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Journal of the American College of Cardiology ; 79(9):2641, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1768646


Background: Hydroxychloroquine (HCQ) has been used to treat many diseases including rheumatic diseases, malaria, and over recent years, as a possible antiviral in the setting of coronavirus disease 2019. Although this drug has shown clinical benefit in many diseases, long term use of this drug can have side effects not well studied. This case report is on Hydroxychloroquine and its side effects after long term use of the drug, specifically focused on Cardiomyopathy and development of heart failure in a patient with no prior history of cardiac disease. This case report focuses on the patients Hydroxychloroquine use, progression of symptoms, and diagnosis of Hydroxychloroquine induced cardiomyopathy and heart failure. Case: A 67 year-old female with Systemic Lupus Erythematous and Rheumatoid Arthritis on long term HCQ presented with shortness of breath and dyspnea on exertion found to have severe cardiomyopathy with decreased ejection fraction of 29% with no significant vascular pathology. Decision-making: Given negative imaging and laboratory testing for the cause of this new onset heart failure and cardiomyopathy, endomyocardial biopsy was performed and sent out for electron microscopy and interpreted showing multiple thick sections of myelinoid bodies and ultrastructural features consistent with hydroxychloroquine cardiotoxicity. Conclusion: Long-term administration of Hydroxychloroquine is correlated with cardiotoxic specific myocardial pathologic findings that are verified by endomyocardial biopsy. Earlier detection and diagnosis along with stopping of hydroxychloroquine may lead to better outcomes.

Blood ; 138:985, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1582151


Background and Objectives: The COVID-19 (CO19) pandemic caused by SARS-CoV-2 remains a significant issue for global health, economics, and society. Several reports have shown that African Americans (AA) have been disproportionately affected by the CO19 pandemic. Limited data have suggested that sickle cell disease (SCD) could be one of the several reasons for higher morbidity and mortality related to CO19 among AA. Recent reports have suggested higher-than-average morbidity and mortality related to CO19 among patients with SCD. We conducted a retrospective, single-institution study in adult patients with SCD who were diagnosed with CO19 infection and their outcomes. Methods: After IRB approval, we conducted a chart review of adult patients (greater than 18 years) with SCD who were diagnosed with CO19 infection between March 1st, 2020, and March 31st, 2021. We recorded demographic data including age, gender, social factors (the type of insurance, availability of primary care provider (PCP), living alone/not), clinical parameters (type of SCD, co-morbidities), outpatient management of SCD, and how CO19 infection was managed like inpatient admission and complications. In patients who were admitted or seen in the emergency department (ED), we collected additional data including vitals, labs, the severity of illness, complications, length of stay, and outcomes. Computations were performed using statistical software SAS 9.4 for Windows. Results: We found a total of 51 patients with SCD diagnosed with CO19 infection in the above period. The median age of patients was 30 years. 61% were females and 39 % were males. All of them were AA. 11.76% were living alone, 49.02% were living with family, 1.96% (1 patient) was institutionalized, and the living situation was unknown in 37.25%. Most of the patients had Medicaid Insurance (52.94%), Medicare in 33.3%, private insurance in 13.73 % and 2% were uninsured. Only 64.71% of patients had a PCP. 60% had HbSS disease, 32% had HbSC disease, 4% had HbS-beta thalassemia, one patient each had HbSS with hereditary persistence of HbF and HbS/HbD. Comorbidities and previous history included acute chest syndrome in 65.96%, avascular necrosis in 36.96%, leg ulcers in 8.7%, hypertension in 8.7%, sickle cell retinopathy in 14.57%, cerebrovascular disease in 26.19%, chronic kidney disease in 7.69%, venous thromboembolism (VTE) in 20.41%, 10.41% were on anticoagulation, history of HIV and hepatitis C infection in 6.38%. 28.21% of patients were maintained on partial exchange transfusions as an outpatient for various indications. 72.73% were on hydroxyurea, 7.5% were on crizanlizumab, 5.26% were on voxelotor and 26.83% were on iron chelation. Vitals and pertinent lab values on initial assessment were recorded and many patients had missing data. On presentation, 25.53% were febrile, 29.17% of patients were tachycardic, 31.25% were hypoxic (SpO2 < 95%), 38.46% were tachypneic, 59.18% had a body mass index (BMI) of > 24.9. Median hemoglobin and hematocrit were 8.9/27.4 g/dL. The median white blood cell count was 9490/uL and platelets were 315,000/uL. Median ferritin was 1573 ug/L. Median bilirubin and creatinine were 2.05 mg/dL and 0.86 mg/dL. The patients were further stratified based on the clinical location where CO19 infection was managed (Table 1). 39.3% were diagnosed in the outpatient setting/ED and 60.3% in the inpatient setting. Among 51 patients, 5.71% (n=2) required ICU admission and was mechanically ventilated. 17.5% received dexamethasone, 7.69% received remdesivir, 2.76% received convalescent plasma, 17.07% had infections and 47% received antibiotics. Only one patient received an exchange transfusion during admission. One patient developed a new VTE after CO19 infection. On statistical analysis, the only factor which impacted the clinical location of management was tachycardia (P=0.007). Of the 51 patients, only 3.9% (2 patients) died of complications of CO19 infection, one with hypoxic respiratory failure, disseminated intravascular coagulation, shock, and the other one with pulmonary mbolism. 13% were readmitted within a month, one of them was admitted with a new pulmonary embolism and the others were admitted for acute painful episodes. Conclusion: We found a mortality rate of 3.9% in our single-center study of patients with SCD and CO19 infection. This mortality rate is lower than other published experiences in patients with SCD and CO19 infection. [Formula presented] Disclosures: Master: Blue Bird Bio: Current holder of individual stocks in a privately-held company.

Journal of the National Medical Association ; 112(5):S41, 2020.
Artigo em Inglês | EMBASE | ID: covidwho-988453


Introduction: The mission of the National Medical Association (NMA) Pediatric Section is to provide comprehensive state-of-the-art and up-to-date material related to the most recent advances in pediatrics, and to assist the practicing pediatrician to continue to provide the best practices as dictated by evidence-based medicine. The NMA Pediatric Section is the forum to encourage research among its members and trainees in pediatrics, and address health issues of national importance to the pediatrician and their constituents. Amid the COVID-19 pandemic, overt racism, and police brutality, the health and safety of children and adolescents, particularly those of color, cannot be minimized. These manifestations of toxic stress and other adverse childhood experiences significantly impact pediatric developmental and behavioral health. Educating the Section on the development and delivery of a vaccine to combat SARS-CoV-2 is essential to ensure positive outcomes in our patients. These topics, along with other significant disorders affecting African American youth (HIV, sickle cell disease, vaping and substance use) were all highlighted in the 2020 NMA Pediatric Section Annual Program.