Performance of the TIMI risk score in predicting mortality after primary percutaneous coronary intervention in elderly women: Results from a developing country

Background: Despite women undergoing primary percutaneous coronary intervention (PPCI) having a higher rate of adverse outcomes than men, data evaluating prognostic risk scores, especially in elderly women, remains scarce. This study was conducted to validate the predictive value of Thrombolysis in Myocardial Infarction (TIMI) risk score in elderly female patients. Materials and Methods: This was a retrospective analysis of elderly (\u3e65 years) female patients who underwent PPCI for ST-elevated myocardial infarction (STEMI) from October 2016 to September 2018. Patients\u27 demographic details and elements of TIMI risk score including age, co-morbidities, Killip classification; weight, anterior MI and total ischemic time were extracted from hospital records. The primary outcome was in-hospital mortality and post-discharge mortality reported on telephonic follow-up. Results: A total of 404 elderly women with a median age of 70 years were included. The mean TIMI score was 5.25±1.45 with 40.3% (163) patients of TIMI score \u3e 5. In-hospital mortality rate was 6.4% (26) and was found to be associated with TIMI score (p\u3c0.001). The in-hospital mortality rate increased from 3.1% at TIMI score of 0-4 to 34.6% at the score of 8. On follow-up (16.43±7.40 months) of 211 (55.8%) patients, the overall mortality rate was 20.3%, and this was also associated with TIMI score (p\u3c0.001). The mortality rate increased from 5.6% at the score of 0-4 to 54.5% at the score of 8. The predictive values (area under the curve) of TIMI risk score for in-hospital and post-discharge mortality were 0.709 (95% CI 0.591-0.827; p \u3c0.001) and 0.689 (95% CI 0.608-0.770; p \u3c0.001), respectively. Conclusion: Increased adverse outcomes were observed with higher TIMI risk score for in hospital and post-discharge follow-up. Therefore, the prognostic TIMI risk score is a robust tool in predicting both in-hospital as well as post-discharge mortality in elderly females

Presentation of Dyke-Davidoff-Masson Syndrome in a 32-year-old female: Report of a rare case with a literature review

Dyke-Davidoff-Masson syndrome (DDMS) is a rare congenital or acquired neurological disorder that most commonly affects the pediatric population but is also rarely reported in adults. DDMS results from brain injury in the intrauterine or early years of life. It is characterized by prominent cortical sulci, hyperpneumatization of the frontal sinus, unilateral cerebral hemiatrophy with ventricular dilation, and associated bony thickness of the cranial vault. Seizures and asymmetric hemiparesis are the most consistent findings in DDMS with facial asymmetry and mental retardation widely reported. Herein, we report a case of a 32-year-old female patient with DDMS presenting with a history of seizure and right-sided hemiparesis. Neuroimaging findings showed asymmetric cerebral encephalomalacia and gliosis with ex vacuo ventricular dilatation and calvarial diploic space widening. Our case report is unique in the sense that our patient presented with DDMS in adulthood with no signs of mental retardation or history of seizures during childhood and well-controlled seizures on monotherapy. Given the adult presentation of DDMS is unusual and rarely reported in the medical literature, our case report will help physicians to keep DDMS high on differential diagnoses in such cases. Awareness of the clinical features of DDMS on imaging can facilitate a timely and accurate diagnosis, thereby enabling appropriate and prompt management

Pancreatic adenocarcinoma in the elderly – recurrence and survival: A physician's challenge

Pancreatic Ductal Adenocarcinomas (PDAC) is one of the most lethal cancer, shifting it from the fourth highest to the third-highest cause of cancer-related deaths in the United States recently. The majority of the cases are diagnosed when the disease has metastasized and is associated with poor 5-year survival. A long-term survival data of PDAC has not been well reported in the literature. Pancreatic Cancer requires the imminent need of a multidisciplinary approach. The key to an improved long-term outcome involves early diagnosis and curative resection along with chemotherapeutic agents. Gemcitabine has played a positive role as an adjuvant after surgical resection. Regular follow-ups post-resection are mandatory for the detection of neoplastic recurrence. To add to what is already a challenging task, isolated recurrence of PDAC poses greater challenges for the physicians treating the patients because there is no general consensus on how to manage these specific groups of patients. To effectively handle this challenging task, a definite strategy must be adopted. Long-term survival if accomplished must therefore be accompanied by regular follow-up visits including Spiral CT scans and keeping an eye on the serum tumor marker CA19-9, a prognostic survival predictor

IgG4-related inflammatory pancreatic head pseudotumor mirrors pancreatic head tumor: A novel case series with a review of the literature

Inflammatory pseudotumor of pancreatic head greatly mimics pancreatic head tumor. One of them is IgG4-related pancreatic disease, which is commonly mistaken as neoplastic disease on imaging. In our novel case series, we report three cases of IgG4-related pancreatic head pseudotumor with patients ranging from 35 to 72 years of age. Patients presented with jaundice and abdominal pain. Alongside initial laboratory workup, abdominal CTs and serum IgG4 levels were also obtained. Imaging features in conjunction with IgG4 levels confirmed the diagnosis of IgG4-related autoimmune pancreatitis. Pancreatic pseudotumors are notorious for being often reported as real tumors. Through our noteworthy case series, we intend to highlight the imaging features and laboratory markers that are crucial in such cases to avoid invasive procedures

Post COVID-19 sequelae of the respiratory system. A single center experience reporting the compromise of the airway, alveolar and vascular components

The long-term sequelae of COVID-19 have now become more common and appreciable. The SARS-CoV-2 virus can cause a variety of infectious and non-infectious pulmonary complications. The purpose of this study is to raise awareness about post-COVID-19 pulmonary sequelae, both infectious and non-infectious, in this geographical area. A retrospective study was conducted from July 1st 2020 to December 20th 2020. A total of 1200 patients were evaluated, with 83 suffering from post-COVID-19 pulmonary complications. The patients\u27 mean age was 62 years (IQR 55-69), with 63 (75.9%) being male. The most common co-morbid illnesses were hypertension (49, 59%) and diabetes (45, 54.2%). The majority of them (37, 44.6%) had severe COVID-19, followed by critical COVID-19 (33, 39.8%). There was no statistically significant difference in recurrence of respiratory symptoms or duration of current illness between non-severe, severe, and critical COVID-19 patients. Non-infectious complications were observed in the majority of patients (n=76, 91.5%), including organizing pneumonia/ground glass opacities in 71 (88%) patients, fibrosis in 44 (55%), pulmonary embolism in 10 (12.5%), pneumomediastinum in 6 (7.4%) and pneumothorax in 7 (8.6%). Infective complications (25, 30.1%) included aspergillus infection in 10 (12.0%) and bacterial infection in 5 (8.47%), with more gram-negative infections and one patient developing Mycobacterium tuberculosis. Post COVID-19 mortality was 11 (13.3%). The long-term pulmonary sequelae of COVID-19 are not rare. Cryptogenic organizing pneumonia, ground glass opacities, and fibrosis were common post-COVID-19 sequelae in our patients. This necessitates frequent close monitoring of these patients in order to initiate early appropriate management and prevent further morbidity and eventual mortality

COVID-19 Pathophysiology and Clinical Effects on Multiple Organ Systems - A Narrative Review

Patients with comorbidities including Hypertension (HTN), Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), Asthma, Obesity, Cardiovascular Disease (CVD), Chronic Kidney Disease (CKD), and those who are immunocompromised are prone to more severe complications of COVID-19 and a higher rate of hospitalizations. In the United States, around 94% of COVID-19 deaths had an average of 2.6 additional conditions or causes per death. In a summary report published by the Chinese Centre for Disease Control and Prevention of 72,314 cases, case-fatality rate was elevated among those with preexisting comorbid conditions—10.5% for cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6.0% for HTN, and 5.6% for cancer. The COVID-19 pandemic continues to threaten people and healthcare systems globally and therefore the global economy. Currently, there is no cure or vaccine for COVID-19 and there is an urgent need to develop target therapies as we continue to learn more about this novel virus. Without therapeutic interventions, much of how we contain the viral spread is prevention through mitigation strategies (social distancing, face masks, supportive care). Early suspicion of COVID-19 symptoms with radiological and laboratory assessments may play a major role in preventing severity of the COVID-19. With this literature review we aim to provide review of pathophysiology of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and its clinical effects on multiple organ systems

COVID-19 Pathophysiology and Clinical Effects on Multiple Organ Systems: A Review

Patients with comorbidities including Hypertension (HTN), Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), Asthma, Obesity, Cardiovascular Disease (CVD), Chronic Kidney Disease (CKD), and those who are immunocompromised are prone to more severe complications of COVID-19 and a higher rate of hospitalizations. In the United States, around 94% of COVID-19 deaths had an average of 2.6 additional conditions or causes per death. In a summary report published by the Chinese Centre for Disease Control and Prevention of 72,314 cases, case-fatality rate was elevated among those with preexisting comorbid conditions—10.5% for cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6.0% for HTN, and 5.6% for cancer. The COVID-19 pandemic continues to threaten people and healthcare systems globally and therefore the global economy. Currently, there is no cure or vaccine for COVID-19 and there is an urgent need to develop target therapies as we continue to learn more about this novel virus. Without therapeutic interventions, much of how we contain the viral spread is prevention through mitigation strategies (social distancing, face masks, supportive care). Early suspicion of COVID-19 symptoms with radiological and laboratory assessments may play a major role in preventing severity of the COVID-19. With this literature review we aim to provide review of pathophysiology of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and its clinical effects on multiple organ systems