Involvement Of Cardiovascular System Research Articles

Comparison of early characteristics of multisystemic inflammatory syndrome and Kawasaki disease in children and the course of Kawasaki disease in the pandemic

IntroductionMultisystemic inflammatory syndrome (MIS-C) is a newly described disease manifestation in children associated with the novel coronavirus SARS-CoV-2 infection and can be easily confused with Kawasaki disease with its clinical and laboratory findings. In this study, the clinical findings, organ involvements, similarities, and differences in laboratory and imaging of the children with MIS-C and KD at the time of admission will be revealed in detail, and the treatment methods and follow-up results will be revealed.Material and methodOur study was a single-center study and included pediatric patients who were treated with a diagnosis of MIS-C between March 2020 and July 2023 in the pediatric cardiology, pediatric emergency, pediatric infection, and pediatric intensive care clinics at Celal Bayar University and who were treated with a diagnosis of KD (complete/incomplete) between January 2015 and July 2023. MIS-C diagnosis was made according to the Turkish Ministry of Health COVID-19 guidelines. Sociodemographic characteristics, clinical, laboratory, and echocardiography findings, treatments given, and clinical course of all patients included in the study were evaluated.ResultsThe median age was 30 months (7–84) in KD and 96 months (6-204) in MIS-C, and it was significantly higher in the MIS-C group (p = 0.000). Symptom duration was significantly longer in the MIS-C group (p = 0.000). In terms of clinical features, gastrointestinal syndrome findings (nausea, vomiting, abdominal pain) and respiratory findings (dyspnea) were significantly higher in the MIS-C group (p = 0.007, p = 0.000, p = 0.002, respectively). Regarding cardiovascular system involvement, coronary involvement was significantly higher in the KD group. However, valvular involvement, left ventricular systolic dysfunction, and pericardial effusion were significantly higher in the MIS-C group (p = 0.000, p = 0.001, p = 0.003, p = 0.023, respectively). In terms of laboratory findings, white blood cell count was higher in KD (p = 0.000), absolute lymphocyte count, platelet level, blood sodium, and albumin levels were lower in MIS-C group (p = 0.000, p = 0.000, p = 0.000, p = 0.000, p = 0.003, respectively), ferritin and troponin levels were significantly higher in MIS-C group. These results were statistically significant (p = 0.000, p = 0.000, respectively). D-dimer and fibrinogen levels were high in both groups, and no significant statistical difference was detected between the two groups. There was no significant difference between the two groups regarding the length of hospitalization and mortality, but steroid use was significantly higher in the MIS-C group (p = 0.000).ConclusionIn conclusion, this study has demonstrated the similarities and differences between MIS-C and KD regarding clinical findings, organ involvement, and laboratory and imaging results. The results of our study have important implications in terms of contributing to the data in the existing literature on these two diseases and for the correct diagnosis and better management of pediatric patients presenting with these disorders.What is knownMultisystemic inflammatory syndrome (MIS-C) is a newly described disease manifestation in children associated with the novel coronavirus SARS-CoV-2 infection and can be easily confused with Kawasaki disease with its clinical and laboratory findings.What is newAlthough MIS-C and KD have many similarities, their symptoms, disease processes, possible complications, and treatment regimens may differ.

Ease of sutureless aortic valve replacement in a patient with unexpected ochronosis: a case report

BackgroundAlkaptonuria is a rare congenital metabolic disorder characterized by homogentisic acid accumulation in body cartilage and connective tissues due to a deficient homogentisic acid dioxygenase enzyme. This disorder manifests in various clinical symptoms, including spondyloarthropathy, ocular and dermal pigmentation, genitourinary tract obstruction by ochronosis stones, and cardiovascular system involvement. Cardiac ochronosis is a rare manifestation of alkaptonuria that may present as aortic stenosis, sometimes accompanied by other cardiovascular complications.Case presentationWe report an unexpected case of ochronosis diagnosed during cardiac surgery. Due to the fragile, thin, and atheromatous nature of the ascending aorta in patients with ochronosis, we opted for a sutureless aortic valve replacement procedure. This approach appears to be more suitable for patients with ochronosis.ConclusionsAlthough cardiac ochronosis is rare, surgeons should remain vigilant and consider the possibility of this condition when examining patients with aortic valve stenosis, paying close attention to the clinical manifestations of alkaptonuria.

Multisystem Inflammatory Syndrome in Neonates Associated with COVID-19 in Neonatal ICU of a Tertiary Care Hospital.

Neonatal multisystem inflammatory syndrome (MIS-N) is a unique disease of neonates described in several case reports from all over the world with a myriad of presentations and the emergence of new cases. Retrospective case series. Place and Duration of the Study: Department of Paediatrics, Fazaia Medical College, Pakistan Air Force Hospital, Islamabad, Pakistan, from December 2021 to November 2022. The study was conducted on neonates who were managed as MIS-N in the neonatal ICU. Data were collected and analysed on SPSS version 24. Patients in this study ranged from newborns to 13 days of age with a mean age of 3.27 ± 4.29 days and average gestational age of 35.18 ± 3.67 weeks. Among these neonates, 7 (63.6%) had bleeding diathesis, 11 (100%) had seizures, 8 (72.2%) presented with haemodynamic instability and shock, and 7 (63.3%) had signs of heart failure. All neonates (100%) had markedly raised SARS-CoV2 IgG antibodies, CRP, ferritin, D-dimers, interleukin 6, procalcitonin, 10 (90.9%) had hypoalbuminemia, and 7 (63.3%) had deranged coagulation profile. Cardiac involvement was seen in all neonates (100%) with raised proBNP and myocardial dysfunction on echocardiography. Pulmonary hypertension was present in 6 (54.4%) neonates. High mortality was observed at 6 (54.5%) among which 4 (66.6%) were premature neonates. MIS-N is a new disease entity which is still under research. There is a high propensity for cardiovascular system involvement and higher mortality among preterm neonates. Neonatal multisystem inflammatory syndrome (MIS-N), Multisystem inflammatory syndrome in children (MIS-C), SARS-CoV2 infection, SARS-CoV2 spike protein, SARS-CoV2 IgG antibodies.

Congenital heart defects and postoperative follow-up of patients with Williams syndrome as a single center experience and review of the cases from Türkiye.

Cardiovascular system involvement is quite common and the leading cause of morbidity and mortality in patients with Williams syndrome (WS), most of whom need surgery. The present study aimed to provide a detailed evaluation of the features of surgical procedures and outcomes of patients with WS given as single-center experience, and additionally to make a detailed review from Türkiye. Thirty-five children with WS diagnosed between the years 1992 and 2021 were evaluated retrospectively including cardiovascular data, surgical treatment features, and outcomes. A total of six articles from Türkiye were evaluated. A total of 35 patients with Williams Syndrome (24 male) with a median age of cardiologic diagnosis of 6 months (range, 2 days-6 years) were evaluated. The cardiac defects of the patients with WS were found as supravalvular aortic stenosis (SVAS) (n=30, 85%) and peripheral pulmonary stenosis (PPS) (n=21, 65%). Additional cardiac anomalies were seen in 71% patients. The rate of SVAS and PPS surgery in all patients with WS was 77.1%. The median surgical age of the patients was 2.5 years (range, 7 months-15.5 years). No patients died due to surgery. But one patient died because of ventricular tachycardia due to anesthesia at the beginning of angiography. A total of 138 (63% male) patients with WS were evaluated from the articles published in Türkiye. Of 138 patients, 64.4% had SVAS, 52.1% had PPS, and 39.8% had additional cardiac anomaly. The median follow-up period ranged from 17 months to 18 years, and six (4.3%) patients died in the early postoperative period. Cardiovascular system involvement is extremely common and is the leading cause of morbidity and mortality in patients with WS, often requiring surgical intervention. As seen in our study including 35 patients with WS and in publications from Türkiye, SVAS in patients with WS generally requires surgery, especially in the first year of life. PPS, on the other hand, requires surgery less frequently than SVAS, and pulmonary stenosis appears to decrease over time.

Identifying Cardiovascular System Involvement through Heart Rate Trends in Food-Induced Systemic Reactions in Infants and Toddlers

Identifying Cardiovascular System Involvement through Heart Rate Trends in Food-Induced Systemic Reactions in Infants and Toddlers

Multisystem Inflammatory Syndrome in Children (MIS-C) with Involvement of Cardiovascular, Respiratory and Gastrointestinal System: a Case Report

MIS-C is a rare complication after COVID-19 infection that manifests with multi-system involvement. This case report presents a 7-year-old girl with MIS-C with involvement of the cardiovascular, respiratory, and gastrointestinal systems. The patient was treated with intravenous immunoglobulins (IVIG) and glucocorticoids, resulting in recovery and hospital discharge after two weeks. Keywords: MIS-C; COVID-19; hepatitis; case report.

Case Series of Multisystem Inflammatory Syndrome in Neonates (MIS-N) With a Link to Coagulopathy.

Introduction Multisystem inflammatory syndrome in neonates (MIS-N) is an emerging clinical entity observed in neonates born to mothers with exposure to the SARS-CoV-2 virus before or during the antenatal period. Methods We report 18 neonates diagnosed with MIS-N from retrospectively collected data.A total of 18 neonates (13 term and five late-preterm; 10 males) admitted to the neonatal intensive care unit (NICU) of a tertiary care medical institute, between June 2021 to November 2022, were diagnosed with MIS-N. Results The median age of presentation of the 18 neonates was 1.5 days of life. All the neonates were positive for SARS-CoV-2 IgG antibodies and had elevated D-dimer levels. Respiratory system involvement was the most common (12 of 18 neonates: 66.67%). Ten out of 18 neonates (55.55%) had coagulopathy. Seven of the ten neonates with coagulopathy had central nervous system (CNS) involvement as seizures and/or intracerebral infarcts/bleeds. Cardiovascular and gastrointestinal system involvement was observed in nine (50%) and seven (38.89%) neonates, respectively. One out of 18 neonates died due to intraventricular and cerebral hemorrhage. The mortality rate was 5.55% (n=1). Ten of 18 neonates with coagulopathy required fresh frozen plasma along with repeated therapeutic doses of injection vitamin K. Eight neonates (44.44%) required human intravenous immunoglobulin (IVIG), and three neonates (16.67%) required steroids and IVIG for recovery along with supportive care. Conclusion Coagulopathy can be one of the salient features of presentation in MIS-N. In the immediate post-pandemic era, it is essential that MIS-N is considered in the differential diagnosis of neonates presenting with intracerebral bleeds/infarcts. IVIGand steroids might play an important role in the treatment of neonates with MIS-N.

Anti-inflammatory treatment improves systolic and diastolic tissue doppler parameters in patients with newly diagnosed rheumatoid arthritis

Background The frequency of cardiovascular system involvement is increased in rheumatoid arthritis (RA) and may result in serious morbidity and mortality. Early intervention and control of the disease activity may reduce the risk of cardiovascular events. The purpose of this study is to examine the effects of steroids and methotrexate (Mtx) on the heart functions of newly diagnosed RA patients. Methods Our study is a prospective cohort study involving thirty-six newly diagnosed RA patients according to the American Society of Rheumatology classification criteria. Right and left ventricular echocardiography, and Doppler parameters were evaluated in these patients thrice; before treatment, after one month of steroid treatment, and after three months of Mtx treatment, and laboratory/clinical parameters were noted. Results The mean age of the patients was 52.66 ± 13.66 years. After the treatment, a significant decrease was observed in the values of inflammatory markers (ESR and CRP) and disease activity score (DAS28) [p < .05]. Left ventricular tissue Doppler showed an increase in lateral S, septal S, and mitral S waves compared to baseline (8.37 ± 1.89 vs 10.0 ± 1.8 cm/s p = .001). While there was a decrease in tissue Doppler tricuspid a wave (18.33 ± 4.76 vs 15.63 ± 4.36 p = .016), an increase in Tricuspid E/e’ value and Tricuspid tissue Doppler e/a value was detected after treatment (0.76 ± 0.30) vs 0.94 ± 0.53) p < .010). Significant changes were found to be more prominent after the Mtx treatment. Conclusion In RA patients, steroid and Mtx treatment significantly positively affects left ventricular systolic and right ventricular diastolic functions.

Right ventricular failure due to acute pulmonary embolism associated with Graves’ disease: A case report

Background Graves' disease is a prevalent endocrine disorder characterized by diverse clinical manifestations affecting multiple organs, exhibiting varying degrees of severity. Cardiovascular system involvement is one of the most common manifestations, which include palpitation, tachycardia, cardiomyopathy, atrial fibrillation, pulmonary hypertension, or heart failure. Additionally, excessive thyroid hormone can lead to a hypercoagulable state, increasing the risk of venous thrombosis. However, thrombotic events, particularly deep vein thrombosis, cerebral venous thrombosis, or pulmonary embolism, are rare complications of Graves’ disease. Case presentation In this report, we present the case of a 53 years old woman who presented with progressively worsening dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral leg edema, and jaundice for 2 weeks. She had also reported a weight loss of 4 kilograms within 3 months. Upon admission to our hospital, she initially received a diagnosis of congestive heart failure with atrial fibrillation and thyrotoxicosis. Following diuretic therapy, the patient developed hypotension and severe hypoxemia. Subsequent investigation revealed acute right ventricular failure due to an acute sub-segmental pulmonary embolism, which was confirmed by computed tomography of the pulmonary artery. The patient's condition improved after resuscitation involving intravenous fluid administration to increase right ventricular preload, intravenous vasopressor infusion to elevate systemic blood pressure, management of severe thyrotoxicosis, and intravenous administration of heparin. Conclusion Graves’ disease, accompanied by hemodynamic disturbances due to acute right ventricular failure, necessitates admission to the intensive care unit for resuscitation and close monitoring. Although acute pulmonary embolism is an uncommon condition associated with Graves’ disease, it should be considered, particularly in patients who develop acute right ventricular failure.

Clinical characteristics of the cardiovascular system involvement in various variants of ankylosing spondylitis

Inflammatory and degenerative spinal diseases are one of the pressing problems of modern rheumatology due to the high prevalence, frequent incidence of diseases of young and middle-aged men, frequent lesions of internal organs, early disability of patients, socio-economic damage caused to the patient and society [1]. Since 1892, when V.M.Bekhterev described the main clinical manifestations of the disease and suggested that it should be singled out as a separate nosological form, researchers from the leading countries of the world have achieved certain success in studying its nature, mechanisms of development, as well as treatment and rehabilitation of patients. Nevertheless, ankylosing spondylitis (AC), which is regarded as a disease of the musculoskeletal apparatus, affecting mainly young men, remains one of the leading socioeconomic problems of our time, leading to disability in working age.

Clinical and functional characteristics of the cardiovascular system involvement in various variants of ankylosing spondylitis

Inflammatory and degenerative spinal diseases are one of the pressing problems of modern rheumatology due to the high prevalence, frequent incidence of diseases of young and middle-aged men, frequent lesions of internal organs, early disability of patients, socio-economic damage caused to the patient and society. Since 1892, when V.M.Bekhterev described the main clinical manifestations of the disease and suggested that it should be singled out as a separate nosological form, researchers from the leading countries of the world have achieved certain success in studying its nature, mechanisms of development, as well as treatment and rehabilitation of patients. Nevertheless, ankylosing spondylitis (AC), which is regarded as a disease of the musculoskeletal apparatus, affecting mainly young men, remains one of the leading socio-economic problems of our time, leading to disability in working age

Prevalence and characteristics of adult patients with adult-onset and childhood-onset food allergy.

IgE-mediated food allergy (FA) affects health-related quality of life, and may cause life-threatening reactions. Few studies characterizing adult FA patients have been reported, especially first ever reaction (FER) in adult-onset. We describe the characteristics of adult FA patients, especially FER and compare these characteristics between childhood- and adult-onset FA. A cross-sectional study of all adult patients visiting the Allergy Clinic, Siriraj Hospital at the outpatient department between January 2009 to December 2019 was conducted. Demographic, clinical data, and first reaction in life data were collected. Adult-onset was defined as ≥ 18 years old. Of 711 patients visiting the clinic, 174 (24.4%) were FA with a median age of 31.0 years (interquartile range 24.0, 44.0 years); 29.3% were male. FA patients had significantly higher prevalence of sensitization to cockroach compared with non-FA patients (67.4% vs. 56.3%); p = 0.016). The three most common food triggers were shellfish (68.0%), wheat (28.7%), and fruit and vegetables (10.0%). Before diagnosis, 56.7% (97/171) experienced at least 1 food-related anaphylaxis. Of the 166 patients compared on age of onset, 127 (76.5%) were adult-onset. In FER, patients with adult-onset had significantly more reactions to fruit and vegetables, more respiratory system involvement, and more other systems involvement [OR 8.95 (1.13, 1157); p = 0.034; OR 3.15 (95%CI 1.30, 8.25), p = 0.011; OR 10.8 (1.35, 1404), p = 0.019, respectively]. In sensitivity analysis, the cardiovascular system involvement was also significantly more common [OR 2.78 (1.05, 9.15); p = 0.038]. Shellfish was the most common trigger foods in adult FA patients. In FER, anaphylaxis was common for adult-onset. Adult-onset FA patients also had more respiratory, cardiovascular, and other systems involvements than childhood-onset ones. FA awareness, early diagnosis, and proper management are encouraged. Further studies on the adult-onset food allergic patients are required.

Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland.

Multisystem inflammatory syndrome in children (MIS-C) is an immune-mediated complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cardiovascular system is commonly involved. Acute heart failure (AHF) is the most severe complication of MIS-C, leading to cardiogenic shock. The aim of the study was to characterise the course of MIS-C with a focus on cardiovascular involvement, based on echocardiographic (echo) evaluation, in 498 children (median age 8.3 years, 63% boys) hospitalised in 50 cities in Poland. Among them, 456 (91.5%) had cardiovascular system involvement: 190 (48.2%) of patients had (most commonly atrioventricular) valvular insufficiency, 155 (41.0%) had contractility abnormalities and 132 (35.6%) had decreased left ventricular ejection fraction (LVEF < 55%). Most of these abnormalities improved within a few days. Analysis of the results obtained from two echo descriptions (a median of 5 days apart) revealed a >10% increase in LVEF even in children with primarily normal LVEF. Lower levels of lymphocytes, platelets and sodium and higher levels of inflammatory markers on admission were significantly more common among older children with contractility dysfunction, while younger children developed coronary artery abnormality (CAA) more often. The incidence of ventricular dysfunction might be underestimated. The majority of children with AHF improved significantly within a few days. CAAs were relatively rare. Children with impaired contractility as well as other cardiac abnormalities differed significantly from children without such conditions. Due to the exploratory nature of this study, these findings should be confirmed in further studies.

Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19.

Multisystem inflammatory syndrome in children (MIS-C) is a dysregulated autoimmune-mediated illness in genetically susceptible patients following COVID-19 with an interval of 2-6 weeks. The median age of patients with MIS-C is 6-11 years. Most common manifestations are involvement of gastrointestinal tract, cardiovascular system, hematological system, and mucocutaneous system. Respiratory tract, neurological system, musculoskeletal system, and kidney are less frequently affected. Mucocutaneous manifestations and coronary artery abnormalities characteristic for Kawasaki disease (KD) may be observed in a significant proportion of MIS-C patients that may make the differential diagnosis be difficult for some patients, especially in the post-pandemic era. The mortality rate is 1-3%. Management and prognosis of MIS-C are similar to that of KD. MIS-C and KD may share a common pathogenic process. Based on the observation of MIS-C-like illness in uninfected neonates, i.e. multisystem inflammatory syndrome in neonates, both MIS-C and KD may be a consequence of dysregulated, over-exaggerated humoral immune responses triggered by a specific infectious agent.

Clinical Characteristics and Laboratory Findings in Children with Multisystem Inflammatory Syndrome (MIS-C)-A Retrospective Study of a Tertiary Care Center from Constanta, Romania.

A new hyper-inflammatory syndrome in children was identified after SARS-CoV-2 infection as a post-infectious complication that is temporally associated with coronavirus disease (COVID-19). Fever, rash, conjunctival hyperemia, and gastrointestinal problems are all clinical manifestations of multisystem inflammatory syndrome in children. This condition, in some cases, causes multisystem involvement, affecting multiple organ systems and necessitating admission to a pediatric intensive care unit. Due to limited clinical studies, it is necessary to analyze the characteristics of the pathology in order to improve the management and long-term follow-up of high-risk patients. The objective of the study was to analyze the clinical and paraclinical characteristics of children diagnosed with MIS-C. The clinical study is a retrospective, observational, descriptive research work that includes patients diagnosed with MIS-C, temporally associated with coronavirus disease, and it contains clinical characteristics, laboratory data, and demographic information. The majority of patients had normal or slightly increased leukocyte counts, which were associated with neutrophilia, lymphocytopenia, and significantly elevated inflammatory markers, including high levels of C-reactive protein, fibrinogen, the erythrocyte sedimentation rate, serum ferritin, and IL 6 and elevated levels of the cardiac enzymes NT-proBNP and D-dimers, owing to the cardiovascular system involvement in the pro-inflammatory process. At the same time, renal system involvement led to raised creatinine and high proteinuria in association with hypoalbuminemia. This characteristic of the pro-inflammatory status as well as multisystem impairment are highly suggestive of the post-infection immunological reaction of the multisystem syndrome temporally associated with SARS-CoV-2 infection.

Multisystem inflammatory syndrome in children (MIS-C) and "Near MIS-C": A continuum?

Reports of multisystem inflammatory syndrome in children (MIS-C), following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, have been increasing worldwide, with an incidence varying significantly across studies based on the definition used for the diagnosis. At our tertiary medical center in Lebanon, we encountered several cases that presented a diagnostic challenge because they mimicked MIS-C but did not meet the US Centers for Disease Control and Prevention (CDC) definition. We decided to review these cases and describe their features in comparison with cases that met the CDC criteria of MIS-C and those that had an alternative diagnosis. This is a retrospective chart review of subjects aged <19 years old admitted to the American University of Beirut Medical Center (AUBMC) between March 1, 2020, and May 31, 2021, with suspected or confirmed MIS-C, following documented COVID-19 infection, with sufficient or insufficient criteria for diagnosis. Subjects were classified into 3 groups: "MIS-C", "Near MIS-C" and "Alternative Diagnosis". A total number of 29 subjects were included in our cohort. Fever was present in all subjects. In the MIS-C group, evidence for cardiovascular system involvement was the most common feature followed by the mucocutaneous and gastrointestinal systems. In the "Near MIS-C" and "Alternative Diagnosis" group, gastrointestinal symptoms were the most common with only one patient with cardiac abnormalities and none with coagulopathy. Subjects with typical MIS-C presentation had higher inflammatory markers when compared to subjects in the other groups. Almost all the subjects had positive IgG for SARS-CoV-2. Of the 29 subjects, the Royal College of Paediatrics and Child Health (RCPCH) case definition would have identified all suspected cases without an alternative diagnosis as MIS-C, whereas the World Health Organization (WHO) and the CDC definitions would have excluded 6 and 10 subjects, respectively. MIS-C presents a diagnostic challenge due to the nonspecific symptoms, lack of pathognomonic findings, and potentially fatal complications. More research is needed to fully understand its pathogenesis, clinical presentation spectrum, and diagnostic criteria. Based on our experience, we favor the hypothesis that MIS-C has a continuum of severity that necessitates revisiting and unifying the current definitions.

Study of the Orbital Vessels by Color Doppler in Known Diabetic Patients for Evaluation of Diabetic Retinopathy

Introduction: Diabetic retinopathy is a vascular disorder affecting the microvasculature of retina. It is caused bychanges in the blood vessels of retina. If untreated, it may lead to blindness which is usually preventable if retinopathyis diagnosed early and treated promptly. As the prevalence of diabetes is rising, the systemic complications thatinclude retinopathy, nephropathy , neuropathy and involvement of cardiovascular system are also increasing.Diabetic retinopathy is the leading cause of blindness in the world. Prevention of retinopathy needs early diagnosis.(1) In ophthalmology, Color Doppler imaging is a new method that enables us to assess the orbital vasculature. Itallows for simultaneous two dimensional anatomical and Doppler evaluations of retinal artery.Objective and Aim: Aim of the study is to evaluate the ocular blood flow in patients with diabetes mellitus withno ocular symptoms.Materials and Methods: Color Doppler evaluation of 50 diabetic patients (100 eyes) was done with SIEMENSSONOLINE G- 50 machine with High frequency probe (5-7.5 Mega Hertz). Doppler spectral analysis of ophthalmicarteries (OA) and central retinal arteries (CRA) were done. The peak systolic velocity (PSV), end diastolic velocity(EDV), resistive index (RI) and S/D ratio were calculated. PSV, EDV, RI were measured in all patients in both the eyes.Results: The PSV of CRA in diabetics was significantly reduced (p=&lt;0.05). The EDV of CRA in diabetics wasalso significantly reduced (p=&lt;0.05). The RI of CRA is significantly increased (p=&lt;0.05) in diabetics. The 95%confidence interval is observed in PSV, EDV, RI of CRA in diabetics.Conclusion: There was statistical significant difference between the PSV, EDV and RI of CRA in diabetics. Thissignificant difference could be due to the circulatory changes in blood vessels in diabetics. No significant differencewas made in OA in diabetics. This study concludes that retinal hemodynamic changes were present even beforethe clinical manifestations of retinopathy in diabetics.

СТАН СЕРЦЕВО-СУДИННОЇ СИСТЕМИ У ХВОРИХ ІЗ ЗАДИШКОЮ, ЯКІ ПЕРЕНЕСЛИ ПНЕВМОНІЮ, АСОЦІЙОВАНУ З COVID-19

The aim of this study is to determine the contribution of cardiovascular system impairment to the development of dyspnea in post-acute COVID-19 pneumonia patients. Materials and methods. A total of 108 patients with dyspnea in the post-acute phase of COVID-19 (at 47 (38; 62) days after the onset of symptoms) were examined. These patients had experienced COVID-19associated pneumonia between April and November 2021. 21 patients were excluded due to comorbidities that could be a potential cause of dyspnea in the post-COVID-19 period. Thus, a group of 87 patients was formed, with an average age of 56 (49; 65) years, including 42 (48.3%) males. Patients were divided into three subgroups based on the severity of their acute COVID-19 illness: subgroup 1 (35 patients) — moderate, subgroup 2 (37 patients) — severe and subgroup 3 (15 patients) with critical. Investigation methods included clinical examinations, the mMRC dyspnea questionnaire, chest CT scans (both anamnestic and during examination), spirometry, ECG, echo-Doppler, serum NT-proBNP levels. Results. Patients in subgroups 1 and 2 in the post-acute phase of COVID-19 had less pronounced dyspnea compared to patients in subgroup 3 (1 (1; 2) and 2 (1; 3) vs. 3 (2; 4), respectively) (p &lt; 0.001). Residual changes on chest CT scans were more frequently observed in subgroup 3 than in subgroups 1 and 2 (15 (100%) vs. 7 (20.0%) and 20 (54.1%), respectively) (p &lt; 0.001). Obstructive ventilation disorders were only observed in subgroups 1 and 2 (in 15 (42.9%) and 6 (16.2%) patients, respectively), while restrictive disorders were found in subgroups 2 and 3 (in 14 (37.8%) and 12 (80.0%) patients, respectively). Clinically significant rhythm or conduction disturbances were not detected on ECG in any patient. According to echo-Doppler, subgroup 1 had diastolic dysfunction of the left ventricle (LV) in 3 (8.5%) patients; subgroup 2 had diastolic dysfunction of both the LV and right ventricle (RV) in 5 (13.5%) and 4 (10.8%) patients, respectively; and subgroup 3 had diastolic dysfunction of both the LV and RV in 4 (26.7%) patients. Mild pulmonary hypertension was observed only in subgroups 2 and 3 (in 13 (35.1%) and 14 (93.3%) patients, respectively). Elevated NT-proBNP levels were found in 22.9% of patients, with no significant differences between subgroups (p &gt; 0.05). Conclusions. The severity of dyspnea in the post-acute phase of COVID-19 is related to the duration of lung involvement and the severity of the acute illness. In patients with moderate-severity acute COVID-19, dyspnea in the post-acute phase is primarily due to residual respiratory system changes (in 20.0% of patients) and mild obstructive ventilation disorders (in 42.9% of patients). Cardiovascular system involvement in these patients is mainly detected by elevated serum NT-proBNP levels (in 22.9% of patients), which may serve as a marker for the heart failure onset, necessitating consultation with a cardiologist. In patients with severe- acute COVID-19, dyspnea in the post-acute phase is due to residual morphological lesions in the respiratory system based on chest CT findings (in 54.1% of patients) and cardiovascular pathology (in 45.9% of patients). Therefore, managing this patient cohort in the post-acute phase requires collaboration between pulmonologists and cardiologists, especially when dyspnea does not correlate with morphological lesions in the respiratory system on chest CT. In patients with critical acute COVID-19, dyspnea in the post-acute phase is consistently caused by both residual morphological lesions in the respiratory system (in 100% of patients) and cardiovascular pathology (in 93.3% of patients). This substantiates the imperative for joint management by pulmonologists and cardiologists.

CLINICAL AND BLOOD PARAMETERS IN RELATION TO THE OUTCOMES OF COMMUNITY ACQUIRED PNEUMONIA

Background: Risk stratification of Community acquired pneumonia (CAP) is challenging for physicians. Though various biomarkers are available, they are costly or not readily available in all health care settings. This study aimed to analyze the prognostic value of routinely available clinical and blood parameters in relation to the outcome of patients admitted with community acquired pneumonia. Methods: This was a hospital-based observational study of the patients admitted to Chitwan Medical College (CMC), Nepal between August 2021 and December 2021. We enrolled patients 18 years old and above with the diagnosis of CAP in the study and excluded patients with COVID and active pulmonary tuberculosis. The outcomes of the patients were recorded as improved, not-improved, or dead. Fischer exact, Kruskal-Wallis or Mann-Whitney tests were used for analysis wherever appropriate. Results: Total 92 patients with mean age 58.2 years were enrolled in the study. Patients who were not improved or were dead had higher age (p=0.029), respiratory rate (p&lt;0.001), shock index (p=0.013), total leukocyte count (TLC) (p=0.019), urea (p=0.046), creatinine (p&lt;0.01), potassium (p&lt;0.001), bilirubin (p=0.029), and lactate (P&lt;0.05) and lower SpO2 (p&lt;0.01), SpO2/FiO2 (p=0.018), pH (p=0.0497), and PaCO2 (p&lt;0.001). Patients with nervous (p&lt;0.001), cardiovascular (p=0.032) and renal system (p=0.019) involvement were also found to be associated with poor outcome. Conclusions: CAP patients with higher TLC, urea, creatinine, bilirubin and lactate, with lower SpO2, SpO2/FiO2, pH and PaCO2 and with involvement of more than one organ systems were found to have unfavorable prognosis. Higher potassium level was also found to be a potential marker of CAP severity.

A Study Of Incidence Of Pre-Eclampsia In Relation To Parity

The glory of attaining motherhood is often associated with shadows of life threatening dangers to the mother and the unborn child, even though pregnancy and childbirth is purely a physiological process.&#x0D; Pre-eclampsia is one of the complication of pregnancy and contributes significantly maternal as well as perinatal morbidity and mortality(1,2). This disorder is characterised by involvement of cardiovascular, coagulation, renal and hepatic system(3,4). This is a life threatening complication of pregnancy and is characterised by high blood pressure and proteinuria(5).&#x0D; Extensive studies have been made to detect the aetiology and pathogenesis of the condition. But despite decade of research, the aetiology of PIH has remained elusive and no definite and universally accepted conclusion has been reached(6). During normal pregnancy, renal blood flow and glomerular filtration increases appreciably. With the development of pre-eclampsia renal perfusion and glomerular filtration are reduced, resulting in impairment of renal function. The main characteristic feature of pre-eclampsia i.e. edema, proteinuria and hypertension are due to renal involvement. There occurs renal vasospasm which eventually produce endothelial damage, proteinuria and hypertension(7,8,9).&#x0D; So considering the mater related to our country an attempt has been made to study the incidence of pre-eclampsia in relation to parity.