Symptomatic Myocarditis Post COVID-19 Vaccination.

There are few major adverse events after the coronavirus disease 2019 (COVID-19) vaccination. However, increasing cases of myocarditis and pericarditis are being reported to the Vaccine Adverse Event Reporting System (VAERS) in young people, primarily after the second dose of messenger RNA (mRNA) COVID-19 vaccines. We present a case series of myopericarditis post mRNA (Moderna) and myocarditis post vector-based (Johnson & Johnson) COVID-19 vaccines. We intend to highlight the importance of early diagnosis and treatment of vaccine-related myocarditis to reduce mortality and morbidity.

Asymptomatic Left Atrial Myxoma Treated With Minimally Invasive Surgical Approach.

Myxomas, being the most common primary benign tumor among all cardiac tumors, occur rarely with a very low incidence rate. Myxomas can cause various clinical manifestations or can be diagnosed incidentally. Some patients with cardiac myxomas are completely asymptomatic. Cardiac myxomas cause life-threatening complications, thus early diagnosis is imperative. We are reporting a case of atrial myxoma in a 38-year-old female without any significant past medical history, who came to our clinic for cardiology evaluation prior to plastic surgery. The elliptical mobile mass, located in the left atrium with its attachment to the interatrial septum, was diagnosed by transthoracic echocardiography. The patient was referred for surgery and a minimally invasive surgical approach was chosen. A histological report confirmed the diagnosis of myxoma. The patient recovered well. Three years of follow-up did not reveal any signs of recurrence of the tumor. We are also analyzing 20 previously published cases of asymptomatic myxomas and myxomas treated with a minimally invasive surgical approach, reported in the PubMed database for the last 20 years (2001-2021) in the adult patient population (age 19 and over). The aim of this study is to highlight the asymptomatic presentation of cardiac myxomas and to underline the advantages of a minimally invasive surgical approach. In summary, asymptomatic cardiac myxomas are rare incidental findings. Attention to subtle symptoms during a physical exam and scrupulous history-taking can provide a clue to this diagnosis. Early diagnosis of cardiac myxomas is crucial to prevent life-threatening complications. Minimally invasive surgery is a promising alternative approach to standard open-heart surgery for treating cardiac myxomas, providing faster recovery and higher patient satisfaction with surgical care.

Complete Dissection of the Interventricular Septum Following Myocardial Infarction.

In this report, we present a case of interventricular septal dissection (IVSD) following inferior wall myocardial infarction (MI) in a 64-year-old patient; the patient ultimately recovered after prompt resuscitation and intervention, despite the high mortality associated with these cases. A 64-year-old male with a history of hypertension and obesity was brought to the hospital following an episode of syncope at home. He had been experiencing chest tightness over the past few days prior to the admission. On physical exam, he had a heart rate of 72 beats per minute and blood pressure of 73/52 mmHg. His electrocardiogram revealed ST-segment elevations in leads II, III, and aVF. Emergent coronary angiography revealed 100% occlusion of the right coronary artery (RCA) with no collateral supply and 95% stenosis of the left anterior descending (LAD) artery. Aspiration thrombectomy and balloon angioplasty and subsequent stenting of the RCA were performed. Transthoracic echocardiogram with color Doppler was performed, which confirmed the presence of a defect in the septum. Color Doppler demonstrated a clear jet entering the ventricular septum from the left ventricle (LV), with the jet traversing the entire length of the septum through a dissection and entering into the right ventricle (RV), consistent with complete IVSD. The patient subsequently underwent a successful bovine pericardial patch repair of the ventricular septum. IVSD is a rare anomaly of the IVS. An echocardiogram is a useful tool to establish the diagnosis. The mortality rate after ventricular septal rupture remains high. Fortunately, our patient had interventricular dissection without rupture. Prompt surgical repair remains the choice of treatment for this condition.

Salt Consumption and Myocardial Infarction: Is Limited Salt Intake Beneficial?

INTRODUCTION: Sodium is an essential mineral that plays a crucial role in the maintenance of normal cellular homeostasis, regulation of fluid and electrolytes, and blood pressure (BP). Due to the presence of sodium in a variety of regularly consumed food products, the deficiency of sodium is extremely unlikely. On the other hand, excess intake of dietary sodium is observed in many populations as it is generally used in most food products. Existing guidelines recommend lowering salt consumption for better cardiovascular health; these dietary sodium intake recommendations are not reassuring as the evolving studies show evidence that there is a higher risk of cardiovascular disease (CVD) with low sodium consumption. The aim of this study was to identify the association between salt consumption and myocardial infarction (MI). METHODS: The National Health and Nutrition Examination Survey (NHANES) data between 2017- 2018 was analyzed to examine the association between sodium intake (use in daily meal preparation) and reported history of MI. Logistic regression was used to assess for significant differences between the groups and calculated odds ratios while adjusting for confounders. RESULTS: A total of 4626 participants were included in the study, with a mean age of 66 ± 11 years in those with a history of MI (n = 212). Amongst these participants, those with salt consumption "Occasionally used" or "Very often used" were less likely to have suffered from MI than those who "Never used" salt in meal preparation. Multivariable logistic regression was performed to control for confounders. "Occasionally used" compared to "Never used" odds ratio was 0.5227 (95% confidence interval (CI); 0.3053-0.9009 p = 0.0184) and "Very often used" compared to "Never used" odds ratio was 0.5033 (95% CI; 0.2892-0.8799 p = 0.0152). CONCLUSION: After adjusting for confounders, the participants that used salt more liberally during meal preparation were less likely to have MI than those who minimally or never used salt in meal preparation.

The Role of Interleukin-6 Inhibitors in the Treatment of COVID-19 Infections: A Case Series.

An outbreak of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) infection started in December 2019 in China that resulted in a global health emergency. The World Health Organization later named the disease as coronavirus disease 2019 (COVID-19). Currently, there is no effective treatment available and the data are evolving through continuous clinical trials and ongoing research. Severe infections present with hypoxemic respiratory failure from acute respiratory distress syndrome as one of the major complications. We report two cases of COVID-19 patients who initially presented with moderate to severe symptoms. Later, their clinical course worsened despite ongoing treatment with multiple medications such as hydroxychloroquine and azithromycin until they were started on tocilizumab. Within a short period after they were administered tocilizumab, their oxygen saturation improved and other inflammatory markers such as D-dimer levels, lactate dehydrogenase, and ferritin levels decreased. There is an increase in the amount of research citing the role of various cytokines in the pathophysiology of COVID-19. Targeting the inflammatory mediators in the pathogenesis, especially interleukin-6 pathway inhibitors, would improve overall morbidity and mortality, thus decreasing the burden on healthcare systems.

Lyme Carditis: A Rare Presentation of Sinus Bradycardia Without Any Conduction Defects.

Lyme carditis is a rare cardiac manifestation of Lyme disease that occurs when bacterial spirochetes infect the pericardium or myocardium triggering an inflammatory response. The most common electrocardiogram (EKG) findings in these patients include atrioventricular (AV) conduction abnormalities (first, second, and third degree heart block). A 56-year-old male with a history of hypothyroidism, from the Northeastern region of the United States, presented to the emergency department with lightheadedness and chest pain. His EKG revealed sinus bradycardia with a heart rate of 49 beats per minute, without ST segment elevation, T wave inversions, or signs of heart block. An enzyme-linked immunosorbent assay (ELISA) Lyme titer was elevated, and confirmatory Western blot was positive for IgG and negative for IgM. He was treated with intravenous (IV) ceftriaxone; however, he continued to have persistent bradycardia with his heart rate dropping to 20 to 30 beats per minute throughout the night. Additionally, he had several sinus pauses while sleeping, with the longest lasting for 6.1 seconds. A pacemaker and an additional three-week course of IV ceftriaxone was determined to be the best treatment for his resistant bradycardia secondary to Lyme carditis. No symptoms were present at his one month follow-up appointment, as an outpatient, after completing ceftriaxone therapy. The patient follows up with cardiology regularly to have his pacemaker checked. Here we present a unique case of Lyme carditis, without the classical findings of Lyme disease or common EKG findings of AV conduction abnormalities. A high clinical suspicion of Lyme carditis is required when someone from a Lyme endemic region presents with unexplained cardiac symptoms and electrocardiogram abnormalities. This case report aims to add to the knowledge gap between suspicion of Lyme carditis and sinus bradycardia as the only presenting symptom.

Adult Burkitt lymphoma- an Island between lymphomas and leukemias.

Background: Burkitt lymphoma is a rare, aggressive and rapidly fatal, B-cell non-Hodgkin's lymphoma. It has an incidence of 0.4/100,000 age-adjusted to the USA standard population. Here we describe the case of a 77-year-old patient who presented with Burkitt lymphoma. Case: A 77-year-old male presented to his primary care physician with fatigue and listlessness and was referred to the hospital with a white blood cell count (WBC)-23.7 K/uL (neutrophils 37%, lymphocyte 11%, blasts 9%) and platelets-19 K/uL. During his stay in the hospital, repeat investigations revealed WBC-29.9 K/uL (neutrophils 22%, lymphocyte 27%, atypical lymphocytes 5%, blasts 20%) and platelets-10 K/uL with no evidence of mucosal bleeds, neck or abdominal masses or generalized lymphadenopathy. Bone marrow aspirate revealed the presence of MYC rearrangements (8q24) on flow cytometry and fluorescent in-situ hybridization (FISH), indicative but not typical of BL. He was transfused with platelets due to a rapidly deteriorating platelet count and episodes of epistaxis. He was discharged after four days with a plan of outpatient chemotherapy over a period of 4 months. An Ommaya reservoir was placed in the right ventricle for intrathecal chemotherapy. After four months of chemotherapy, computerized tomography of the chest, abdomen, and pelvis confirmed remission. A magnetic resonance imaging of the brain a month after completion of chemotherapy revealed metastatic lymphoma in the temporal, parietal and occipital lobes. He was discharged to hospice for palliative care. Conclusion: Unconventional presentations, as seen in our case of a leukemia-like picture in the absence of a bulky disease, are the quagmire that might delay aggressive management and result in poorer outcomes.

Device-associated Central Nervous System Infection Caused by Candida parapsilosis.

Meningitis is a common and life-threatening infection of the central nervous system (CNS) in infants with long-term and disabling sequelae like hydrocephalus. Hydrocephalus is treated by diverting cerebrospinal fluid (CSF) either to another body cavity (via CSF shunt) or externally (via CSF drain) which are prone to infection. Though rare, Candida parapsilosis (C. parapsilosis) is a known pathogen in device-associated CNS infections and has been reported in both, infants and adults. A six-month-old male infant was brought to the hospital with disproportionate head enlargement of three months duration. Magnetic resonance imaging (MRI) was suggestive of gross asymmetrical hydrocephalus. An external ventricular drain (EVD) was placed, and vancomycin and meropenem were started. Four weeks later, he developed a fever with a blocked EVD. Repeat MRI revealed gross asymmetric dilatation of left lateral ventricle along with pneumocephalus in the right periventricular region. A right temporoparietal craniotomy with drainage of a multiloculated abscess was done along with the removal of right EVD and placement of left EVD. CSF showed pan-susceptible C. parapsilosis and fluconazole was started. Despite treatment, CSF continued to grow C. parapsilosis through day 10. The EVD was removed, and an Ommaya reservoir along with the ventricular catheter was placed for better interventricular antibiotic administration. After day 13 CSF became sterile. Ommaya reservoir was removed, fluconazole was continued for three weeks, and a ventriculoperitoneal shunt was placed five weeks later. The device-associated CNS infections are insidious with nonspecific manifestations making diagnosis difficult. C. parapsilosis has been increasing in prevalence, especially in immunocompromised hosts, infants, and in patients with indwelling catheters. Amphotericin B or fluconazole is the usual treatment with excellent outcomes and no mortality. This case underscores the need for suspicion of C. parapsilosis as a cause of device-associated CNS infections.

Prevalence of Vitamin D Deficiency and Associated Risk Factors in the US Population (2011-2012).

Introduction 1,25-dihydroxyvitamin D3 (cholecalciferol), the hormonally active form of vitamin D3, is a lipid-soluble compound that plays a significant role in clinical medicine due to its potent effects on calcium homeostasis and bone metabolism. Since foods containing natural vitamin D are rare, the primary source of the compound remains its nonenzymatic dermal synthesis through exposure to ultraviolet rays in sunlight. Although uncommon in most developed countries, recent literature has demonstrated that subclinical vitamin D deficiency can exist in certain populations and plays a role in downstream clinical consequences, including cardiovascular disease, cancer, diabetes, osteoporosis, and fractures. This study aims to identify the prevalence and change in the pattern of vitamin D deficiency in subpopulations throughout the United States to provide a foundation for further clinical studies correlating the clinical outcomes to vitamin deficiency. Methods Data analyzed in this study were collected through National Health and Nutrition Examination Survey (NHANES), specifically from a population of 4962 participants, age ≥20 years, who were hospitalized between 2011 and 2012. This cohort was stratified to divide the population into patients that were vitamin D sufficient (>50 nmol/L) versus patients who were vitamin D deficient (50 nmol/L). The risk factors were compared between the subpopulations in 2005-2006 and 2011-2012. Conclusions The prevalence of vitamin D deficiency is greater in certain clinical subpopulations, and the presence of associated characteristics should raise the index of suspicion for the practicing clinician with regard to conditions associated with vitamin D deficiency, such as osteoporosis and osteomalacia. Further research investigating the pathophysiology of hypovitaminosis D and its clinical consequences can help better understand and prevent the development of associated comorbidities.

Reverse engineering dynamic temporal models of biological processes and their relationships.

Biological processes such as circadian rhythms, cell division, metabolism, and development occur as ordered sequences of events. The synchronization of these coordinated events is essential for proper cell function, and hence the determination of critical time points in biological processes is an important component of all biological investigations. In particular, such critical time points establish logical ordering constraints on subprocesses, impose prerequisites on temporal regulation and spatial compartmentalization, and situate dynamic reorganization of functional elements in preparation for subsequent stages. Thus, building temporal phenomenological representations of biological processes from genome-wide datasets is relevant in formulating biological hypotheses on: how processes are mechanistically regulated; how the regulations vary on an evolutionary scale, and how their inadvertent disregulation leads to a diseased state or fatality. This paper presents a general framework (GOALIE) to reconstruct temporal models of cellular processes from time-course gene expression data. We mathematically formulate the problem as one of optimally segmenting datasets into a succession of "informative" windows such that time points within a window expose concerted clusters of gene action whereas time points straddling window boundaries constitute points of significant restructuring. We illustrate here how GOALIE successfully brings out the interplay between multiple yeast processes, inferred from combined experimental datasets for the cell cycle and the metabolic cycle.

Simultaneously segmenting multiple gene expression time courses by analyzing cluster dynamics.

We present a new approach to segmenting multiple time series by analyzing the dynamics of cluster formation and rearrangement around putative segment boundaries. This approach finds application in distilling large numbers of gene expression profiles into temporal relationships underlying biological processes. By directly minimizing information-theoretic measures of segmentation quality derived from Kullback-Leibler (KL) divergences, our formulation reveals clusters of genes along with a segmentation such that clusters show concerted behavior within segments but exhibit significant regrouping across segmentation boundaries. The results of the segmentation algorithm can be summarized as Gantt charts revealing temporal dependencies in the ordering of key biological processes. Applications to the yeast metabolic cycle and the yeast cell cycle are described.