Qatar
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Abdi A, AlOtaiby S, Badarin FA, Khraibi A, Hamdan H, Nader M. Interaction of SARS-CoV-2 with cardiomyocytes: Insight into the underlying molecular mechanisms of cardiac injury and pharmacotherapy. Biomed Pharmacother 2022; 146:112518. [PMID: 34906770 PMCID: PMC8654598 DOI: 10.1016/j.biopha.2021.112518] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/15/2021] [Accepted: 12/06/2021] [Indexed: 01/07/2023] Open
Abstract
SARS-CoV-2 causes respiratory illness with a spectrum of systemic complications. However, the mechanism for cardiac infection and cardiomyocyte injury in COVID-19 patients remains unclear. The current literature supports the notion that SARS-CoV-2 particles access the heart either by the circulating blood cells or by extracellular vesicles, originating from the inflamed lungs, and encapsulating the virus along with its receptor (ACE2). Both cardiomyocytes and pericytes (coronary arteries) express the necessary accessory proteins for access of SARS-CoV-2 particles (i.e. ACE2, NRP-1, TMPRSS2, CD147, integrin α5β1, and CTSB/L). These proteins facilitate the SARS-CoV-2 interaction and entry into the pericytes and cardiomyocytes thus leading to cardiac manifestations. Subsequently, various signaling pathways are altered in the infected cardiomyocytes (i.e. increased ROS production, reduced contraction, impaired calcium homeostasis), causing cardiac dysfunction. The currently adopted pharmacotherapy in severe COVID-19 subjects exhibited side effects on the heart, often manifested by electrical abnormalities. Nonetheless, cardiovascular adverse repercussions have been associated with the advent of some of the SARS-CoV-2 vaccines with no clear mechanisms underlining these complications. We provide herein an overview of the pathways involved with cardiomyocyte in COVID-19 subjects to help promoting pharmacotherapies that can protect against SARS-CoV-2-induced cardiac injuries.
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Affiliation(s)
- Abdulhamid Abdi
- Department of Physiology and Immunology, College of Medicine and Health Sciences, and Biotechnology Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Shahad AlOtaiby
- Research Center, King Fahad Medical City, Central Second Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Firas Al Badarin
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ali Khraibi
- Department of Physiology and Immunology, College of Medicine and Health Sciences, and Biotechnology Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Hamdan Hamdan
- Department of Physiology and Immunology, College of Medicine and Health Sciences, and Biotechnology Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Moni Nader
- Department of Physiology and Immunology, College of Medicine and Health Sciences, and Biotechnology Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates.
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Philip AM, George LJ, John KJ, George AA, Nayar J, Sahu KK, Selvaraj V, Lal A, Mishra AK. A review of the presentation and outcome of left ventricular thrombus in coronavirus disease 2019 infection. J Clin Transl Res 2021; 7:797-808. [PMID: 34988332 PMCID: PMC8715711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/22/2021] [Accepted: 09/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiovascular complications of the coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), have been documented both in the acute phase and in convalescence. One such complication is the formation of the left ventricular (LV) thrombus. There is a lack of clarity regarding the incidence, risk factors, and management of this complication. AIM The aim of the study is to identify the clinical presentation, risk factors and outcome of COVID-19 patients with left ventricular thrombus (LVT). METHODS A literature search was conducted to identify all case reports of COVID-19 with LVT in PubMed/Medline, Embase, Web of Science, and Google Scholar. RESULTS Among the 65 patients identified, 60 had LVT, either at admission, or during the acute phase of the illness. Six patients with mild symptoms during the acute phase of viral illness had only the COVID-19 antibody test positivity at the time LV thrombus was detected. Few of the patients (23.1%) had no comorbidities. The mean age of the patients was 52.8 years, and the youngest patient was 4 years old. This suggests that LVT formation can occur in young COVID-19 patients with no co-morbid conditions. Most of the patients (69.2%) had more than one site of thrombosis. A mortality rate of 23.1% was observed in our review, and ST-elevation myocardial infarction (STEMI) was diagnosed in 33.3% of those who died. CONCLUSIONS A high degree of suspicion for LVT must be maintained in patients with known cardiac disease and those with new-onset arterial or venous thromboembolism, and such patients may benefit from a screening echocardiography at admission. RELEVANCE FOR PATIENTS The patients with preexisting cardiovascular disease must take added precautions to prevent acquiring COVID-19 infection as there is a higher risk of developing LV thrombus. In patients who develop LVT in COVID-19, mortality rate is higher.
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Affiliation(s)
- Anil Mathew Philip
- 1Department of Medicine, St. Thomas Mission Hospital, Kattanam, India,Corresponding author: Anil Mathew Philip Department of Medicine, St. Thomas Mission Hospital, Kattanam, India. E-mail:
| | - Lina James George
- 2Department of Pulmonary Medicine, DR KM Cherian Institute of Medical Sciences, Kallissery, India
| | - Kevin John John
- 3Department of Critical Care, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - Anu Anna George
- 4Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, 01608, USA
| | - Jemimah Nayar
- 5Department of Nuclear Medicine, Christian Medical College, Vellore, India
| | - Kamal Kant Sahu
- 6Division of Hematooncology, Huntsman Cancer Institute, University of Utah, United States
| | - Vijairam Selvaraj
- 7Internal Medicine, Warren Apert School of Brown University, Miriam Hospital, 164 Summit Ave, Providence, 02906, RI
| | - Amos Lal
- 8Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Ajay Kumar Mishra
- 9Department of Internal Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, Massachusetts, 01608, USA
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Cardio-cerebral infarction in left MCA strokes: a case series and literature review. Neurol Sci 2021; 43:2413-2422. [PMID: 34590206 PMCID: PMC8480750 DOI: 10.1007/s10072-021-05628-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/23/2021] [Indexed: 10/27/2022]
Abstract
The objective of this manuscript is to describe the challenges of Cardio-Cerebral Infarction (CCI) treatment and to highlight the variable approaches in management. CCI is a rare clinical presentation of simultaneous acute ischemic stroke (AIS) and acute myocardial infarction (AMI) and poses a therapeutic challenge for practitioners. Each disease requires timely intervention to prevent irreversible damage; however, optimal management remains unclear. We describe three cases of CCI. All three patients presented with symptomatic left MCA (M1) occlusion, with ST elevation myocardial infarction (STEMI) and left ventricular apical thrombus. Fibrinolysis and mechanical thrombectomy (MT) were discussed in all cases, but only one patient received alteplase (0.9 mg/kg) and none underwent MT. Percutaneous intervention (PCI) was done in only one case. The two patients that did not receive thrombolysis were treated with modified therapeutic heparin (no bolus), and all received antiplatelet therapy. Ultimately, all three patients passed away. CCI poses a clinical challenge for physicians including (1) optimal strategies to enable swift mechanical reperfusion to both the brain and myocardium; (2) difference in dosage of thrombolytics for AIS versus AMI; (3) risk of symptomatic intracerebral hemorrhage following administration of anticoagulation and/or antiplatelet therapy; and (4) caution with use of thrombolytics in the setting of acute STEMI due to the risk of myocardial rupture. In the absence of high quality evidence and clinical guidelines, treatment of CCI is highly individualized.
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Lashkari A, Ranjbar R. A case-based systematic review on the SARS-COVID-2-associated cerebrovascular diseases and the possible virus routes of entry. J Neurovirol 2021; 27:691-701. [PMID: 34546547 PMCID: PMC8454012 DOI: 10.1007/s13365-021-01013-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sparked a global pandemic that continues to affect various facets of human existence. Many sources reported virus-induced acute cerebrovascular disorders. Systematically, this paper reviews the case studies of COVID-19-related acute cerebrovascular diseases such as ischaemic stroke, intracerebral hemorrhage, and cerebral sinus thrombosis. We also spoke about how SARS-CoV-2 can infect the brain and trigger the aforementioned disorders. We stated that SARS-CoV-2 neuroinvasion and BBB dysfunction could cause the observed disorders; however, further research is required to specify the mechanisms and pathogenesis of the virus.
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Affiliation(s)
- Ali Lashkari
- Institute of Biochemistry and Biophysics (IBB), University of Tehran, Tehran, Iran
| | - Reza Ranjbar
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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9
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Jiang F. Letter to the Editor regarding article "Electrocardiographic markers of increased risk of sudden cardiac death in patients with COVID-19 pneumonia". Ann Noninvasive Electrocardiol 2021; 26:e12868. [PMID: 34288250 PMCID: PMC8293597 DOI: 10.1111/anec.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/11/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Fenglin Jiang
- Department of Ultrasound Medicine, Yanbian University Hospital, Yanji, China
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