Tacrolimus-induced posterior reversible encephalopathy syndrome following liver transplantation.

In this editorial, we talk about a compelling case focusing on posterior reversible encephalopathy syndrome (PRES) as a complication in patients undergoing liver transplantation and treated with Tacrolimus. Tacrolimus (FK 506), derived from Streptomyces tsukubaensis, is a potent immunosuppressive macrolide. It inhibits T-cell transcription by binding to FK-binding protein, and is able to amplify glucocorticoid and progesterone effects. Tacrolimus effectively prevents allograft rejection in transplant patients but has adverse effects such as Tacrolimus-related PRES. PRES presents with various neurological symptoms alongside elevated blood pressure, and is primarily characterized by vasogenic edema on neuroimaging. While computed tomography detects initial lesions, magnetic resonance imaging, especially the Fluid-Attenuated Inversion Recovery sequence, is superior for diagnosing cortical and subcortical edema. Our discussion centers on the incidence of PRES in solid organ transplant recipients, which ranges between 0.5 to 5 +ACU-, with varying presentations, from seizures to visual disturbances. The case of a 66-year-old male status post liver transplantation highlights the diagnostic and management challenges associated with Tacrolimus-related PRES. Radiographically evident in the parietal and occipital lobes, PRES underlines the need for heightened vigilance among healthcare providers. This editorial emphasizes the importance of early recognition, accurate diagnosis, and effective management of PRES to optimize outcomes in liver transplant patients. The case further explores the balance between the efficacy of immunosuppression with Tacrolimus and its potential neurological risks, underlining the necessity for careful monitoring and intervention strategies in this patient population.

Prevalence and factors associated with cognitive frailty in heart failure: a systematic review and meta-analysis protocol.

INTRODUCTION: Heart failure (HF) is a global health issue affecting millions of people worldwide. Cognitive frailty, a syndrome characterised by physical frailty and cognitive impairment without dementia, is increasingly recognised in this population. Cognitive frailty is associated with worse outcomes, including increased hospitalisation, disability and mortality. This systematic review and meta-analysis aimed to investigate the incidence, prevalence and predictors of cognitive frailty in HF patients. METHODS: A systematic search will be conducted in MEDLINE/PubMed, EMBASE/Ovid, Web of Science and Google Scholar from inception to the latest search date. Eligible studies will report original data on adult patients (age ≥18 years) with HF, focusing on the incidence, prevalence and predictors of cognitive frailty. Two investigators will independently extract data and assess study quality using the Newcastle-Ottawa Scale and mixed-methods appraisal tool. Meta-analyses and meta-regression will be performed to estimate the pooled prevalence of cognitive frailty in HF patients and to identify predictors associated with increased risk, respectively. Subgroup analyses will be conducted to explore potential sources of heterogeneity. ETHICS AND DISSEMINATION: This systematic review does not require ethical approval and informed consent, as it does not use identifiable patient data. The results of this study will be submitted for publication in a peer-reviewed medical journal. This comprehensive meta-analysis of the literature on cognitive frailty among HF patients will inform tailored interventions and management strategies, ultimately improving patients' quality of life and outcomes.

Spectrum of Suspected Cardiomyopathy Due to COVID-19: A Case Series.

The effects of COVID-19 on the cardiovascular system remains understudied given the early stage of the pandemic. Several case series and case reports have been published on COVID-19 related cardiomyopathies; however, there is often a lack of baseline echocardiographic data confirming a normal cardiac health prior to infection. Here we examine four patients with preserved left ventricular systolic function on prior echocardiogram who developed de novo cardiomyopathies which following COVID-19 infection. The study comprised of four individuals with an average age of 80.5 years, 75% of which were white males. 50% of cases were suspected to have Takotsubo CM vs. myocarditis while the remaining half were diagnosed as myocarditis. Left ventricular systolic function dropped from a normal range to an average of 30% during COVID-19 infection in these individuals. Moreover, half of the cases later died. In conclusion, the COVID-19 pandemic has demonstrated its ability to cause several serious cardiovascular complications with associated worsening of prognosis. Repeat TTE showed recovery of systolic function in 50% of the patients included. There does not appear to be any correlation between COVID-19 related treatments, age, or level of inflammatory markers in those who recovered systolic function versus those who remained depressed. Given the minimal literature on this topic, it is evident more information is needed to help advance treatment and understanding of COVID-19 induced cardiomyopathies; particularly if the vaccination fails to protect against novel strains of COVID-19 and the virus becomes endemic.