SGLT2i at patient with CABG, metabolic syndrome and T2DM

Introduction SGLT2i are associated with a reduction in adverse major cardiac and cerebrovascular events especially in patients with heart failure and T2DM. Effect and safety in treatment using this new drugs results in a greater reduction in HBA1C,TT,FPG,PPG,SBP,BMI,LDL and is recommended in a patient with poor glicoregulation after a previously performed aorto-coronary bypass and metabolic syndrome(obesity,hypertension,diabetes,hypertriglyceridemia). Aim The high potencial of mechanism of SGLT2i in patient with heart failure,T2DM and many comorbidities reduce the risk for hospitalization and cardiovascular mortality. Material and methods Male patient 53,with T2DM more than 3 years, CABGX5 before 4 months on a therapy with Insulin Humulin N 26+12, HBA1C=15%,poor glicoregulation, FPG=16,6…trig=3,6,creatinin=96,TT=110,GFR=81,urine=normal,TA 150/100,HR/112,EF=44% with fatigue,ringing in the ears and dizziness came at internal department. The therapy was changed with:Tbl.Siofor 2x1000,Insulin Ryzodeg 24ie+22ie s.c.Tbl.Jardiance+statin,beta blocker,antihypertensive and antiagregation drugs.It was recommended to take more care of hygiene of the genitourinary tract and diet. Results After 1 month patient didn’t show up on control,after 6 months was done another echocardiography EF=47%,fpg=8,8,trig=1,9,creatinin=90,hba1c=11,37%,tt=106,TA 135/90,subjectively feels better and has no new hospitalizations. Conclusion SGLT2i improved endothelial function,glicoregulation,contractility,reduction of blood pressure,cardiac metabolism,reduction of albuminuria ,glomerular pressure and renal protection.All these characteristrics place it highly in the treatment of patients with HF,T2DM and many comorbidities. Key words SGLT2i(empagliflozine),HF(heart failure),T2DM(diabetes mellitus typ 2)

AV block type2 as a cardiovascular complication of COVID-19

Introduction: COVID 19 is a serious disease which has symptoms that range from asymptomatic to moderate and severe pain symptoms including fever, cough, and dyspnea due to pneumonia. Cardiac complication includes: acute myocardial infarction, arrhythmias, heart blocks and cardiomyopathies. Objective: To present a case in a patient with AV block type 2 (Mobitz II) as a complication of COVID 19 infection. Material and methods: The patient was admitted to our hospital with fatigue, palpitations, anxiety and heaviness in the chest during exertion in the last two weeks. PCR test for COVID 19 was positive from the beginning of the symptoms, but for the entire period without worsening of the condition. Results: His blood pressure was 130/80 mmHg, heart rate was 42 beats/min, respiratory rate was 14 breaths/min, oxygen saturation was 96%. Cardiac markers are not specific. His ECG findings are shown in Figures 1 and 2. Echocardiographic findings had a left ventricular ejection fraction of 47%. Coronary angiographic findings without significant features. After a consultation, the patient was referred for implantation of a permanent pacemaker at the Clinic of Cardiology-Skopje. Conclusion: Identifying heart blocks as a potential complication of COVID-19 will help health professionals better manage the condition in this pandemic by shortening hospital stays and improving patient prognosis. Key words: Covid 19, AV block, cardiovascular complication

Pneumothorax and pneumomediastinum unusual complications in patients with Covid-19 pneumonia - report of three cases and literature review

Coronavirus 2019 (COVID-19) has rapidly spread worldwide. Numerous studies have shown typical and atypical CT findings of complications with COVID-19 pneumonia. As the pandemic progresses, the number of unusual presentation of the disease, such as pneumothorax and pneumomediastinum increases. Recent evidence suggests that these findings may occur in the context of COVID-19 pneumonia, even in the absence of mechanical ventilation – related barotrauma. We present three patients with COVID-19 pneumonia complicated by pneumothorax or pneumomediastinum. The first patient was a 62-year-old man who developed COVID-19 pneumonia. His clinical course was complicated by a small pneumomediastinum that was treated conservatively. He had spontaneous resolution of the pneumomediastinum. The second patient is a 46-year-old man diagnosed with COVID-19 pneumonia who developed spontaneous massive pneumothorax, which was treated surgically with a thoracic drain. The third patient is a 77-year-old man with pneumonia and massive pneumothorax and surgically treated with a thoracic drain. None of our patients used invasive or non-invasive positive pressure ventilation or previously diagnosed respiratory disease. We performed literature review of cases of COVID-19 pneumonia that developed pneumothorax, pneumomediastinum or both complications together. The probable cause of these events is severe alveolar damage. Thus, it is necessary to pay attention to these complications as early identification and management can reduce the associated morbidity and mortality. Keywords: pneumothorax, pneumomediastinum, COVID-19 pneumoni

Спонтан пнеумоперитонеум и субкутан емфизем како невообичаени компликации на Ковид 19

Презентираниот случај е ретко клиничко сценарио на субкутан емфизем и спонтан пнеумоперитонеум кај Ковид19 пациент каде КТ беше од есенцијано значење за поставување на дијагноза. Нашето знаење за овој нов вирус е доста лимитирано. Идеално би било да се направи скрининг за секој пациент пред операција

Пациентка со тешка ментална ретардација и Ковид 19

Коронарна артериска болест и хронична опструктивна белодроба болест кај пациенти со тешка ментална ретардација (шизофренија, биполарно нарушување, мајорна депресија) го зголемува ризикот за инфекција со Ковид19 и неизвесен исход

Covid-19 patient and acute pulmonary embolism

Introduction: Thrombotic complications in patients diagnosed with coronavirus disease 2019 are emerging as important sequelae that contribute to significant morbidity and mortality. Pulmonary embolism, deep vein thrombosis, ischemic stroke and myocardial infarction are examples of complications described in patients. Objective: To present a case in a patient with COVID 19 infection and acute pulmonary embolism. Material and methods: A 80-year-old female patient was hospitalized due to symptoms of dry cough, scratching in the throat, fever, malaise. Unvaccinated for COVID 19. A quick COVID 19 test was positive. ECG: AFF with SF 160/min, TA 150/95, SpO2 92%. Lung auscultation is heard vesicular breathing with crepitations on both sides of the base. Within a few days, the patient's symptoms worsened. Results: CT native of chest - multiple zones of milk glass attenuation bilaterally peripherally distributed (Figure 1). CT pulmonary angiography - Sings of massive PTE: defects in filling in principal pulmonary vessels as well as in segmental and subsegmental branches bilaterally (Figure 1). Laboratory analysis (Le 14.83x109/L, hsTroponin 22ng/L, LDH 395U/L, CRP 29mg/L, D dimer 30480. Conclusion: Pulmonary embolism is a common emergency that may easily be missed because of its varied presentation. It is associated with breathlessness, which may or may not be insidious, and requires a high index of suspicion in order to diagnose. Left untreated, it is potentially fatal. Key words: Covid 19, acute pulmonary embolism, complication

Spontaneous pneumothorax in a patient with COVID 19

By presenting this case we emphasize the possible clinical scenario of spontaneous pneumothorax accompanied by COVID-19 pneumonia through CT finding. Clinicians should be aware that pneumothorax may be seen within the radiological manifestations of a patient with COVID-19 pneumonia. Pneumothorax is rarely associated with COVID-19 pneumonia. COVID19 spontaneous pneumothorax associated with an otherwise healthy individual may be an undiagnosed entity. This association may be secondary to undiagnosed bullous lung disease and rupture. Further research is needed to demonstrate the association of pneumothorax in a patient with COVID-19 bilateral pneumonia

Thromboembolism after partus praeteporarius spontaneus

Thromboembolism after partus praeteporarius spontaneus is not unusual but need multidisciplinary treatment

Spontaneous pneumomediastinum in an adult male with bilateral pneumonia. Complication of COVID-19 or not?

The appearance of a pneumomediastum should indicate careful monitoring of the patient whether or not COVID-19 infection has been demonstrated. There are several papers in the world (2-8) where spontaneous pneumomediastinum is a common complication of severe acute respiratory syndrome. Further research is needed to investigate its association with COVID-19 infection

False negative Covid-19 test in a patient with coronavirus infection symptoms

This case reminds the clinician that a patient with high clinical suspicion of COVID-19 and multiple negative PCR-molecular test results should not be taken out of isolation. A combination of the patient's history, clinical manifestations, laboratory tests, and typical chest CT findings play an important role in making a preliminary diagnosis, early isolation of the patient, and appropriate treatment. Repeated swab tests are useful in diagnosing this type of patient, especially serological tests to test for the presence of antibodies will help us detect the rate of infection in the community and determine the mortality rate from the disease