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  • 1
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    Palpitations and Fatigue Post COVID: A Harbinger of Silent Thyroiditis!
    The Endocrine Society ; 2021
    In:  Journal of the Endocrine Society Vol. 5, No. Supplement_1 ( 2021-05-03), p. A946-A946
    Details
    In: Journal of the Endocrine Society, The Endocrine Society, Vol. 5, No. Supplement_1 ( 2021-05-03), p. A946-A946
    Abstract: Background: Subacute thyroiditis is a self-limiting condition brought about by an inflammatory reaction often linked to a recent viral infection. SARS-COV2 (COVID-19), an RNA coronavirus that started a global pandemic in December 2019 has been linked mostly to severe acute respiratory distress syndrome. However, there have been increasing reports of its effect on other organ systems. We present a case of a 32-year-old female recovering from COVID-19, only to develop silent thyroiditis afterwards. Clinical Case: A 32-year-old female with anxiety disorder but otherwise in excellent health was diagnosed with COVID-19 via nasal swab RT-PCR after experiencing low grade fever and cough. She quarantined at home and was on her way to recovery when, a few weeks later, she began to experience increasing bouts of chest pain with no relation to activity, intermittent headaches and lower extremity edema. This prompted her to visit the emergency department. Work-up done at that time was unremarkable and her symptoms were attributed mostly to anxiety. She was advised to follow-up as an outpatient with a cardiologist. One month later, due to the persistence of her fatigue, low exercise tolerance and tremors, she decided to seek consult with a cardiologist. An electrocardiogram done during that visit showed normal sinus rhythm with poor-R wave progression and early repolarization changes. Both the echocardiogram and 24-hour Holter monitoring, which were subsequently done, were unremarkable. Blood work-up, however, revealed a significantly low thyroid stimulating hormone (TSH) level of 0.17 mU/L, for which she was referred to an endocrinologist. A month later, she sought consult with an endocrinologist. Thyroid gland was non-tender on palpation. Repeat blood work-up showed an elevated TSH level (23.50 mU/L) with a low Free T4 (0.42 ng/dL) and an elevated thyroid peroxidase antibody (TPO-Ab) level (900 mU/mL), indicative of subacute thyroiditis, but without associated neck pain. Thyroid sonography done showed diffusely heterogeneous thyroid lobes with no evidence of a dominant mass or nodule. A decision was made to start her on low dose levothyroxine. Two months into treatment, she underwent repeat thyroid hormone levels. Normal TSH and normal free T4 were observed. However, TPO-Ab was still elevated. It was decided to continue her therapy for one more month before gradually tapering her levothyroxine dose. She was told to follow-up in a month for further monitoring. Conclusion: Subacute thyroiditis associated with COVID-19 infection has become a more common occurrence as more cases of COVID-19 are noted worldwide. Our patient followed the usual course of subacute thyroiditis, initially presenting with a thyrotoxicosis phase which typically lasts 4-10 weeks, then subsequently developing hypothyroidism, inadvertently needing thyroid hormone replacement. What made this case more intriguing was that she did not have severe anterior neck pain, the classic clinical presentation of subacute thyroiditis. While there is a very strong association between COVID-19 and respiratory failure, there is paucity of evidence linking COVID-19 to dysfunction of other body systems. This case of thyroiditis presenting post COVID-19 illness, buttresses the versatility of COVID-19. Physicians should keep this in mind when evaluating a COVID-19 survivor who continue to present with persistent tachycardia or palpitations with or without anterior neck pain even after a month or two from infection. Routine follow-up TSH assay on COVID-19 survivors may be a valuable consideration.
    Type of Medium: Online Resource
    ISSN: 2472-1972
    URL: Article
    DOI: 10.1210/jendso/bvab048.1933
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2021
    detail.hit.zdb_id: 2881023-5
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  • 2
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    Abstract 15382: Geriatric HFpEF: When It Isn’t Hypertensive Heart Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Transthyretin amyloid cardiomyopathy (ATTR) is thought to be a rare cause of HF, but recent studies showed this is the cause of 30% of HFpEF patients older than 75. With new treatments for amyloidosis, timely diagnosis has become critical. Case: A 78-female with HFpEF, HTN, and diabetes followed for progressive functional decline and hospitalizations for HFpEF exacerbations. EKG at baseline showed LBBB with normal QRS voltages. Serial echocardiogram (echo) showed an ejection fraction (EF) of 60-70%, mild LVH, and moderate TR with RVSP 〉 50 mmHg. Latest echo showed progressive LA enlargement, MR, a new small pericardial effusion, and EF 50%. Regadenoson nuclear scan showed normal perfusion with preserved LVEF. Despite adequate control of her HTN, dyspnea continued to worsen. Because of this, the diagnosis of Cardiac amyloidosis was considered. Further review revealed a history of Carpal Tunnel Syndrome (CTS) and speckled pattern within the ventricular wall on echo. A technetium pyrophosphate scintigraphy ( 99m Tc-PYP) confirmed ATTR with grade three uptake, AL amyloid was ruled out with normal SPEP/UPEP, and she was started on Tafamidis. Discussion: Cardiac amyloidosis should be considered in HFpEF patients with functional decline despite medical optimization. It can mimic LVH caused by HTN on echo and easily dismissed in patients with traditional risk factors, but presence of CTS or lumbar spinal stenosis can be supportive. Traditionally ATTR is associated with low-voltage EKG, however this patient presented with normal QRS voltages for years, making the diagnosis more elusive. Conclusion: Advances in noninvasive imaging and treatments allow for early diagnosis of cardiac amyloidosis, reducing morbidity and mortality. Diagnosis is often delayed or missed, as features could be subtle and mimic other more common cardiac disease. Screening & nbsp; 99m Tc-PYP for elderly patients with HFpEF could translate to improved outcomes
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.15382
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 3
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    Early Outcomes of Adult Heart Transplantation From COVID-19 Infected Donors
    Elsevier BV ; 2023
    In:  Journal of the American College of Cardiology Vol. 81, No. 24 ( 2023-06), p. 2344-2357
    Details
    In: Journal of the American College of Cardiology, Elsevier BV, Vol. 81, No. 24 ( 2023-06), p. 2344-2357
    Type of Medium: Online Resource
    ISSN: 0735-1097
    URL: Article
    DOI: 10.1016/j.jacc.2023.04.022
    RVK:
    XA 17760
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 1468327-1
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  • 4
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    Abstract 15353: Identifying Different Clinical Phenotypes in Peripartum Cardiomyopathy by Latent Class Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Peripartum cardiomyopathy (PPCM) is a heterogeneous disorder whose pathophysiology remains poorly understood. To better understand the heterogeneity of PPCM, we used latent class analysis (LCA) to explore the different clinical phenotypes in a large sample of PPCM patients. Methods: Using the National Inpatient Sample (NIS) database, we identified 917 patients admitted to hospitals in 2017-2019 with a primary diagnosis of PPCM. We performed LCA based on 8 risk factors: age ( 〈 30 vs 〉 30), race (African American (AA) vs non-AA), hypertension in pregnancy (HIP) (preeclampsia, gestational hypertension, or chronic hypertension), diabetes mellitus (DM), obesity, tobacco use, cannabis use, and psychiatric disorders (anxiety, depressive, bipolar, or schizophrenia spectrum disorders). We then compared in-hospital outcomes among the different clusters identified by LCA. Data were analyzed using Stata version 17 for descriptive analysis and Mplus version 8.8 for LCA. Results: Four patient clusters were identified. C1 (n=471, 51.4%) had no AA or cannabis users and members had the lowest probability of having HIP (0.387), DM (0.27), and obesity (0.17). C2 (n=328, 35.8%) were all AA who did not use cannabis and had the lowest probability of using tobacco (0.076), and having psychiatric disorders (0.084). C3 (n=31, 3.4%) was the youngest group all of whom used tobacco and cannabis and had the largest probability of having psychiatric disorders (0.484). On the other hand, C4 (n=87, 9.5%) was the oldest group none of whom used cannabis but members had the highest probability being obese (0.664), having HIP (0.825), and DM (0.642). Among all clusters, C3 had the lowest in-hospital mortality (0.0%) and hospital charges ($57,357). C4 had the highest in-hospital mortality 1.1% and longest hospital length of stay (5.4 ± 7.0 days). Conclusions: Using LCA, we identified four clinically distinct classes PPCM with varying in-hospital outcomes. These may reflect different additional underlying mechanisms in PPCM. Our findings may help identify treatment targets and patient selection for future clinical trials.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.15353
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 5
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    Abstract 10551: Air-Ortitis
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Background: Vascular graft infections (VGI) are serious complications of open and endovascular types of surgery with 30-60% perioperative mortality and 40-60 % morbidity. High index of suspicion is necessary in patients with multiple risk factors for graft infection to ensure early detection and intervention. This is a patient who presented with occult graft infection 4 years after endovascular aortic aneurysm repair (EVAR). Case: A 79M with DM, hypertension, coronary artery disease s/p bypass surgery and angioplasty, and abdominal aortic aneurysm s/p EVAR 4 years ago, presented with mild central abdominal pain associated with nausea and loss of appetite. He denied change in bowel habits, fever, or rectal bleeding. Initial workup showed WBC 10,000/ml with left shift of 90%, together with anemia of 7g/dl. Urinalysis showed pyuria and initial blood cultures grew gram negative bacilli later revealed to be Klebsiella pneumonia. Abdominal CT then showed an aortoiliac stent in place with an air-fluid level in the native aortic aneurysm, 6.4 cm in diameter. There was immediate concern for an aorto-enteric fistula and the patient underwent exploratory laparotomy which instead revealed an infected endograft with purulent drainage to the aortic sac. The post operative period was complicated with respiratory failure, requiring intubation for a few days. Tissue culture isolated multidrug resistant Klebsiella pneumoniae necessitating a 6-week course of meropenem. After a long hospital stay, his family opted for comfort care and was discharged to a hospice facility. Conclusions: Surgical treatment of VGI is challenging and involves debridement of infected periprosthetic tissues, excision of the infected graft and secondary revascularization usually in a critically ill patient. VGI have exceedingly high mortality rates; thus, early identification, and screening of high-risk patients with infectious focus for VGI is needed.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.10551
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 6
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    Abstract 15623: Arrhythmia Burden and Associated Outcomes Among Patients With Myelodysplastic Syndromes
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Background: Arrhythmias are an increasingly recognized comorbid condition among patients with cancers. However, there is little research on the relationship between conduction abnormalities and in-hospital outcomes in patients with myelodysplastic syndrome (MDS). This analysis explores the burden of cardiac arrhythmias and associated outcomes in hospitalized MDS patients. Methods: Nationwide Inpatient Sample from 2017 to 2019 was used. MDS-associated hospitalizations with concurrent arrhythmia were identified using appropriate ICD-10 CM codes and compared to MDS-associated hospitalizations without arrhythmia. Primary outcome was all-cause in-hospital mortality. Secondary outcomes were in-hospital length of stay and total costs. Results: About 21% (n=4065) of MDS patients were diagnosed with an arrhythmia. Atrial tachycardias were most common (87%). Frequency of bradyarrhythmias, ventricular tachycardias, and unspecified arrhythmias were 10.7%, 10.4%, and 0.8%, respectively. The MDS-arrhythmia cohort were significantly older (78 vs 71 years), had higher number of comorbidities ( 〉 3 Charlson Comorbidity Index score: 45.5% vs 30%), and were more likely men (57.8% vs 52.7%) (P 〈 0.001). The MDS-arrhythmia cohort demonstrated higher all-cause mortality (10.6% vs. 5%) and had increased odds of in-hospital death after adjusting for sociodemographic and hospital level factors (AOR 2.2, 95% CI 1.59-2.91) (P 〈 .001). Hospital length of stay (8.5 vs. 8.0 days) and hospital charges ($104267 vs. $105654) were similar across both groups. Conclusions: Concurrent arrhythmias were associated with worse survival outcomes for patients with MDS. Understanding the mortality associated with arrhythmias in MDS patients may have clinical implications when planning treatment options in which cardiotoxicity is an adverse event. Awareness of the frequency and risk factors for arrhythmias in MDS patients may encourage the early introduction of cardiac monitoring for arrhythmias in hospitalized patients with MDS.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.15623
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 7
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    Prevention of Contrast-induced Nephropathy by Cordyceps among Patients undergoing Percutaneous Coronary Procedures using Intravenous Contrast
    University of the Philippines Manila ; 2018
    In:  Acta Medica Philippina Vol. 52, No. 1 ( 2018-02-28)
    Details
    In: Acta Medica Philippina, University of the Philippines Manila, Vol. 52, No. 1 ( 2018-02-28)
    Abstract: Objectives. This study aimed to determine the efficacy and safety of Cordyceps in preventing occurrence of contrastinduced nephropathy (CIN) among patients undergoing CA / PCI using IV contrast compared to standard therapy. Methods. We searched Medline, Embase, Cochrane database, and Google Scholars for RCTs involving the use of Cordyceps in contrast-induced nephropathy. We used the search keywords “Cordyceps” and “contrast-induced nephropathy” with the Boolean operator “AND” and filtering search results to include only randomized controlled trials and clinical trials. Three trials were found which satisfied all the inclusion criteria and none of the exclusion criteria. Results. No patient developed clinical renal failure, adverse reactions, or side effects with the Cordyceps arm. CIN occurred in 26 out of 285 patients. The incidence of CIN was less in the Cordyceps group compared to the standard therapy group (p 〈 0.05, CI 0.20, 1.00). Conclusion. Cordyceps shows a trend towards prevention of CIN and a decrease in biomarkers for acute kidney injury. More studies with larger populations need to be performed to further clarify its preventive effects.
    Type of Medium: Online Resource
    ISSN: 2094-9278 , 0001-6071
    URL: Article
    DOI: 10.47895/amp.v52i1.454
    Language: Unknown
    Publisher: University of the Philippines Manila
    Publication Date: 2018
    detail.hit.zdb_id: 2881489-7
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  • 8
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    RACIAL INEQUALITIES IN THE USE OF TRANSCATHETER AORTIC VALVE REPLACEMENT AMONG US ADULTS WITH AORTIC STENOSIS: A BLINDER-OAXACA DECOMPOSITION ANALYSIS
    Elsevier BV ; 2022
    In:  Journal of the American College of Cardiology Vol. 79, No. 9 ( 2022-03), p. 651-
    Details
    In: Journal of the American College of Cardiology, Elsevier BV, Vol. 79, No. 9 ( 2022-03), p. 651-
    Type of Medium: Online Resource
    ISSN: 0735-1097
    URL: Article
    DOI: 10.1016/S0735-1097(22)01642-4
    RVK:
    XA 17760
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 1468327-1
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  • 9
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    Cost-Utility Comparison of Bevacizumab and Aflibercept in the Treatment of Central or Hemiretinal Vein Occlusion in the SCORE2 Trial
    American Medical Association (AMA) ; 2023
    In:  JAMA Ophthalmology Vol. 141, No. 6 ( 2023-06-01), p. 554-
    Details
    In: JAMA Ophthalmology, American Medical Association (AMA), Vol. 141, No. 6 ( 2023-06-01), p. 554-
    Abstract: Retinal vein occlusion is the second most common retinal vascular disease. Bevacizumab was demonstrated in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) to be noninferior to aflibercept with respect to visual acuity in study participants with macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) following 6 months of therapy. In this study, the cost-utility of bevacizumab vs aflibercept for treatment of CRVO is evaluated. Objective To investigate the relative cost-effectiveness of bevacizumab vs aflibercept for treatment of macular edema associated with CRVO or HRVO. Design, Setting, and Participants This economic evaluation study used a microsimulation cohort of patients with clinical and demographic characteristics similar to those of SCORE2 participants and a Markov process. Parameters were estimated and validated using a split-sample approach of the SCORE2 population. The simulated cohort included 5000 patients who were evaluated 100 times, each with a different set of characteristics randomly selected based on the SCORE2 trial. SCORE2 data were collected from September 2014 October 2019, and data were analyzed from October 2019 to July 2021. Interventions Bevacizumab (followed by aflibercept among patients with a protocol-defined poor or marginal response to bevacizumab at month 6) vs aflibercept (followed by a dexamethasone implant among patients with a protocol-defined poor or marginal response to aflibercept at month 6). Main Outcomes and Measures Incremental cost-utility ratio. Results The simulation demonstrated that patients treated with aflibercept will have an expected cost $18 127 greater than those treated with bevacizumab in the year following initiation. When coupled with the lack of clinical superiority over bevacizumab (ie, patients treated with bevacizumab had a gain over aflibercept in visual acuity letter score of 4 in the treated eye and 2 in the fellow eye), these results demonstrate that first-line treatment with bevacizumab dominated aflibercept in the simulated cohort of SCORE2 participants. At current price levels, aflibercept would be considered the preferred cost-effective option only if treatment restored the patient to nearly perfect health. Conclusions and Relevance While there will be some patients with CRVO-associated or HRVO-associated macular edema who will benefit from first-line treatment with aflibercept rather than bevacizumab, given the minimal differences in visual acuity outcomes and large cost differences for bevacizumab vs aflibercept, first-line treatment with bevacizumab is cost-effective for this condition.
    Type of Medium: Online Resource
    ISSN: 2168-6165
    URL: Article
    DOI: 10.1001/jamaophthalmol.2023.1463
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
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  • 10
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    Intraocular Pressure–Related Events After Anti–Vascular Endothelial Growth Factor Therapy for Macular Edema Due to Central Retinal Vein Occlusion or Hemiretinal Vein Occlusion : SCORE2 Report 16 on a Secondary Analysis of a Randomized Clinical Trial
    American Medical Association (AMA) ; 2021
    In:  JAMA Ophthalmology Vol. 139, No. 12 ( 2021-12-01), p. 1285-
    Details
    In: JAMA Ophthalmology, American Medical Association (AMA), Vol. 139, No. 12 ( 2021-12-01), p. 1285-
    Type of Medium: Online Resource
    ISSN: 2168-6165
    URL: Article
    DOI: 10.1001/jamaophthalmol.2021.4395
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2021
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