COVID-19 Complicated by Concomitant Renal, Splenic, and Myocardial Infarction: Double Whammy

A 76-year-old man presented with shortness of breath, fever, and fatigue with confirmed COVID-19 by positive RT-PCR test for the SARS-COV-2. Abdominal and pelvis computed tomography with intravenous contrast was performed several days later given the patient’s severe abdominal pain which showed both renal and splenic infarcts despite the use of a proper thromboprophylaxis with subcutaneous heparin, and therefore, therapeutic anticoagulation was initiated. In the course of hospitalization, he developed acute kidney injury, uremic syndrome, and myocardial infarction as well. The patient was treated with fibrinolytic therapy and was eventually discharged on a direct oral anticoagulant

Effect of Adjuvant Electroconvulsive Therapy Compared to Antipsychotic Medication Alone on the Brain Metabolites of Patients with Chronic Schizophrenia: A Proton Magnetic Resonance Spectroscopy Study

Objective: Schizophrenia is a common psychiatric disease and is characterized by changes in several brain metabolites detectable by magnetic resonance spectroscopy (MRS). Electroconvulsive therapy (ECT) is a general method of management for most severe psychiatric conditions that may play a role in changing the brain metabolites. This study examined the effectiveness of adjuvant ECT with oral medication compared to that of oral second generation antipsychotic medication alone on brain metabolites in patients with chronic schizophrenia. Method: This study was conducted on 20 patients with chronic schizophrenia who were admitted to a hospital; of them, 10 underwent ECT as an adjuvant therapy with oral medication at least 8 times, and 10 patients were given a second- generation antipsychotic therapy drug (risperidone and olanzapine) without ECT for at least 4 weeks. MRS was used to assess brain metabolites, including N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), myoinositol (MI), and Glx (glutamate [Glu] and glutamine [Gln]), in the left prefrontal cortex, left thalamus, left hippocampus, and left occipital cortex. Differences between the 2 groups were not significant, except for method of treatment. Results: The NAA/Cr ratio in the left prefrontal cortex was significantly higher in ECT-treated patients (P = 0.035). In addition, the Cho/Cr ratios in the left prefrontal cortex and left thalamus were statisticaly lower in the ECT-treated patients than those treated with oral antipsychotic drugs alone (P = 0.019). No statistically significant changes were observed between the 2 groups in other sites of the brain. In addition, no statistically significant differences were detected between the 2 groups in SAPS and DES scores. Conclusion: Compared to oral antipsychotic drug treatment, ECT had improving effects on at least 2 metabolites in the brains of patients with schizophrenia. Therefore, ECT may have a neuroprotective effect in these patients

Aortopulmonary window in infants

One of the rarest congenital heart diseases that results from a defect between the main pulmonary artery and the proximal aorta is named aortopulmonary window (APW). Such abnormality could be isolated, but in fifty percent of patients may be associated with other cardiac abnormalities, including arch abnormalities, specifically coarctation of the aorta, interrupted aortic arch, tetralogy of fallot, and atrial septal defect (ASD). Surgical closure or catheter-delivered devices is recommended in all patients with APW and should be performed after diagnosis as soon as possible to prevent irreversible pulmonary vascular disease. In the current era, early mortality following repair of simple APW is low and depends on the presence of associated lesions, especially interrupted aortic arch. We report an 8-month-old boy with APW who was referred to our center by respiratory symptoms and heart murmurs

Report of a Coarctation of Aorta Stenting in an Infant

Coarctation of aorta (CoA) is a congenital heart disease that can lead to heart failure during infancy and neonatal period. Several treatments have been proposed for this disease, including surgery and balloon angioplasty. The experiences of using stents in small infants or neonatal patients are very low. In this article, we report a 3 months old age infant who after balloon angioplasty, his CoA symptoms had return and stenting of CoA was performed for him

Surgical repair of Tetralogy of Fallot following primary palliation: Right ventricular outflow track stenting versus modified Blalock-Taussig shunt

Background: Tetralogy of Fallot (TOF) is a cyanotic disease requiring early intervention. We assessed the effect of right ventricular outflow tract (RVOT) stenting versus modified Blalock-Taussig shunt (mBTS) on outcomes of surgical repair of TOF. Methods: Fifteen palliated TOF infants underwent complete repair surgery. RVOT stenting was performed in seven infants and mBTS was done in eight infants. Data on sequential patients who underwent surgery were collected and reviewed retrospectively. Results: Stenting group were significantly younger (1.62 ± 0.34 vs 2.80 ± 0.52, p = 0.001), had lower body weight (3.28 ± 0.48 vs 5.03 ± 0.67, p = 0.001) and lesser body surface area (0.20 ± 0.01 vs 0.26 ± 0.20, p = 0.001) than the mBTS group at palliation. Mean right pulmonary artery (RPA) diameter in stenting group at palliation was 2.9 ± 0.54 mm (z-score -3.08 ± 0.97) and increased at surgery to 4.6 ± 0.49 mm (z-score –0.79 ± 0.66) (p = 0.001). The mean left pulmonary artery (LPA) diameter was 2.5 ± 0.42 mm (z-score -3.3 ± 0.86), which increased to 3.3 ± 0.40 mm (z-score -2.2 ± 0.74) at surgery (p = 0.005). The mean RPA diameter in mBTS group at palliation was 3.2 ± 0.32 mm (z-score –2.9 ± 0.70) and increased at surgery to 4.3 ± 0.55 mm (z-score –1.1 ± 0.94) (p = 0.001). The mean LPA diameter was 2.8 ± 0.26 mm (z-score -3.3 ± 0.62), which increased to 3.2 ± 0.24 mm (z-score –2.4 ± 0.52) at surgery (p = 0.032). Repeat echocardiography showed significant increase in McGoon ratio and Nakata index in both groups (p = 0.001). No significant differences were seen between the two groups regarding surgical procedure and postoperative complications. Conclusion: RVOT stenting is a safe and effective approach instead of mBTS in hazardous TOF infants with hypercyanotic spell, small PAs and complex anatomies. Keywords: Cardiac catheterization, Tetralogy of Fallot, Thoracic surgery, Infant, Low birth weigh

Correlation of Post-Operative Hypoalbuminemia with Outcome of Pediatric Cardiac Surgery

Background: Hypoalbuminemia may be caused by liver disease, nephrotic syndrome, burns, protein-losing entropathy, malnutrition, and metabolic stress. Alterations in albumin in metabolic stress such as cardiac surgery have been previously investigated. We studied serum albumin concentration in children with congenital heart disease and also the association of hypoalbuminemia with mortality and morbidity after pediatric cardiac surgery.Methods: We measured serum albumin concentration prospectively in 300 children with congenital heart disease who underwent surgery between July and September 2008 in Shaheed Rajaee hospital. Serum albumin concentration was measured before and 48 hours after cardiac surgery and was subsequently compared between 2 groups: cyanotic and acyanotic and also with normal values.Results: Serum albumin concentration decreased on the second post-operative day in 70 (23.3%) patients. There was a positive correlation between the post-surgical hypoalbuminemia and cyanotic heart disease. The cyanotic children had lower serum albumin concentration than the acyanotic ones (P value <0.001). There was a significant association between post-operative serum albumin concentration and acute renal failure (P value <0.001) and death (P value <0.001). Drop in serum albumin concentration was more prominent in the males than in the females (P value=0.038) and in the cyanotic patients than in the acyanotic ones (P value <0.001) as well as in those with acute renal failure (P value <0.001), pericardial effusion (P value=0.050), seizure (P value <0.001), and death (P value <0.001). Hypoalbuminemia was not associated with longer hospital (P value=0.142) or intensive care unit stay (P value=0.199 ).Conclusion: Post-operative serum albumin concentration was lower in the cyanotic children and male patients in our study. In addition, the post-operative decrease in albumin was associated with an increased risk of pericardial effusion, renal failure, seizure, and death

Tissue Doppler Echocardiographic Findings of Left Ventricle in Children with Sickle-Cell Anemia

Background: Sickle-cell disease (SCD) is an inherited hemoglobin childhood disorder, frequently complicated by pulmonary hypertension and cardiac involvement. Cardiovascular events and complications are the leading cause of mortality and morbidity in patients with SCD. Tissue Doppler imaging and the myocardial performance index (Tei index), are simple indices for the assessment of the cardiac function. The purpose of this study was to assess the left ventricular function in children with SCD. Methods: Sixty-four patients with SCD (mean age = 11.7 ± 5.5 years) were compared with 50 age matched healthy controls (mean age = 11.2 ± 5.20 years). Myocardial wall motion velocities at the lateral mitral annulus and the junction between the medial mitral annulus and the interventricular septum were assessed during systole (Sa), early diastole (Ea), and late diastole (Aa) through a four-chamber view using pulsed Doppler echocardiography. The ejection fraction and shortening fraction were estimated. The Tei index was estimated via tissue Doppler echocardiography. Results: The results showed that Ea and Aa velocity in the mitral annulus and interventricular septum had no difference between the patients and controls (p value > 0.05), and nor was there any difference between the two groups as regards the Tei index, Ea/Aa, ejection fraction, and shortening fraction (p value > 0.05). Sa difference between the two groups (p value < 0.038).wave velocity, however, had a significant Conclusion: The Tei index is a sensitive indicator for the cardiac function in chronic diseases and the right ventricular function in some disorders such as SCD

Hemolacria secondary to major depressive disorder and generalized anxiety disorder: A case report

Key Clinical Message Hemolacria can occur on the basis of a psychiatric disorder without an organic cause. However, this should be a diagnosis of exclusion. Treatment of the underlying psychiatric illness may relieve this condition. Abstract A 24‐year‐old man presented with the chief complaint of bloody tears, which began 4 months earlier after commencing mandatory military service. He had no underlying diseases, and all work‐ups returned normal, though a microscopic examination confirmed red blood cells. He was diagnosed with hemolacria secondary to generalized anxiety disorder and major depressive disorder, responding to propranolol and sertraline. Hemolacria was totally cured after 6 months of treating the underlying psychiatric illness

Lipid and Glucose Serum Levels in Children with Congenital Heart Disease

Background: Coronary artery disease is one of the most common causes of morbidity and mortality in developed countries. Atherosclerosis begins in early childhood and progresses through life. With advances in pediatric cardiology, the prevalence of congenital heart disease in adults has increased in relation to children. A great deal of research has been conducted on serum glucose and lipid concentrations in patients with congenital heart disease, but comparison has yet to be made between congenital patients and the general population, especially in pediatric groups. The aim of this study was to compare the serum concentrations of glucose and lipids between pediatric congenital heart disease patients and a healthy age and sex-matched control group. Methods: We measured and compared the total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride (TG), and plasma glucose concentrations of 100 pediatric congenital heart disease patients (cases) and 100 individuals matched for age and sex (controls) during a period of 7 months between November 2011 and June 2012. Results: Total cholesterol, triglyceride, HDL cholesterol, and LDL cholesterol concentrations were significantly higher in the patients than in the control group (p value < 0.05). Blood sugar levels in both groups had no significant difference (p value = 0.25). In the case group, the cholesterol level was higher in the males than in the females (p value = 0.30); moreover, the TG and HDL cholesterol levels were lower in the males than in the females and the LDL cholesterol and blood sugar levels had no statistically significant difference. In the control group, there was no difference between the males and females in terms of the cholesterol, HDL cholesterol, LDL cholesterol, TG, and blood sugar levels. Conclusion: The results of this study showed that our pediatric congenital heart disease patients had significantly higher levels of serum lipids than did their age and sex-matched controls. In light of these results, we recommend that the lipid profile be screened in children with congenital heart disease so as to reduce the risk of atherosclerosis

Segmented Coronary Artery Aneurysms and Kawasaki Disease

Kawasaki disease (KD) is an acute vasculitis syndrome of unknown etiology. It occurs in infants and young children,affecting mainly small and medium-sized arteries, particularly the coronary arteries. Generalized microvasculitis occurs in the first 10 days, and the inflammation persists in the walls of medium and small arteries, especially the coronary arteries, and changes to coronary artery aneurysms.We report the case of a 10-month-old girl referred to our center three months after the onset of disease due to the aneurysmsof the coronary arteries. During the acute phase of her illness, she received 2 gr/kg intravenous gamma globulin; and afterher referral to us, the patient was treated by antiaggregant doses of acetylsalicylic acid (ASA) (5 mg/kg) and Warfarin (1 mg/daily). At three months’ follow-up, the aneurysms still persisted in the echocardiogram