The Mysterious Association Between Atrial Fibrillation and Cancer: A Literature Review

Atrial fibrillation (AF) is a prevalent cardiac dysrhythmia, particularly affecting older adults, with its prevalence rising due to the aging population. AF is linked to several adverse outcomes, including embolic stroke, heart failure, and cancer. The association between AF and cancer is intricate and not yet fully understood. Studies suggest that the rise in cancer survivorship, along with cancer treatments, may contribute to an increased incidence of AF among cancer patients. This literature review was conducted using various databases to explore the relationship between AF and cancer. Studies from 2002 to 2022 were included, focusing on the adult population. Independent authors evaluated and validated the studies, ensuring rigorous methodology. The connection between AF and cancer appears multifaceted. There is evidence of increased cancer incidence within the first few months following an AF diagnosis, with potential shared risk factors like age, obesity, and smoking. Medications used to treat AF, notably amiodarone, were associated with increased cancer risk. Colon cancer risk might be linked to anticoagulation-induced gastrointestinal bleeding. It remains uncertain whether AF diagnosis leads to early cancer detection or if cancer itself contributes to AF development. The complex interplay between AF and cancer involves shared risk factors, potential medication-related influences, and unclear causal directions. The intricacies of this relationship warrant further research to clarify the underlying mechanisms and potential interactions. A comprehensive meta-analysis could provide more insights into this intriguing association and guide future clinical interventions.

Clostridium difficile Infection: Risk and Poor Prognostic Factors at a Tertiary Hospital in the Eastern Region of Saudi Arabia

BACKGROUND

 Clostridium difficile (C. difficile) is a common cause of hospital-acquired diarrhea. It is associated with significantly higher mortality and morbidity in addition to the cost-effectiveness burden on the healthcare system. The primary risk factors for C. difficile infection (CDI) are past C. difficile exposure, proton pump inhibitors, and antibiotic usage. These risk factors are also associated with poor prognosis.

OBJECTIVE

This study was performed in Dr. Sulaiman Al Habib Tertiary Hospital in the Eastern Region of Saudi Arabia. The aim was to evaluate the risk and prognostic factors of CDI and their association with the outcomes of hospital stay, such as complications, length of stay (LOS), and treatment duration.

PATIENTS AND METHODS

This is a retrospective cohort study for all patients who tested for C. difficile in the medical department. The target population was all adult patients ≥16 years with positive stool toxins for C. difficile between April 2019 and July 2022. The main outcome measures are risk and poor prognostic factors for CDI.

RESULTS

C. difficle infection patients were included in the study; 12 (52.2%) were female, and 11 (47.8%) were male. The mean age of the patients was 58.3 (SD: 21.5) years; 13 (56.5%) patients were below 65 years, and 10 were above 65 years. Only four patients were without comorbidities, and 19 (82.6%) patients had various comorbidities. Importantly, hypertension was the most common comorbidity in 47.8% of the patients. Furthermore, advanced age significantly impacted the hospital LOS as the mean age among patients who stayed at the hospital less than four days and those who stayed ≥4 days was 49.08 (19.7) and 68.36 (19.5), respectively (P = .028).

CONCLUSION

 Advanced age was the most frequent poor prognostic factor among our inpatient participants with positive CDI. It was significantly associated with longer hospital LOS, more complications, and longer treatment duration.

Methylprednisolone-Induced Symptomatic Sinus Bradycardia in a Multiple Sclerosis Patient: A Case Report

Intermittent high-dose methylprednisolone therapy is widely used for various autoimmune conditions treatment. Common side effects are well known and monitored carefully during therapy. Although cardiovascular adverse events are uncommon, they have been increasingly reported in the literature. This is a case of a 30-year-old female who developed symptomatic sinus bradycardia after receiving three grams of intravenous methylprednisolone pulse therapy for multiple sclerosis flare-ups. Her pulse rate reached 40bpm, together with lightheadedness and chest tightness. An electrocardiogram confirmed sinus bradycardia, for which she was initially managed by splitting the methylprednisolone dose in half; however, 12 hours later, the heart rate decreased further to 35bpm, and her symptoms worsened.

Subsequently, the medicine was omitted, and the patient shifted to the intensive care unit for close observation and monitoring. She was treated conservatively with close observation resulted in a gradual normalization of the heart rate. The diagnosis of methylprednisolone pulse-induced bradycardia was made after excluding other common etiologies of sinus bradycardia. This case report aims for careful cardiovascular monitoring in patients receiving high doses of methylprednisolone due to the dose-dependent cardiovascular risks. 

Acute Myocarditis Following the Administration of the Second BNT162b2 COVID-19 Vaccine Dose

COVID-19 disease has infected millions of people worldwide during the pandemic; hence, the need for an effective and safe vaccine was urgently required. A two-dose of the BNT162b2 mRNA COVID-19 vaccine was reported to have 95% efficacy in preventing COVID-19. The short-term safety profile recorded mild to moderate pain at the injection site, fatigue, and headache. The critical adverse effects were low and similar in the placebo group. However, we report the case of an 18-year-old male who developed acute central crushing chest pain four days following administration of the second dose of the BNT162b2 COVID-19 vaccine. After extensive cardiac workup, including coronary arteries diagnostic angiography, myocarditis was suspected and confirmed by a cardiac MRI. Fortunately, the patient's clinical condition gradually improved in the form of clinical symptoms and laboratory findings. He was discharged after one week of stay in hospital with regular follow-up in the cardiac clinic.

Intracardiac Thrombus Formation and Bilateral Pulmonary Embolisms in a Patient With Behcet's Disease While on Regular Infliximab Infusion: A Case Report

Vascular complications of Behcet'sdisease, including intracardiac thrombus formation, are one of the significant causes of mortality and morbidity in this population. Similar to other vasculitic disorders, Behcet's disease is primarily treated with immunosuppressants. While the benefit of adding anticoagulants in Behcet's disease with thromboembolism remains debatable, some literature encourages its use with concomitant intracardiac thrombus. Herewith, we present the case of a young male who was diagnosed with bilateral pulmonary embolism in addition to right ventricle intracardiac thrombus upon his scheduled dose of infliximab infusion. He was managed by adding azathioprine to his regimen together with oral prednisolone and warfarin with a target international normalized ratio of 2-3. This case report addresses the importance and outcome of early identification of Behcet's disease's vascular complications and immediate initiation of anticoagulation accordingly.

COVID-19-Induced Encephalitis: A Case Report of a Rare Presentation With a Prolonged Electroencephalogram

Encephalitis is one of the rare complications of coronavirus disease 2019 (COVID-19) that can be missed and confused with other causes of encephalitis. There was a 36-year-old male known to have glucose-6 phosphate dehydrogenase deficiency, who was brought to the emergency department with fever and confusion of one-week duration. Altered mental status work-up, including cerebrospinal fluid analysis, was done and turned out to be nondiagnostic. Multiple prolonged video-electroencephalographic recordings were done and showed different abnormalities suggestive of encephalitis. The diagnosis of COVID-19-induced encephalitis was made by exclusion of other encephalitis-related etiologies in the presence of a positive COVID-19 polymerase chain reaction (PCR) test, and treatment was initiated accordingly. Over a period of three weeks, the patient showed progressive improvement and was discharged home with regular follow-up in the neurology clinic. Upon follow-up in the clinic, the patient was fully independent but with multiple abnormal electroencephalographic recordings showing generalized encephalopathy with no epileptic discharges.