The Impact of Elexacaftor/Ivacaftor/Tezacaftor on Cystic Fibrosis Patients Who Acquire COVID-19 Infection.

The combination of medication containing elexacaftor, ivacaftor, and tezacaftor (EIT) has dramatically impacted the treatment and prognosis for patients with cystic fibrosis (CF). Lung function, weight, and self-reported quality of life have improved for many of these patients, but little is known about whether this treatment will have a beneficial effect in preventing morbidity and/or mortality from respiratory infections such as COVID-19. EIT received Food and Drug Administration (FDA) approval shortly before the first cases of COVID-19 appeared in the United States. We performed an analysis using the TriNetX (Cambridge, MA, USA) research database to determine if patients being treated with EIT who became infected with COVID-19 experienced significantly different outcomes compared to patients who were not receiving it.

Incidence of Acute Ischemic Stroke in Hospitalized Patients With Atrial Fibrillation Who Had Anticoagulation Interruption: A Retrospective Study.

BACKGROUND: Atrial fibrillation (AF) is one of the leading causes of acute ischemic stroke requiring anticoagulation. Many patients experience treatment interruption in the hospital setting. The aim of this study was to evaluate the effect of anticoagulation interruption on short-term risk of ischemic stroke in hospitalized patients with AF. METHODS: We performed a retrospective medical record review using the Hospital Corporation of America (HCA) database. We included patients admitted to our institution between December 2015 and December 2018 who had a prior history of AF. Patients were excluded if they had ischemic stroke, hemorrhagic stroke, history venous thromboembolism or mechanical valve on admission. We compared the incidence of ischemic stroke in patients in whom anticoagulation was interrupted for more than 48 h to those who continued anticoagulation. RESULTS: A total of 2,277 patients with history of AF were included in the study. In this cohort, 79 patients (3.47%) had anticoagulation interruption of more than 48 h during their hospital stay. There was no difference in incidence of stroke between the interruption and no interruption groups (1.27% (n = 1) vs. 0.23% (n = 5), P = 0.19). Interruption of anticoagulation did not associate with a significant increase in the risk of in-hospital ischemic stroke. CHA2DS2VASc score was a strong predictor of in-hospital stroke risk regardless of anticoagulation interruption (odds ratio: 7.199, 95% confidence interval: 2.920 - 17.751). CONCLUSION: In this study, the in-hospital incidence of ischemic stroke in patients with AF did not significantly increase by short-term anticoagulation interruption.

Evolution of Acute Pulmonary Embolism Management: Review Article.

Acute pulmonary emboli are a major cause of morbidity and mortality and require prompt evaluation, diagnosis, and treatment. To date, anticoagulation using low molecular weight heparin or non-Vitamin K oral anticoagulants has been the mainstay of treatment in the subset of patients in whom pulmonary embolism does not compromise hemodynamics. On the other hand however, patients with massive pulmonary embolism and shock, thrombolytic therapy is necessary. This raises the question whether ultrasound-assisted catheter directed thrombolytic delivery might be superior to systemic administration. This review article aims to consolidate recent literature to help achieve a better understanding toward the utility of catheter directed therapy.

Aspiration Thrombectomy for Acute ST-Elevation Myocardial Infarction: Literature Review.

Over the years, aspiration thrombectomy for management of acute coronary syndrome was the center of discussion however due to multiple randomized control trials which did not provide sufficient evidence supporting use of this approach, this method is not routinely used. The benefit of this approach remains unknown, however, it is important to acknowledge the evolution of aspiration catheters and their potential in minimizing complications which were previously the set back of this approach. We provide a comprehensive review of the previous trials and how those catheters have since evolved significantly.

Atrial Myxoma, a Rare Cause of Sudden Cardiac Death: A Case Report and Review of Literature.

Despite the huge improvement in cardiovascular care over the past several decades and the decline in cardiovascular deaths, sudden cardiac death (SCD) continues to present a nationwide health problem accounting to more than half of all deaths from cardiovascular disease. Majority of these cases are related to coronary artery disease and arrhythmias, however, a very small number of these cases are secondary to cardiac neoplasms. These neoplasms commonly present with conduction abnormalities or symptoms secondary to valvular disease such as dyspnea, orthopnea, cough and/or edema. This is a rare case of a 63-year-old gentleman who suffered sudden cardiac death secondary to a cardiac myxoma.

A Rare Case of Severe Hypercalcemia Secondary to Atypical Parathyroid Cystic Adenoma with Negative Sestamibi Scan.

The two types of parathyroid cysts are functional and non-functional cysts. Cystic parathyroid lesions are a rare cause of hypercalcemia and often pose a diagnostic challenge due to the reduced detection on preoperative imaging studies. We, herein, present a rare case of an elderly female presenting to the emergency department with altered mental status associated with hypercalcemic crisis and a negative sestamibi scan. Following surgical resection, pathology revealed the diagnosis of cystic parathyroid adenoma and normalization of serum calcium levels.