Long-Term Outcomes of Resynchronization-Defibrillation for Heart Failure.

BACKGROUND: The Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) showed a greater benefit with respect to mortality at 5 years among patients who received cardiac-resynchronization therapy (CRT) than among those who received implantable cardioverter-defibrillators (ICDs). However, the effect of CRT on long-term survival is not known. METHODS: We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) to receive either an ICD alone or a CRT defibrillator (CRT-D). We assessed long-term outcomes among patients at the eight highest-enrolling participating sites. The primary outcome was death from any cause; the secondary outcome was a composite of death from any cause, heart transplantation, or implantation of a ventricular assist device. RESULTS: The trial enrolled 1798 patients, of whom 1050 were included in the long-term survival trial; the median duration of follow-up for the 1050 patients was 7.7 years (interquartile range, 3.9 to 12.8), and the median duration of follow-up for those who survived was 13.9 years (interquartile range, 12.8 to 15.7). Death occurred in 405 of 530 patients (76.4%) assigned to the ICD group and in 370 of 520 patients (71.2%) assigned to the CRT-D group. The time until death appeared to be longer for those assigned to receive a CRT-D than for those assigned to receive an ICD (acceleration factor, 0.80; 95% confidence interval, 0.69 to 0.92; P = 0.002). A secondary-outcome event occurred in 412 patients (77.7%) in the ICD group and in 392 (75.4%) in the CRT-D group. CONCLUSIONS: Among patients with a reduced ejection fraction, a widened QRS complex, and NYHA class II or III heart failure, the survival benefit associated with receipt of a CRT-D as compared with ICD appeared to be sustained during a median of nearly 14 years of follow-up. (RAFT ClinicalTrials.gov number, NCT00251251.).

Efficacy and safety of supraclavicular and pectoralis nerve blocks as primary peri-procedural analgesia for cardiac electronic device implantation: A pilot study.

BACKGROUND: Cardiac implantable electronic devices (CIEDs) are routinely implanted using intravenous drugs for sedation. However, some patients are poor candidates for intravenous sedation. OBJECTIVE: We present a case series demonstrating the safety and efficacy of a novel, ultrasound-guided nerve block technique that allows for pre-pectoral CIED implantation. The targets are the supraclavicular nerve (SCN) and pectoral nerve (PECS1). METHODS: We enrolled 20 patients who were planned for new CIED implantation. Following US-localization of the SCN and PECS1, local anesthetic (LA) was instilled at least 30-60 min pre-procedure. Successful nerve block was determined if < 5 mL of intraprocedural LA was used, along with lack of sensation with skin and deep tissue pinprick. Optional sedation was offered to patients' pre-procedure if discomfort was reported. RESULTS: Seventeen patients (85%) had a successful periprocedural nerve block, with only three patients exceeding 5 mL of LA. SCN and PECS1 success occurred in 19 (95%) and 18 (90%) patients, respectively. The overall success of nerve block by fulfilling all the criteria was demonstrated in 17 out of 20 patients (85%). Patients who reported no pain (VAS score = 0) were distributed as follows: 13 patients (65%) in the immediate post-procedure interval, 18 patients (90%) at the 1 h post-implant interval, and 14 patients (70%) at the 24 h post- implant interval. The median cumulative VAS score was 0 (IQR = 0 - 1). There were no reported significant adverse effects. CONCLUSION: SCN and PECS1 nerve blocks are safe and effective for patients undergoing CIED implantation to minimize or eliminate the use of intravenous sedation.

Evaluation of parameters used in echocardiography and ultrasound protocol for the diagnosis of shock etiology in emergency setting.

BACKGROUND: Early recognition and appropriate treatment has shown to decrease morbidity and mortality in patients with undifferentiated shock. There are many ultrasound protocols in shock; each protocol combines core ultrasound elements such as IVC and cardiac assessment which includes detection of cardiac tamponade, left ventricular function and right ventricular strain.Valvular assessment is absent in majority of ultasound protocols, while lung ultrasound is included in some of them. OBJECTIVE: In this study we investigated which parameters used in Echo - US protocol help differentiate shock types. METHODS: This cross sectional study was conducted on 150 patients with shock (140 patients were included while, 10 patients were excluded).Sensitivity and specificity of different parameters used in the Echo-US protocol were analyzed to detect which parameters can diffentiate shock types. RESULTS: Velocity time integral of Aorta and IVC maximum diameter were good discriminators for distributive shock, with area under the ROC curve (AUC) = 0.8885 (95% CI 0.8144 to 0.9406) and 0.7728 (95% CI 0.6832 to 0.8473) (Z = 10.256 p < 0.0001) and (Z = 5.079 p < 0.0001) respectively. Left ventricular systolic function, presence of pneumonia, pneumothorax or valve vegetations were of great value in differentiating shock types, while CUST, FAST, TAPSE and RV diameter were not useful in differentiating shock types. CONCLUSION: Ultrasound and echocardiography are powerful tools that can be used to identify shock etiology when the clinical picture overlaps.

Accuracy of echocardiography and ultrasound protocol to identify shock etiology in emergency department.

BACKGROUND: Early diagnosis and appropriate management of shock aimed at prevention of prolonged hypoperfusion has shown to decrease morbidity and mortality in patients with undifferentiated shock. However, there is often a challenge in emergency department (ED) - where diagnosis is mainly based on clinical signs and standard monitoring parameters. Early use of point of care ultrasound could reduce the diagnostic time and improve diagnostic accuracy. PURPOSE: The aim of this study is to investigate the accuracy of echocardiography - ultrasound protocol to identify the cause of shock in ED. METHOD: The study was conducted on 150 shocked patients admitted to emergency department of Alexandria Main University Hospital from December 2018 to December 2020. The study was conducted to reach initial impression about shock etiology which was then compared to final diagnosis to determine accuracy, agreement, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: One hundred forty patients were included in the study (10 patients were excluded). The protocol was 100% accurate for diagnosing cases with obstructive and mixed obstructive distributive shock. It showed excellent rule- out characteristics for cardiogenic shock (sensitivity and NPV = 100%). There was almost perfect agreement between provisional and final shock type for mixed distributive cardiogenic shock (kappa 0.915). Echo- US protocol had lowest agreement and PPV for patients with hypovolemic shock Kappa 0.48 and 35% respectively. CONCLUSION: The Echo- US protocol showed a high accuracy in identifying shock etiology in ED and is likely a promising diagnostic tool in emergency care.

Predicting acute kidney injury following nonemergent cardiac surgery: A preoperative scorecard.

OBJECTIVE: To determine the predictors of postoperative acute kidney injury (AKI) following nonemergent cardiac surgery among patients with variable preoperative estimated glomerular filtration rate (eGFR) levels. METHODS: A retrospective study of patients who underwent elective or in-hospital cardiac surgical procedures was performed between January 2006 and November 2015. The procedures included isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), or combined CABG and AVR. The primary outcome AKI (any stage) following nonemergent cardiac surgery utilizing the 2012 Kidney Disease-Improving Global Outcomes (KDIGO) criteria. Patients were categorized based on the following renal outcomes: mild AKI, severe AKI (KDIGO stage 2 or 3), and postoperative dialysis. Patients with G5 preoperative kidney function (including dialysis patients) were excluded. RESULTS: A total of 6675 patients were included in our study. The mean age was 66.8 years (SD ± 10.4), with 76.3% being males. A total of 4487 patients had normal or mildly decreased eGFR (G1 or G2) preoperatively (67.2%), while 1960 patients were in the G3 category (29.4%). Only 228 patients (3.4%) had G4 renal function. A total of 1453 (21.7%) patients experienced postoperative AKI. The need for postoperative dialysis occurred in 3.2% of the AKI subgroup. In-hospital mortality was higher among the AKI subgroup (7.2% vs. 0.5%; p < .0001). In an adjusted model, a lower preoperative eGFR category was the strongest predictor of AKI. A practical scorecard for the preoperative estimation of severe AKI for nonemergent cardiac procedures incorporating these parameters was developed. CONCLUSIONS: Preoperative eGFR is the strongest predictor of postoperative AKI in individuals undergoing nonemergent cardiac surgery. A practical scorecard incorporating preoperative predictors of AKI may allow informed decision-making and predict AKI following nonemergent cardiac surgery.

When is the optimal time to discontinue clopidogrel before in-hospital coronary bypass surgery? A closer look at the current literature.

BACKGROUND: Clopidogrel and other P2Y12 inhibitors have become the standard of care among patients presenting with acute coronary syndromes. A substantial proportion of these patients require surgical revascularization during index hospitalization. HYPOTHESIS: Guidelines recommend a 5-day waiting period off clopidogrel before coronary artery bypass grafting (CABG) to reduce hemorrhagic complications. These recommendations are not routinely followed in clinical practice, while recent studies also propose shorter waiting periods off clopidogrel for patients awaiting in-hospital CABG. METHODS: A preliminary PubMed search was conducted using the following MeSH terms under the publication type "Hemorrhage:" "Clopidogrel," AND "Coronary Artery Bypass." Relevant studies and guidelines were then reviewed and selected based on a predetermined criteria. Studies that formulated the current recommendations for stopping clopidogrel preoperative to CABG are discussed in detail this review. RESULTS: A comprehensive review of recent evidence illustrates mixed bleeding and transfusion outcomes among CABG patients with preoperative exposure to clopidogrel in less than 5 days. CONCLUSIONS: The optimal discontinuation time of clopidogrel before CABG is still poorly defined. The recommendation of a 5-day washout period for clopidogrel should be reconsidered to be on par with current clinical practice.

Migrated fractured sternal wire in proximity to the main pulmonary artery: Case report and review.

BACKGROUND: We present a case of a 83-year-old man with a prior history of coronary artery bypass who presented to his family physician with progressive symptoms that raised concern for heart failure exacerbation. A chest X-ray was performed, which showed a fractured topmost sternal wire in the lateral projection and indicated that the sternal wire had migrated into the anterior mediastinum. An emergent electrocardiogram-gated flash computed tomography angiography confirmed the location of the fractured wire to be in close proximity to the main pulmonary artery. A discussion of migrated sternal wires with a literature review of cases is provided as well. AIMS: To present a case of a migrated sternal wire and a literature review. METHODS: An extensive literature review using pubmed and medline with relevant keywords was preformed. RESULTS: 11 known cases of migrated sternal wires with various complications, as detailed in the review table. The mortality rate is low but can be associated with significant morbidity. DISCUSSION: Fractured wires are quite common and are usually a benign radiographic finding. However, migration of sternal wires is an extremely rare phenomenon. Only a few reported cases in the literature were sternal wires have migrated beyond the sternum, leading to catastrophic clinical consequences, as detailed in the review table. CONCLUSION: Sternal wire complications secondary to migration beyond the sternum are rare but potentially fatal. Precise wire location and risk assessment with CT are more appropriate when wire location cannot be clearly delineated by plain film radiography.

Strong association between long and heterogeneous telomere length in blood lymphocytes and bladder cancer risk in Egyptian.

Although it is widely recognized that telomere dysfunction plays an important role in cancer, the relationship between telomere function and bladder cancer risk is not well defined. In a case-control study of bladder cancer in Egypt, we examined relationships between two telomere features and bladder cancer risk. Telomere fluorescent in situ hybridization was used to measure telomere features using short-term cultured blood lymphocytes. Logistic regression was used to estimate the strength of association between telomere features and the risk of urothelial carcinoma of the bladder. High telomere length variation (TLV) across all chromosomal ends was significantly associated with an increased risk of bladder cancer [adjusted odds ratios (OR) = 2.22, 95% confidence interval (CI) = 1.48-3.35], as was long average telomere length (OR = 3.19, 95% CI = 2.07, 4.91). Further, TLV and average telomere length jointly affected bladder cancer risk: when comparing individuals with long telomere length and high TLV to those with short telomere length and low TLV, the adjusted OR was 14.68 (95% CI: 6.74-31.98). These associations were stronger among individuals who are 60 years of age or younger. In summary, long and heterogeneous telomere length in blood lymphocytes was strongly associated with an increased bladder cancer risk in Egyptian and the association was modulated by age.

Three-dimensional domain identification in a single hexagonal manganite nanocrystal.

The three-dimensional domain structure of ferroelectric materials significantly influences their properties. The ferroelectric domain structure of improper multiferroics, such as YMnO3, is driven by a non-ferroelectric order parameter, leading to unique hexagonal vortex patterns and topologically protected domain walls. Characterizing the three-dimensional structure of these domains and domain walls has been elusive, however, due to a lack of suitable imaging techniques. Here, we present a multi-peak Bragg coherent x-ray diffraction imaging determination of the domain structure in single YMnO3 nanocrystals. We resolve two ferroelectric domains separated by a domain wall and confirm that the primary atomic displacements occur along the crystallographic c-axis. Correlation with atomistic simulations confirms the Mexican hat symmetry model of domain formation, identifying two domains with opposite ferroelectric polarization and adjacent trimerization, manifesting in a clockwise arrangement around the hat's brim.

Antimesenteric sleeve tapering enteroplasty with end-to-end anastomosis versus primary end-to-side anastomosis for the management of jejunal/ileal atresia.

BACKGROUND/OBJECTIVE: Small bowel atresia commonly causes neonatal intestinal obstructions. Technical problems are associated with the surgical management of atresia using primary end-to-end anastomosis. Furthermore, the significantly dilated proximal loop may be associated with the stasis of intestinal fluid, thus increasing pressure on the anastomosis and prolonging fasting time before initiation of oral intake. This study aimed to perform antimesenteric tapering of the proximal loop using a linear stapler to reduce its diameter and facilitate anastomosis with the distal loop. METHODS: This retrospective study included 57 neonates diagnosed with jejunoileal atresia. They were categorised into two groups: Group A (n = 29), which included neonates treated using antimesenteric sleeve enteroplasty tapering using a linear stapler and Group B (n = 28), which included neonates treated at the primary end of the proximal loop to the side of the distal loop anastomosis. RESULTS: The mean operative time was 122.5 min in group A vs. 118 min in group B, and the mean duration to reach full oral intake was 17 days in group A vs. 20.2 days in group B (p = 0.03). The mean length of hospital stay was 25 and 35 days in groups A and B, respectively (p = 0.042). CONCLUSION: Tapering the proximal dilated bowel loop to achieve anastomosis with the distal loop improved the transient time, reduced stasis and its associated translocation and colonisation, and allowed for early initiation and maintenance of oral intake. All these parameters shortened the overall length of hospital stay.

Knowledge, attitudes, and practices toward depression among physicians in Sudan.

OBJECTIVES: The present study assessed the knowledge, attitudes, and practices of physicians in Sudan regarding depression. METHODS: A cross-sectional study was conducted among physicians who practiced at public and private health facilities in Sudan in December of 2022. An online Google form questionnaire was administered that included knowledge, practice, and sociodemographic sections of the depression attitude questionnaire. The link to the questionnaire was sent to a convenience sample of physicians through a variety of methods including social media. RESULTS: A total of 407 physicians completed the questionnaire. The majority (81.1%) had no formal training on mental health after graduation. A total of 43.0% reported difficulties in differentiating between unhappiness and clinical depression, although 48.6% indicated that they could differentiate between chemical and psychological causes for depression. Half (50.4%) did not feel comfortable dealing with depressed patients. Nearly 70% indicated that psychotherapy was a better option for treating these patients than antidepressants, but only 45.7% had any mental health services at their health facility. Physicians with prior mental health training (both pre- and postgraduate training) were more likely to provide treatment options for depressed patients. CONCLUSIONS: This study indicates a moderate knowledge among physicians about depression, but also significant concern regarding poor attitudes and practices held toward the treatment of depression, and a lack of training. These findings highlight the urgent need for the training of physicians in the diagnosis and treatment of depression in Sudan.

Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery.

BACKGROUND: Major societal guidelines recommend a 5-day stop interval before cardiac surgery for patients with acute coronary syndrome receiving clopidogrel. Yet, many such patients present with high acuity, generating surgeon inclination toward use of shorter stop intervals. Thus, this study aimed to determine the impact of the duration and timing of the interval of clopidogrel cessation on adverse bleeding events. METHODS: Patients who underwent cardiac surgery between 2009 and 2016 at a tertiary-care centre were included in this retrospective cohort study. Multivariable logistic regression models adjusted for clopidogrel stop interval, age, urgency of procedure, and procedure type were used to quantify the effect of clinically relevant baseline demographic characteristics on incidence of massive transfusion as well as hemorrhagic complication outcomes. RESULTS: A total of 5748 patients underwent cardiac surgery. In this cohort, 1743 patients (30.3%) received clopidogrel preoperatively, and 884 (50.7%) of these patients discontinued clopidogrel 5 days before presenting to the operating room. The administration of clopidogrel 1-2 days before surgery (odds ratio 1.97; 95% confidence interval: 1.18 to 3.29) was an independent predictor for massive transfusions and hemorrhagic complications (odds ratio 1.85; 95% confidence interval: 1.01 to 3.37). The 3-4 day group did not have an increased risk of major bleeding complications. The risk for both massive transfusions and hemorrhagic complications also increased with the urgency and complexity of surgery. CONCLUSION: A clopidogrel stop interval of 3-4 days preoperatively was not associated with an increased risk for major bleeding complications.

INTRODUCTION: Les grandes lignes directrices sociétales recommandent une interruption de cinq jours avant l'intervention chirurgicale du cœur des patients atteints d'un syndrome coronarien aigu qui prennent du clopidogrel. Toutefois, comme il s'agit pour plusieurs d'entre eux de patients de haute acuité, le chirurgien penche vers l'utilisation d'une interruption plus courte. Par conséquent, la présente étude avait pour objectif de déterminer les conséquences de la durée et du moment de la cessation du clopidogrel sur les événements hémorragiques indésirables. MÉTHODES: La présente étude de cohorte rétrospective portait sur les patients qui avaient subi une intervention chirurgicale au cœur entre 2009 et 2016 dans un centre de soins tertiaires. Nous avons utilisé les modèles multivariés de régression logistique ajustés à l'interruption du clopidogrel, à l'âge, à l'urgence de l'intervention chirurgicale et au type d'intervention chirurgicale pour quantifier les effets des caractéristiques démographiques initiales cliniquement pertinentes sur la fréquence des transfusions massives ainsi que sur les issues des complications hémorragiques. RÉSULTATS: Un total de 5 748 patients ont subi une intervention chirurgicale au cœur. Dans cette cohorte, parmi les 1 743 patients (30,3 %) qui avaient reçu du clopidogrel avant l'opération, 884 (50,7 %) avaient cessé le clopidogrel cinq jours avant leur admission à la salle d'opération. L'administration du clopidogrel un à deux jours avant l'intervention chirurgicale (ratio d'incidence approché 1,97; intervalle de confiance [IC] à 95 % : de 1,18 à 3,29) était un prédicteur indépendant des transfusions massives et des complications hémorragiques (ratio d'incidence approché 1,85; [IC] à 95 % : de 1,01 à 3,37). Le groupe de l'interruption de trois à quatre jours n'a pas montré de risque accru de complications hémorragiques graves. Le risque de transfusions massives et de complications hémorragiques a aussi contribué à l'augmentation de l'urgence et de la complexité de l'intervention chirurgicale. CONCLUSION: Une interruption du clopidogrel de trois à quatre jours avant l'opération n'a pas été associée à un risque accru de complications hémorragiques graves.

A Novel Nerve Block Technique for a Patient Undergoing Cardiac Device Implantation.

A woman with type 1 myotonic dystrophy received an implantable cardioverter-defibrillator using a novel combination of ultrasound-guided supraclavicular nerve and pectoral nerve blocks. The entire procedure was completed without any procedural sedation or local anesthetic, and the patient did not experience any pain during or after the procedure. (Level of Difficulty: Advanced.).

Blown Wide Open: An Unusual Case of Torrential Mitral Regurgitation Resolving With a Cough.

Mitral regurgitation can have varying hemodynamic parameters dependent on factors such as pressure gradients, exercise, and/or provocative maneuvers. We present a case of unusual dynamic mitral regurgitation resolved by coughing in a patient with hypertrophic cardiomyopathy. (Level of Difficulty: Intermediate.).

Outcomes and risk factors for death in patients with coronavirus disease-2019 (COVID-19) pneumonia admitted to the intensive care units of an Egyptian University Hospital. A retrospective cohort study.

BACKGROUND: The characteristics, outcomes, and risk factors for in-hospital death of critically ill intensive care unit (ICU) patients with coronavirus disease-2019 (COVID-19) have been described in patients from Europe, North America and China, but there are few data from COVID-19 patients in Middle Eastern countries. The aim of this study was to investigate the characteristics, outcomes, and risk factors for in-hospital death of critically ill patients with COVID-19 pneumonia admitted to the ICUs of a University Hospital in Egypt. METHODS: Retrospective analysis of patients with COVID-19 pneumonia admitted between April 28 and July 29, 2020 to two ICUs dedicated to the isolation and treatment of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Cairo University Hospitals. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples and radiologic evidence of pneumonia. RESULTS: Of the 177 patients admitted to the ICUs during the study period, 160 patients had COVID-19 pneumonia and were included in the analysis (mean age: 60 ± 14 years, 67.5% males); 23% of patients had no known comorbidities. The overall ICU and hospital mortality rates were both 24.4%. The ICU and hospital lengths of stay were 7 (25-75% interquartile range: 4-10) and 10 (25-75% interquartile range: 7-14) days, respectively. In a multivariable analysis with in-hospital death as the dependent variable, ischemic heart disease, history of smoking, and secondary bacterial pneumonia were independently associated with a higher risk of in-hospital death, whereas greater PaO2/FiO2 ratio on admission to the ICU was associated with a lower risk. CONCLUSION: In this cohort of critically ill patients with COVID-19 pneumonia, ischemic heart disease, history of smoking, and secondary bacterial pneumonia were independently associated with a higher risk of in-hospital death.

Periodontal diseases and potential risk factors in Egyptian adult population-Results from a national cross-sectional study.

BACKGROUND: Despite the interdependence of general and periodontal health, there is paucity of national representative data on the prevalence of periodontal diseases and their associated risk factors in Egyptian population. This cross-sectional study, thus, aimed to assess the prevalence of periodontitis and tooth loss among Egyptian adults and investigate the association between potential risk factors and periodontal diseases. METHODS: A total of 5,954 adults aged ≥ 20 years were included in this study as a subsample from Egypt's national oral health survey. Periodontitis was diagnosed with Community Periodontal Index 'CPI' scores ≥3 and tooth loss not due to caries was included in the analysis. Socio-demographic data and information on behavioral factors and history of diabetes were gathered in a face-to-face interview. Logistic regression was done to interpret the impact of potential predictors on the incidence of the two selected outcome variables. RESULTS: The overall prevalence of periodontitis was 26% and regression analysis revealed that higher odds of periodontitis existed among illiterate participants (OR = 1.74; 95% CI: 1.40-2.17), smokers (OR = 1.93; 95% CI: 1.69-2.20) and rural residents (OR = 1.16; 95% CI: 1.03-1.30). On the other hand, old age, frequency of dental attendance and history of diabetes were the main predictive factors for tooth loss. CONCLUSIONS: Among Egyptian adults, periodontal diseases were strongly associated with a multitude of modifiable and non-modifiable risk factors and inequalities in distribution of periodontal treatment needs were determined mainly by age, gender, level of education and residency location.

COVID-19 and Myocarditis: What Do We Know So Far?

COVID-19 has been declared a global pandemic by the World Health Organization and is responsible for hundreds of thousands of deaths worldwide. COVID-19 is caused by SARS-CoV-2, and common clinical symptoms include fever, cough, sore throat, headache, and fatigue. Myocardial injury is relatively common in patients with COVID-19, accounting for 7%-23% of cases, and is associated with a higher rate of morbidity and mortality. There is a discrepancy in the literature about myocarditis as the etiology of myocardial injury in patients with COVID-19; although many anecdotal reports of myocarditis have been noted, there are only a handful of case reports in the literature about myocarditis related to COVID-19. In this review we summarize the most up to date literature around the association between COVID-19 and myocarditis and provide clinicians a practical framework about the clinical manifestations, diagnostic tools, and treatment options currently available. Importantly, this review will heighten suspicion for myocarditis as an etiology of myocardial injury in COVID-19 patients, therefore improving clinical outcomes and encouraging shared clinical decision-making. This will also open the door for further research to build around this review. Emergent treatment options for COVID-19 are in clinical trials and might be of benefit to COVID-19 patients with myocarditis in addition to current guideline-based recommendations.

La COVID-19 a été déclarée pandémie mondiale par l'Organisation Mondiale de la Santé et elle est responsable de centaines de milliers de décès dans le monde. La COVID-19 est causée par le SARS-CoV-2, et les symptômes cliniques courants sont la fièvre, la toux, le mal de gorge, les maux de tête et la fatigue. Les lésions myocardiques sont relativement fréquentes chez les patients atteints de la COVID-19, représentant 7 à 23 % des cas, et sont associées à un taux de morbidité et de mortalité plus élevé. Il existe des divergences dans la littérature décrivant la myocardite en tant qu'étiologie de lésions myocardiques chez les patients atteints de la COVID-19; bien que de nombreux rapports anecdotiques de myocardite aient été rapportés, il n'y a qu'un nombre limité de rapports de cas dans la littérature concernant des myocardites liées à la COVID-19. Dans cette revue de littérature, nous résumons la bibliographie la plus récente sur l'association entre COVID-19 et myocardite et fournissons aux cliniciens un cadre pratique sur les signes cliniques, les outils de diagnostic et les options de traitement actuellement disponibles. Il est important de noter que cette revue augmentera la suspicion de myocardite comme étiologie de lésions myocardiques chez les patients atteints de la COVID-19, améliorant ainsi le pronostic clinique et encourageant une prise de décision clinique partagée. Cela ouvrira également la voie à d'autres recherches qui pourront s'appuyer sur cette étude. De nouvelles options de traitement de la COVID-19 sont en cours d'essais cliniques et pourraient être bénéfiques aux patients atteints de la COVID-19 qui présentent une myocardite, tout en étant considérées pour les recommandations actuelles basées sur les lignes directrices.

Serum Level of CD48 and Its Expression on Blood Leukocytes in Persistent Asthmatic Patients.

CD48 is a surface receptor (mCD48) expressed on most hematopoietic cells, as well as in a soluble form (sCD48). It seems to play a major role in asthma through the interactions of mast cells with eosinophils via its ligand CD244. Hence, this study was done to evaluate the role of CD48, in its membrane and soluble forms, as a novel biomarker in asthma with various degrees of severity. One hundred participants were enrolled in this study and divided into 4 equal groups matched in age and sex; mild asthma, moderate asthma, severe asthma and apparently healthy controls. All were investigated for blood leukocytes mCD48 expression using flow cytometry and sCD48 in serum using ELISA. Our results revealed that the sCD48 was significantly elevated in patients with mild asthma compared with the controls (P<0.001) while significantly decreased in severe asthma than mild asthma (P<0.001) and moderate asthma (P=0.002) patient groups. Expression of mCD48 on eosinophils in moderate asthma group was significantly elevated compared with the control and the mild asthmatic groups (P<0.001). However, it was significantly decreased in severe asthma compared with moderate and mild asthma (P<0.001 and P=0.03, respectively). While it was significantly upregulated in severe asthmatic group compared to controls, patients with mild and moderate asthma on T-cell, B cells, Monocytes and NK cells (P<0.001 for all). In conclusion, CD48 may play a role in asthma and its level varies with severity of the disease being a useful marker in mild asthma.