COVID-19 Associated Pneumonia and Pleural Effusion Masquerading as Heart Failure in Rheumatic Heart Disease

The ongoing outbreak of coronavirus disease 2019 (COVID-19) that began in Wuhan, China, became an international emergency when thousands of people were infected around the world. COVID-19 emerged in Pakistan in April 2020, precipitating a nationwide lockdown. While some countries are now recovering from the pandemic, its peak is not estimated to occur in Pakistan until August 2020. We present a case of rheumatic heart disease with fever, myalgia and an unusual radiological finding of the virus

Impact of Graphic Warning Labels on Cigarette Packs in Changing Smokers' Views and Habits: An Opinion Survey

Background: Smoking has become a major issue worldwide. With the advancement in technology, morevulnerable populations, such as teenagers, are also being harmed. One deterrent is the presence of graphiclabels on cigarette packs. With this rationale in mind, the objective of our study is to assess the impact ofthese warning labels on the habits and opinions of smokers.Methods: A cross-sectional study was conducted by distributing a validated paper-based questionnaire.The sample size was calculated to be 200 using statistical software. The study targeted students ofIslamabad, Pakistan, who were studying in twelfth grade and were smokers. The sampling method usedwas ‘snowball sampling’.Findings: 128 (64%) males and 72 (36%) females participated in the study. The mean age of the participantswas 17.59 ± 0.51 years. 40 participants reported choosing local brands for cigarettes due to cigarette‘freshness’, regardless of presence or absence of a graphic label, which was a new concept. 94% ofparticipants believed that presence of a visual label helped with understanding the harm and 78% believedthat the side effects were accurately portrayed. Participants who were more than 17 years of age believed thatthe graphic label provided a clear description of the consequences of smoking. Similar results were seen inthe female participants of the study.Conclusion: There is a general consensus on graphic labels altering the opinions of smokers. The presenceof these labels is, however, targeting only a specific type of audience and hence, should be expanded for alarger audienc

Lead Cap Use in Interventional Cardiology: Time to Protect Our Head in the Cardiac Catheterisation Laboratory?

Background: Radiation exposure is an occupational hazard for interventional cardiologists and cardiac catheterisation laboratory staff that can manifest with serious long-term health consequences. Personal protective equipment, including lead jackets and glasses, is common, but the use of radiation protective lead caps is inconsistent. Methods: A systematic review qualitative assessment of five observational studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines protocol was performed. Results: It was concluded that lead caps significantly reduce radiation exposure to the head, even when a ceiling-mounted lead shield was present. Conclusion: Although newer protective systems are being studied and introduced, tools, such as lead caps, need to be strongly considered and employed in the catheterisation laboratory as mainstay personal protective equipment

Dual right coronary artery: an unconventional presentation from Pakistan

There is a significant variation in the mapping of epicardial coronary arteries. This variation may present as different anomalies. These anomalies are usually asymptomatic and can be present at birth. Some might become symptomatic during adulthood and subsequently, result in sudden death. The anomalies, in turn, present a challenge to clinicians during therapeutic intervention. Therefore, there is a growing need to have knowledge about the various forms of the coronary artery anomalies. In our case report, we present the case of a patient who had one such anomaly and provide a hint at one strategy that was used to tackle the challenge

Transgender Person and Pre-Exposure Prophylaxis for HIV: A Renal Dilemma

Sexual health care for transgender people is often inadequate and not addressed. Targeted prevention approaches that respond to the specific needs of transgender individuals are essential to reducing HIV infections. HIV prophylaxis is a proven intervention in the prevention of HIV among high-risk populations. However, creatinine clearance is one major determining factor in prescribing HIV pre-exposure prophylaxis. One of the variables used in the equation to calculate creatinine clearance is gender. Additionally, regarding transgender people, gender-affirming hormonal therapy also alters the clearance by modifying other variables, such as muscle mass. Here, we present the case of a 58-year-old designated female at birth, who transitioned to male 15 months ago, currently using testosterone, and had presented to the clinic requesting HIV pre-exposure prophylaxis, due to his anticipation of new sexual partners soon. He was initially denied HIV pre-exposure prophylaxis, due to lower estimated creatinine clearance when calculated per his natal assigned gender. The transgender population requires effective HIV pre-exposure prophylaxis, dependent on creatinine clearance, that is dictated by many factors, considering the high prevalence rate. Therefore, validation of eGFR equations in the transgender population is of utmost importance to ensure optimal decision-making and provision of health care

Diffuse Dermal Angiomatosis Manifestation of Underlying Severe Peripheral Vascular Disease

Diffuse dermal angiomatosis is a benign vascular disorder suspected in patients with cardiovascular risk factors. We report the case of a 62-year-old woman with a non-healing hip wound but no significant cardiovascular risk factors, who was found to have diffuse dermal angiomatosis on biopsy leading to the diagnosis of severe peripheral vascular disease. Her wound healed after revascularization

Clinical markers in heart failure: a narrative review

Heart failure is a complex clinical syndrome that is one of the causes of high mortality worldwide. Additionally, healthcare systems around the world are also being burdened by the aging population and subsequently, increasing estimates of patients with heart failure. As a result, it is crucial to determine novel ways to reduce the healthcare costs, rate of hospitalizations and mortality. In this regard, clinical biomarkers play a very important role in stratifying risk, determining prognosis or diagnosis and monitoring patient responses to therapy. This narrative review discusses the wide spectrum of clinical biomarkers, novel inventions of new techniques, their advantages and limitations as well as applications. As heart failure rates increase, cost-effective diagnostic tools such as B-type natriuretic peptide and N-terminal pro b-type natriuretic peptide are crucial, with emerging markers like neprilysin and cardiac imaging showing promise, though larger studies are needed to confirm their effectiveness compared with traditional markers

COVID-19 Vaccination in Developing Nations: Challenges and Opportunities for Innovation

Vaccines offer a hope toward ending the global pandemic caused by SARS-CoV2. Mass vaccination of the global population offers hope to curb the spread. Developing nations, however, face monumental challenges in procurement, allocation, distribution and uptake of vaccines. Inequities in vaccine supply are already evident with resource-rich nations having secured a large chunk of the available vaccine doses for 2021. Once supplies are made available, vaccines will have to be distributed and administered to entire populations—with considerations for individual risk level, remote geography, cultural and socio-economic factors. This would require logistical and trained personnel support that can be hard to come by for resource-poor nations. Several vaccines also require ultra-cold temperatures for storage and transport and therefore the need for specialized equipment and reliable power supply which may also not be readily available. Lastly, attention will need to be paid to ensuring adequate uptake of vaccines since vaccine hesitancy has already been reported for COVID vaccines. However, existing strengths of local and regional communities can be leveraged to provide innovative solutions and mitigate some of the challenges. Regional and international cooperation can also play a big role in ensuring equity in vaccine access and vaccination

Eribulin and Confusion: A Previously Unknown Drug Side-Effect

Eribulin is an antineoplastic agent used in advanced breast cancer refractory to anthracycline and taxane treatment regimens. A wide variety of side effects with unclear mechanisms have been noted, but encephalopathy has not been widely reported. Here we describe the case of a middle-aged woman treated with eribulin for advanced breast cancer who subsequently developed central nervous system drug-induced toxicity but improved promptly with steroid administration