Right atrial mass in a patient with COVID-19 pneumonia: A case report.

Lipomatous hypertrophy of the interatrial septum can have an atypical appearance by transthoracic echocardiography. The authors emphasize on the importance of the multimodality imaging approach to reach the appropriate diagnosis in such cases.

Percutaneous endoscopic gastrostomy in children: A single center experience in Saudi Arabia.

OBJECTIVES: To evaluate the demographic data and complications in children who had undergone percutaneous endoscopic gastrostomy (PEG) over 9 years period. METHODS: The demographic data, complications, length of hospital admission related to PEG insertion and follow-up findings of 39 patients who had undergone percutaneous endoscopic gastrostomy using the standard pull-through technique between 2011 and 2020 were examined. The study took place at the Gastroenterology Division, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia RESULTS: The most common indications of feeding with a gastrostomy tube include neurological diseases (n=30, 76.9%), followed by metabolic disorders (n=3, 7.69%), chronic diarrhea (n=2, 5.1%), chronic kidney diseases (n=2, 5.1%), cystic fibrosis (n=1, 2.56%), feeding aversion fibrosis (n=1, 2.56%). Out of the 39 patients, 20 (51%) did not have any complications. However, minor complication are expected. Most common complications included local infection (n=14, 35.89%) followed by granulation tissue (n=6, 15.38%), "buried bumper syndrome" developed in one. CONCLUSION: Percutaneous endoscopic gastrostomy tube is the desirable method for patients who are unable to feed orally, feeding is not adequate for demands, has special feeding requirements, or swallowing dysfunction. The technique has become more widespread because of its simplicity, safety, and low cost. Major complications are rare. The procedure is safe and effective and could be carried out by pediatric gastroenterologists after training.

Impact of Polypharmacy on Adherence to Evidence-Based Medication in Patients who Underwent Percutaneous Coronary Intervention.

BACKGROUND: The primary objective of this study was to evaluate the impact of polypharmacy on primary and secondary adherence to evidence-based medication (EBM) and to measure factors associated with non-adherence among patients who underwent percutaneous coronary intervention (PCI). METHODS: We conducted a retrospective analysis for patients who underwent PCI at a tertiary cardiac care hospital in Qatar. Patients who had polypharmacy (defined as ≥6 medications) were compared with those who had no polypharmacy at hospital discharge in terms of primary and secondary adherence to dual antiplatelet therapy (DAPT), beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEIs) and statins. RESULTS: A total of 557 patients (mean age: 53±10 years; 85%; males) who underwent PCI were included. The majority of patients (84.6%) received ≥6 medications (polypharmacy group) while only 15.4% patients received ≥5 medications (nonpolypharmacy group). The two groups were comparable in term of gender, nationality, socioeconomic status and medical insurance. The non-polypharmacy patients had significantly higher adherence to first refill of DAPT compared with patients in the polypharmacy group (100 vs. 76.9%; p=0.001). Similarly, the non-polypharmacy patients were significantly more adherent to secondary preventive medications (BB, ACEI and statins) than the polypharmacy group. CONCLUSION: In patients who underwent PCI, polypharmacy at discharge could play a negative role in the adherence to the first refill of EBM. Further studies should investigate other parameters that contribute to long term non-adherence.

Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia.

BACKGROUND: Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total or completion thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. A simple, reliable indicator to identify patients at risk would permit earlier pharmacologic prophylaxis to avoid these adverse outcomes. We examined the role of intact parathormone (PTH) levels 1 hour after surgery as a predictor of post-thyroidectomy hypocalcemia. METHODS: We prospectively reviewed the cases of consecutive patients undergoing total or completion thyroidectomy. Ionized calcium (Ca(2+)) and intact PTH levels were measured preoperatively and at 1-, 6- and 24-hour intervals postoperatively. The specificity, sensitivity, negative and positive predictive values of the 1-hour PTH serum levels (PTH-1) in predicting 24-hour post-thyroidectomy hypocalcemia and eucalcemia were determined. RESULTS: We reviewed the cases of 149 patients. Biochemical hypocalcaemia (Ca(2+) < 1.1 mmol/L) developed in 38 of 149 (25.7%) patients 24 hours after thyroidectomy. The sensitivity, specificity, positive and negative predictive values of a low PTH-1 were 89%, 100%, 97% and 100%, respectively. CONCLUSION: We found that PTH-1 levels were predictive of symptomatic hypocalcemia 24 hours after thyroidectomy. Routine use of this assay should be considered, as it could prompt the early administration of calcitriol in patients at risk of hypocalcemia and allow for the safe and timely discharge of patients expected to remain eucalcemic.

CONTEXTE: Il n'est pas rare qu'un dysfonctionnement des glandes parathyroïdes entraînant une hypocalcémie symptomatique s'observe après une thyroïdectomie totale ou de complétion et il est souvent associé à une importante morbidité chez les patients et à un séjour hospitalier prolongé. Un indicateur simple et fiable permettant de reconnaître les patients à risque pourrait favoriser une prophylaxie pharmacologique précoce afin d'éviter ces complications. Nous avons examiné le rôle des taux de parathormone (PTH) intacte une heure après la chirurgie comme prédicteurs de l'hypocalcémie post-thyroïdectomie. MÉTHODES: Nous avons passé en revue de manière prospective des cas consécutifs de patients soumis à une thyroïdectomie totale ou de complétion. Les taux de calcium ionisé (Ca2+) et de PTH intacte ont été mesurés avant l'intervention, puis 1 heure, 6 heures et 24 heures après. Il a ainsi été possible de déterminer la spécificité, la sensibilité, la valeur prédictive négative et positive des taux sériques de PTH 1 heure après l'intervention (PTH-1) pour ce qui est de prédire l'hypocalcémie et l'eucalcémie 24 heures après la thyroïdectomie. RÉSULTATS: Nous avons analysé 149 cas. L'hypocalcémie biochimique (Ca2+ < 1,1 mmol/L) a été observée chez 38 patients sur 149 (25,7 %) 24 heures après la thyroïdectomie. La sensibilité, la spécificité, la valeur prédictive positive et négative d'un taux de PTH-1 faible ont été respectivement de 89 %, 100 %, 97 % et 100 %. CONCLUSION: Nous avons noté que les taux de PTH-1 étaient prédictifs d'une hypocalcémie symptomatique 24 heures après la thyroïdectomie. L'utilisation d'emblée de ce test est à envisager puisqu'elle permettrait l'administration précoce de calcitriol chez les patients exposés à un risque d'hypocalcémie et un congé sécuritaire et rapide chez les patients dont on s'attend à ce qu'ils demeurent eucalcémiques.

Acute severe hypothyroidism is not associated with hyponatremia even with increased water intake: a prospective study in thyroid cancer patients.

BACKGROUND: Hypothyroidism, commonly induced in preparation for radioiodine treatment of differentiated thyroid cancer, is a text-book cause for hyponatremia. Nausea, stress, and increased fluid intake associated with the treatment are expected to exacerbate hyponatremia. METHODS: We prospectively studied 212 (80% females) consecutive thyroid cancer patients for the incidence of hypothyroidism-induced hyponatremia and associated risk factors. RESULTS: Mean(SD) age was 39.7(14.1) year, creatinine 82.0(20.8) µmol/l, TSH 141.6(92.0) mU/l, pre- and post-isolation sodium 139.5(2.3) and 137.8(3.0) mEq/l, respectively, and estimated fluid intake during isolation 9.7(6.2) L. Mild hyponatremia (≥130 mEq/l) was present in 18 patients (8.5%) and moderate hyponatremia (≥120 mEq/l) in 4(1.9%), 3 of the latter had elevated creatinine concentration and 2 were on diuretics. There was no significant correlation between post-isolation sodium concentration and TSH concentration (r = 0.03, p = 0.69) or estimated fluid intake (r = 0.10, p =0.17). There was significant correlation between post-isolation sodium concentration and age (r = -0.24, p < 0.0001) and creatinine concentration (r = -0.22, p = 0.001). Pre-post-isolation drop in sodium concentration was more in females (mean difference 1.21, p = 0.02). Compared to eunatremic patients, hyponatremic patients were more likely to have pre-isolation hyponatremia (9% vs. 0.5%, p = 0.03), elevated creatinine concentration (36% vs. 13%, p = 0.008), and to be on diuretics (23% vs. 1%, p = 0.0001). CONCLUSIONS: In the setting of acute severe hypothyroidism: 1) clinically-important hyponatremia is uncommon; sodium concentration may not need to be monitored unless patients have impaired renal function or are on diuretics, 2) age and female gender are associated with lower sodium concentration. Uncomplicated acute severe hypothyroidism didn't cause clinically-important hyponatremia/SIADH in this cohort of patients.

Atrial fibrillation post cardiac surgery trends toward management.

Post operative atrial fibrillation (POAF) is more common than before due to increased numbers of cardiac surgeries. This in turn is associated with increased incidence of post operative complication, length of hospital stay and subsequent increase the cost of hospitalization. Therefore preventing and/or minimizing atrial fibrillation by pharmacological or nonpharmacological means is a reasonable goal. POAF has also been associated with postoperative delirium and neurocognitive decline. The precise pathophysiology of POAF is unknown, however most of the evidence suggests it is multifactorial. Different risk factors have been reported, and many studies have evaluated the prophylactic effects of different interventions. This review article highlights the incidence, risk factors, and pathogenesis, prevention, and treatment strategies of POAF.