Constrictive Pericarditis from an Atraumatic Hemopericardium After Systemic Thrombolysis for a Massive Pulmonary Embolism.

Constrictive pericarditis most commonly results from fibrosis and adhesions of the parietal and visceral pericardium due to long-standing inflammation. Common etiologies include idiopathic, post-surgical, radiation injury and infectious etiologies including tuberculosis. Traumatic hemopericardium is a rare cause of constrictive pericarditis but atraumatic hemopericardium causing constrictive pericarditis has not been reported in the literature to date. We present a case of constrictive pericarditis from an atraumatic hemopericardium after systemic thrombolysis for a massive pulmonary embolism.

In type 2 diabetes, glargine and liraglutide each improved glycemic outcomes at 5 y vs. glimepiride or sitagliptin.

SOURCE CITATION: GRADE Study Research Group; Nathan DM, Lachin JM, Balasubramanyam A, et al. Glycemia reduction in type 2 diabetes-glycemic outcomes. N Engl J Med. 2022;387:1063-74. 36129996.

In type 2 diabetes, liraglutide reduced CV events at 5 y vs. glargine, glimepiride, or sitagliptin.

SOURCE CITATION: GRADE Study Research Group; Nathan DM, Lachin JM, Buse JB, et al. Glycemia reduction in type 2 diabetes-microvascular and cardiovascular outcomes. N Engl J Med. 2022;387:1075-88. 36129997.

In acute ischemic stroke, thrombectomy was not noninferior to alteplase + thrombectomy for 90-d functional independence.

SOURCE CITATION: Fischer U, Kaesmacher J, Strbian D, et al. Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Lancet. 2022;400:104-15. 35810756.

In persons at intermediate risk for CVD, polypills reduce a composite of CV events at 5 y.

SOURCE CITATION: Joseph P, Roshandel G, Gao P, et al. Fixed-dose combination therapies with and without aspirin for primary prevention of cardiovascular disease: an individual participant data meta-analysis. Lancet. 2021;398:1133-46. 34469765.

In non-critically ill patients with COVID-19, therapeutic anticoagulation improved survival to discharge without organ support.

SOURCE CITATION: Lawler PR, Goligher EC, Berger JS, et al. Therapeutic anticoagulation with heparin in noncritically ill patients with Covid-19. N Engl J Med. 2021;385:790-802. 34351721.

In critically ill patients with COVID-19, therapeutic anticoagulation did not increase organ support-free days.

SOURCE CITATION: Goligher EC, Bradbury CA, McVerry BJ, et al. Therapeutic anticoagulation with heparin in critically ill patients with Covid-19. N Engl J Med. 2021;385:777-89. 34351722.

In patients with acute HF and iron deficiency, IV ferric carboxymaltose improved quality of life at 4 to 24 wk.

SOURCE CITATION: Jankowska EA, Kirwan BA, Kosiborod M, et al. The effect of intravenous ferric carboxymaltose on health-related quality of life in iron-deficient patients with acute heart failure: the results of the AFFIRM-AHF study. Eur Heart J. 2021;42:3011-20. 34080008.

Necrotising myopathy and concurrent thyroiditis in a patient with COVID-19 infection.

A 76-year-old man with hypogammaglobulinemia on monthly intravenous immunoglobulin infusions presented to the hospital with fever, cough, and shortness of breath and was diagnosed with COVID-19 pneumonia requiring intensive care unit admission but not intubation. He was treated with convalescent plasma, remdesivir and corticosteroids. Sixteen days into his hospitalisation he began to report weakness without sensory symptoms and was found on biopsy to have a necrotising myopathy.

In hyponatremia, rapid intermittent bolus vs. slow continuous infusion of hypertonic saline did not differ for overcorrection of serum sodium.

SOURCE CITATION: Baek SH, Jo YH, Ahn S, et al. Risk of overcorrection in rapid intermittent bolus vs slow continuous infusion therapies of hypertonic saline for patients with symptomatic hyponatremia: the SALSA randomized clinical trial. JAMA Intern Med. 2021;181:81-92. 33104189.

Tricuspid valve endocarditis in pregnancy: a case report and review of the literature.

Infective endocarditis (IE) is a rare complication in pregnancy that is associated with significant morbidity and mortality to both mother and fetus. We present a case of a 27-year-old female at 22-weeks gestation with a history of intravenous drug abuse (IVDA) who developed methicillin sensitive Staphylococcus aureus tricuspid valve endocarditis with persistent bacteremia and septic emboli necessitating tricuspid valve extirpation. Four days later, worsening decompensated heart failure required cesarean section at 23w5d. Although the patient's volume status and dyspnea improved significantly, fetal demise occurred 9 days after operative delivery.

Remdesivir improved time to recovery in adults hospitalized with COVID-19 and lower respiratory tract involvement.

SOURCE CITATION: Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of Covid-19-preliminary report. N Engl J Med. 2020. [Epub ahead of print]. 32445440.

Recommendations for caring for patients with severe and nonsevere COVID-19.

SOURCE CITATION: Ye Z, Rochwerg B, Wang Y, et al. Treatment of patients with nonsevere and severe coronavirus disease 2019: an evidence-based guideline. CMAJ. 2020;192:E536-45. 32350002.

Stenotrophomonas maltophilia Infection in a Patient with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD): A Colonizer or True Infection?

BACKGROUND This article describes a finding of sputum culture positive for Stenotrophomonas maltophilia in an elderly woman with past medical history of chronic obstructive pulmonary disease (COPD) and hypertension, presenting with acute hypoxemic hypercapnic respiratory failure secondary to COPD exacerbation from bronchitis/bronchopneumonia. CASE REPORT Computed tomography (CT) of the chest showed secretions in the lower lobe bronchi and small scattered clustered nodules consistent with bronchitis/mild bronchopneumonia without evidence of pulmonary embolism. A sputum culture was positive for Stenotrophomonas maltophilia. She was treated with trimethoprim/sulfamethoxazole for 10 days. She recovered and was subsequently discharged from the hospital. CONCLUSIONS Stenotrophomonas maltophilia, previously known as a colonizer, is now being recognized as a true respiratory infection, especially in immunocompromised patients and those with chronic diseases like COPD presenting with signs and symptoms of infection. Therefore, early identification and prompt treatment of Stenotrophomonas maltophilia infection is important for a favorable outcome.

Adding NT-proBNP to the Revised Cardiac Risk Index improved prediction of CV events after noncardiac surgery.

SOURCE CITATION: Duceppe E, Patel A, Chan MTV, et al. Preoperative N-terminal pro-B-type natriuretic peptide and cardiovascular events after noncardiac surgery: a cohort study. Ann Intern Med. 2020;172:96-104. 31869834.

Supplementation with vitamin D plus calcium reduces fracture risk; vitamin D alone does not.

SOURCE CITATION: Yao P, Bennett D, Mafham M, et al. Vitamin D and calcium for the prevention of fracture: a systematic review and meta-analysis. JAMA Netw Open. 2019;2:e1917789. 31860103.

Hypochloraemia and 30 day readmission rate in patients with acute decompensated heart failure.

AIMS: Despite recent advances in guideline-directed therapy, rehospitalization rates for acute decompensated heart failure (ADHF) remain high. Recently published studies demonstrated the emerging role of hypochloraemia as a predictor of poor outcomes in patients with ADHF. This study sought to determine the correlation between low serum chloride and 30 day hospital readmission in patients with ADHF. METHODS AND RESULTS: We retrospectively reviewed electronic medical records of 1504 patients who were admitted to one 700 bed US tertiary care centre with the diagnosis of ADHF between June 2013 and December 2014. Of the 1504 reviewed records, 1241 were selected for further analysis. Hypochloraemia (either on admission or at discharge) was identified in 289 patients (23.3%) and was associated with significantly higher 30 day hospital readmission rate or death (42.2% vs. 33.7%, P = 0.008). This association persisted in multivariate analysis when controlling for serum sodium, weight loss, diuretic dose, adjunct thiazide use, serum blood urea nitrogen, and BNP levels (OR: 1.35, 95% CI: 1.02-1.77, P = 0.033); however, the predictive value of the overall model was low (Naglkerke R2 = 0.040). Hypochloraemia was also found to be associated with increased 12 month mortality in our cohort (31.4% vs. 20.2%, P = 0.015) that correlates with the results of previously published studies. CONCLUSIONS: Low serum chloride measured in patients admitted for ADHF is independently but weakly associated with increased 30 day readmission rate and demonstrated low predictive value as a potential biomarker in this cohort.

Allergic bronchopulmonary aspergillosis presumably unmasked by PD-1 inhibition.

Programmed cell death-1 (PD-1) inhibitors stimulate immune recognition of tumour cells in cancer patients, but have significant autoimmune side effects including pneumonitis. We report the case of a patient with asthma and mild eosinophilia who developed unusual pulmonary side effect of bronchiectasis, severe eosinophilia (absolute eosinophil count: 3200 c/mm3) and elevated IgE levels (7050 IU/mL; normal: <164 IU/mL) 4 months into therapy with the PD-1 inhibitor pembrolizumab. Aspergillus fumigatus IgG was elevated at 15.60 U/mL (normal: <12.01 U/mL). He responded to therapy with corticosteroids and voriconazole and was able to resume pembrolizumab thereafter with good clinical response.