Pneumonia and acute myocarditis revealing COVID-19 infection in histopathology

Засягането на сърцето е често срещано състояние сред пациенти, хоспитализирани с COVID-19, и е свързано с по-висок риск от болнична смъртност. От първите анализирани случаи в Китай е забелязан повишен сърдечен тропонин при значителна част от пациентите, което предполага увреждане на миокарда като възможен патогенен механизъм, допринасящ за тежко заболяване и смъртност. Лекарите трябва да обърнат внимание на възможността за миокардит в случаите на COVID-19. Представяме ви първи възможен случай на миокардит, свързан със SARS-CoV-2, потвърден с аутопсиен преглед. Припокриването с остър коронарен синдром, остра декомпенсирана сърдечна недостатъчност трябва да се вземе предвид при сегашното състояние на епидемията COVID-19. Cardiac injury is a common condition among patients hospitalized with COVID-19, and it is associated with a higher risk of in-hospital mortality. Since the first data analyses in China, elevated cardiac troponin has been noted in a substantial proportion of patients, implicating myocardial injury as a possible pathogenic mechanism contributing to severe illness and mortality. Physicians need to pay heed to the possibility of myocarditis in cases of COVID-19. We present a first possible SARS-CoV-2 associated myocarditis case, confirmed by autopsy examination. The overlap with acute coronary syndrome, acute decompensated heart failure should be taken into consideration in the current state to COVID-19 epidemics

Intraoperative Radiotherapy with Balloon-Based Electronic Brachytherapy System—A Systematic Review and First Bulgarian Experience in Breast Cancer Patients

(1) Background: We aimed to analyze currently available studies with intraoperative radiotherapy (IORT) as a choice of treatment where the Xoft Axxent® electronic brachytherapy (eBx) system was used as a single-dose irradiation and an exclusive radiotherapy approach at the time of surgery in patients with early breast cancer (EBC). We also compared the results of the systematic review to the Bulgarian experience. (2) Methods and Materials: We performed a systematic review of the studies published before February 2021, which investigate the application of a single-fraction 20 Gy radiation treatment, delivered at the time of lumpectomy in EBC patients with the Xoft Axxent® eBx System. A systematic search in PubMed, Scopus, and ScienceDirect was performed. The results are reported following the PRISMA guidelines. The criteria on patients’ selection for IORT (the additional need for EBRT), cosmetic outcomes, and recurrence rate from the eligible studies are compared to the treatment results in Bulgarian patients. (3) Results: We searched through 1032 results to find 17 eligible studies. There are no published outcomes from randomized trials. When reported, the cosmetic outcomes in most of the studies are defined as excellent. The observed recurrence rate is low (1–5.8%). Still, the number of patients additionally referred to postoperative external breast radiotherapy (EBRT) is up to 31%. Amongst the 20 patients treated in Bulgaria, the cosmetic outcomes are also evaluated as excellent, five of which (25%) are referred for EBRT. Within median follow-up of 39 months, there was one local and one distal recurrence. (4) Conclusions: Current evidence demonstrates the Xoft Axxent® eBx system as a safe and feasible technique for IORT delivery in EBC patients. There are no randomized controlled trials conducted at this time point to prove its long-term effectiveness. Better patient selection and a reimbursement strategy have to be proposed to extend the application of this technique in Bulgaria