Hepatic Hydatid Cyst Presenting as Right-Sided Heart Failure: A Case Report.

Cystic echinococcosis is a parasitic disease caused by Echinococcus granulosus. The transmission of the parasite to dogs occurs when organs of animals that harbor hydatid cysts are consumed. We present the case of a patient presented in the cardiology outpatient clinic with the signs and symptoms of predominant right-sided heart failure. Upon evaluation, a large hepatic septated cyst was revealed, which was compressing the right chambers of the heart, altering diastolic filling, and causing right-sided heart failure. CT scan confirmed the presence of a hydatid cyst measuring 115 mm × 90 mm. The patient underwent surgical excision of the cyst with immediate relief of the symptoms. Two weeks later, the patient presented again with the same symptoms and was diagnosed with a recurrence of the hydatid cyst. He underwent surgical resection and removal of the cyst again. The patient remained asymptomatic and free of recurrence on further follow-up evaluations. Cardiac echinococcosis typically features intra-myocardial cysts, while our case presented an extracardiac location. Extrinsic compression of the heart's right chambers from a hydatid cyst has been rarely reported. The surgical excision of the cyst brings immediate and full resolution of the symptoms. The recurrence of hydatid cysts is also an important clinical feature that should not be underestimated.

Impact of Temperature and Atmospheric Pressure on Hospitalizations of Patients Presenting With Acute Coronary Syndrome.

AIM:  This study aims to investigate the impact of temperature and atmospheric pressure on hospitalizations of patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: This is a retrospective, observational, analytical study conducted in a single center, University Hospital Center "Mother Teresa," Tirana, Albania, in the period January-December 2018. This study included 1,165 patients with ACS, who performed urgent coronary angiography, from January 2018 to December 2018. Patients were diagnosed with ACS based on clinical and examination findings. The data were collected retrospectively using patient files. Baseline demographic, clinical, and procedural characteristics were collected. Data on atmospheric parameters, measured at the weather monitoring station, were obtained from the National Meteorological Service database. Measurements from the meteorological service provided values ​​for each parameter: average daily temperature and atmospheric pressure in each country district. Atmospheric data measurements were taken for the day under review. The number of inhabitants for the respective districts is taken from the National Institute of Statistics (INSTAT). RESULTS: The study involved 1,165 patients, with a mean age of 63.1 years, ranging from 27 years to 89 years old. The majority of patients (78.6%) were male, while 21.4% were female. A statistically significant relationship was observed between seasonal changes in temperature and atmospheric pressure concerning the number of cases with ACS; the autumn season prevails with 27.9% of the total cases, followed by the spring season with 25.6%, the summer season with 24.2%, and winter season with 22.3% (p = 0.04). Additionally, significant changes in the average monthly values ​​of temperature and atmospheric pressure were accompanied by a statistically significant increase in the number of cases as occurred in March-April and October-November (p ≤ 0.05). Most cases in the cold period (November-March) occurred on days with a change in temperature or atmospheric pressure with a statistically significant value of p < 0.05. CONCLUSION:  An important relationship between seasonal, monthly, and daily changes in temperature and atmospheric pressure concerning the frequency of cases with ACS was observed.

Ongoing COVID-19 Pandemic Effects on Admissions and In-Hospital Outcomes in Patients With ST-Elevation Myocardial Infarction (STEMI): An Albanian Observational Study.

Background Multiple studies conducted worldwide and in Albania documented an important reduction of acute ST-elevation myocardial infarction (STEMI) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding STEMI admissions and outcomes during the ongoing pandemic after the initial lockdown. We aimed to study STEMI admissions and in-hospital outcomes after the COVID-19 lockdown period. Methods A retrospective single-center study was conducted, collecting data for all consecutive STEMI admissions from March 9th, (the first COVID-19 case) until April 30th, the corresponding period of 2020 total lockdown, for years 2019 and 2021. The control period was considered the year 2019 [pre-pandemic (PP)] and the study period was in 2021 [ongoing pandemic (OP)]. The incidence rate ratio (IRR) 95% confidence interval (CI) was used to compare all-STEMI admissions, invasive procedures, and risk ratio (RR) 95% CI to compare the mortality and complications rate between the study and control period. Results The study included 217 STEMI patients admitted in 2019, and 234 patients during the 2021 period. The overall-STEMI admissions IRR is in a similar range during the 2021 OP compared to the 2019 PP period IRR=1.07 (95%CI 0.90-1.28). Similar invasive procedures were observed during OP compared to PP period, respectively for coronary-angiography IRR= 1.07; (0.87-1.31), for all-PCI [1.12 (0.92-1.35)], and primary percutaneous coronary interventions (PCI) [1.09 (0.89-1.34)]. The STEMI death rate during OP compared to PP period was similar (7.3 vs. 7.4%), RR=1.01 (0.53-1.96), and a non-significant lower primary-PCI-death rate (4.0 vs 4.8%), RR= 0.83 (0.30-2.3)]. Conclusions After the initial reduction of admissions and invasive procedures in STEMI patients during the 2020 lockdown period and the increase of all-STEMI mortality, the number of hospitalizations, invasive procedures, and mortality returned to a similar range during OP compared to the PP period despite a highly incident ongoing COVID-19 pandemic.

Gender Differences in Admissions and In-Hospital Outcomes of Patients With Acute Coronary Syndromes During the Coronavirus Disease 2019 Pandemic.

Background The incidence of acute coronary syndromes (ACS) decreased during the coronavirus disease 2019 (COVID-19) pandemic. Few studies have investigated gender differences in ACS admissions and outcomes during pandemics and have presented divergent results. This study aimed to investigate the effect of the COVID-19 pandemic on male and female hospitalizations and in-hospital outcomes in patients presenting with ACS. Methodology We designed a retrograde, single-center trial gathering data for ACS hospitalizations during the lockdown (March 9, 2020, to April 30, 2020) compared with the same timeframe of 2019. ACS hospitalizations were subgrouped as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). We calculated the incidence rate ratio (IRR) to compare all-ACS and subgroups for male and female hospitalizations and the risk ratio (RR) to compare overall male/female mortality. Results This study included 321 ACS patients (238 males, 83 females) during the COVID-19 lockdown and 550 patients (400 males, 150 females) during 2019. The IRRs of all-ACS/males/females were significantly lower during the COVID-19 period at 0.58 (95% confidence interval (CI) = 0.44-0.76), 0.59 (95% CI = 0.43-0.75), and 0.55 (95% CI = 0.37-0.74), respectively. The IRR for STEMI was significantly lower among females (0.59 (95% CI = 0.39-0.89)), but not among males (0.76 (95% CI = 0.55-1.08)) The IRR for NSTEMI was not significantly lower, meanwhile it was significantly lower for UA among both males and females. The overall ACS mortality increased during the COVID-19 period (7.4% vs. 3.4%; RR = 2.16 (95% CI = 1.20-3.89)). Important increase was found in males (7.45% vs. 2.5%; RR = 3.02 (95% CI = 1.42-6.44)), but not in females (7.2% vs. 6%; RR = 1.20 (95% CI = 0.44-3.27). Conclusions The admissions of ACS reduced similarly in males and females during the COVID-19 pandemic. The admissions of STEMI reduced predominantly in females. We identified a substantial increase in the overall ACS mortality, but predominantly in males, reducing the differences between males and females. Further studies are necessary to better understand the increase in male mortality during the pandemic.

Hospitalizations and in-hospital outcomes in patients with ST-elevation myocardial infarction during the coronavirus disease 2019 pandemic: The Albanian experience.

OBJECTIVE: Global studies report a significant decline in ST-elevation myocardial infarction (STEMI) related hospitalization rates during the coronavirus disease 2019 (COVID-19) pandemic outbreak. However, there have been several divergent reports on hospital outcomes. In this study, we aim to investigate the impact of the COVID 19 outbreak on hospitalizations because of STEMI and in-hospital outcomes in Albania. METHODS: This was a retrograde study, collecting data for hospitalizations because of STEMI from March 9, (first COVID 19 case in our country) to April 30, 2020, (period of total lockdown) compared with the same period in 2019 at our center. The incidence rate ratio (IRR) was used to compare admissions because of STEMI and procedures and the risk ratio (RR) to compare mortality and other complication rates. RESULTS: Admissions for STEMI declined during the COVID-19 period from a total of 217 in 2019 to 156 in 2020 (-28.1%) representing IRR 0.719 (p=0.033). PCIs also reduced from 168 procedures in 2019 to 113 in 2020 (-33%), representing an IRR of 0.67, p=0.021. The time from symptom onset to arrival at our intensive care unit was significantly higher in 2020 compared to 2019 (925.6±1097 vs. 438.7±385 minutes, p<0.001). The STEMI death rate during the pandemic compared to the control period was significantly increased to 14.1% vs. 7.8% (RR=1.91 p=0.037, but with no significant increase in primary PCI-STEMI death rate (8.9% vs. 4.8% RR=1.85 p=0.217). Cardiogenic shock also increased during the pandemic to 21.2% from 12.4% in 2019 (RR=1.70 p=0.025). CONCLUSION: Hospitalizations and revascularization procedures for STEMI significantly reduced during the COVID-19 pandemic. We identified a substantial increase in the STEMI mortality rate and cardiogenic shock during the pandemic outbreak. Delayed timely reperfusion intervention might be responsible for the increased risk for complications.