Left ventricular global longitudinal strain imaging in identifying subclinical myocardial dysfunction among covid-19 survivors.

BACKGROUND: Covid-19 is multi-system viral infection caused by SARS-CoV-2 virus. Apart from having acute severe respiratory illness causing high mortality, the disease also has a variety of cardiovascular manifestations contributing to morbidity as well as mortality. Cardiac dysfunction and myocarditis are well established complications of Covid-19 as evident in multiple studies after the Covid-19 pandemic. However it is not sufficiently studied in Indian patients either by Echocardiography or by any other imaging modalities like cardiac magnetic resonance imaging (MRI). METHODOLOGY: In this study, we analysed the severity of Left ventricular(LV) dysfunction in Covid-19 survivors. A total of 100 consecutive patients of Covid-19 after one month of discharge who had no underlying cardiovascular diseases underwent echocardiography and global longitudinal strain (GLS) imaging. This study cohort included patients with mild 42 (42%),moderate 46(46%) and severe 12(12%) Covid-19 disease as defined by computerised tomography (CT) severity score. RESULT: We observed that total 36(36%) patients had reduced ejection fraction(EF) which included 11 patients having EF <40% and remaining 25(25%) having EF 40-50% (p<0.002). Also 22 (22%) patients had abnormal global longitudinal strain (GLS) values with normal ejection fraction which is suggestive of subclinical myocarditis. We observed LV dysfunction in 7(19.5%) patients who had severe Covid-19 while mild to moderate LV dysfunction observed in 29(80.5%) non critical patients. CONCLUSION: In conclusion our study demonstrates that myocardial dysfunction is common in covid-19 regardless of disease severity. 2D-echocardiography with GLS is likely to detect early LV dysfunction among these patients.

Parenteral Iron Therapy in Patients with Heart Failure in a Resource Constrained Setting In India - Our Experience.

OBJECTIVES: To assess the prevalence of Iron Deficiency and impact of Parenteral Iron therapy in patients with Symptomatic Heart failure, the role of exercise capacity and serial Echocardiography in assessing treatment response. METHODS: Study was performed in a Government Hospital for 24 months, December 2017 to December 2019.120 participants were recruited. Patients with symptomatic heart failure and Serum Ferritin <100 mg/dl were recruited and those with diagnosed Ischemic Cardiomyopathy or unwilling to give consent were excluded. They underwent a functional assessment and 2D Echo at baseline, after 30 and 90 days of IV Carboxymaltose. The data was analysed represented in appropriate figures. A P value <0.05 was considered significant. RESULTS: Of 120 patients recruited, 28 were male and 92 were female. The mean age of presentation was 44 +/- 5.4 years. The Mean baseline Haemoglobin was 11.7 +/- 0.38 gm/dl.The baseline Ferritin levels were 16.69 +/-2.9 ug/L. HFpEF was predominant with 65% cases. The NYHA status and 6min HWT tests showed a statistically significant improvement and Echocardiography findings showed a statistically insignificant improvement after Parenteral Iron. CONCLUSION: Iron Deficiency is a major risk factor in Heart Failure including HFpEF and prevails in the younger population.Parenteral Iron Carboxymaltose followed by oral iron supplementation is effective in Heart Failure patients, especially in HFpEF. Functional capacity and NYHA status appear to be the time tested markers for Iron repletion.

A Novel Treatment for Malignant Cough Syncope.

Cough Syncope, a form of Neurocardiogenic Syncope, occurs immediately after coughing due to to arterial baroreflex-mediated vasodilatation. Cough syncope has been classically described in patients with obstructive pulmonary diseases. Pulmonary Vascular Diseases, though rare, also present with cough syncope. Malignant Syncope is defined as recurrent syncope with minimal warning, and often associated with self-injury. Here we describe how we managed a case of a young male presenting with recurrent attacks of Malignant Cough syncope.

A Rare Case of Mediastinal Non-seminomatous Germ Cell Tumour with Acute Megakaryocytic Leukaemia.

The most common extragonadal site of Nonseminomatous Germ Cell Tumours is the mediastinum. These are similar to their gonadal counterparts in histology but have a poorer prognosis. The association of mediastinal germ cell tumours with blood borne malignancies has been established in many case reports. However, the association of concomitant mediastinal non seminomatous germ cell tumours with Acute Megakaryocytic Leukemia is very rare with only 26 cases reported in the last 07 Decades. These patients have a very poor prognosis with only one survivor being reported till present date. AML (M7), a rare variant of Primary AML, has been more commonly associated with non seminomatous germ cell tumours. Here, we report such a rare case of dual malignancy, Non Seminomatous Germ Cell Tumour with AML (M7) which was managed at our centre.

Post-transplant Lymphoproliferative Disorder.

Post-transplant lymphoproliferative disorders (PTLDs) are life-threatening complications of solid-organ transplantation and bone marrow transplantation leading to a high mortality. PTLD represents a heterogeneous group of lymphoproliferative diseases. They become clinically relevant because of the expansion of transplantation medicine together with the development of potent immunosuppressive drugs associated now with long survival. The risk of PTLD is highest in the early post-transplant period, but the cumulative risk increases with time. We report a case of two sequential malignancies - carcinoma bladder occurring -13 years and now gastric lymphoma -15 after renal transplantation in a 73-year-old man.

Paraneoplastic Inverse Myasthenic Syndrome as a Presentation of Bronchogenic Carcinoma.

Tumours may produce growth factors and cytokines responsible for signs and symptoms distant to the primary or metastatic site. This may be the first sign of a malignancy and its recognition may be critical for early cancer detection. Moreover, proper diagnosis spares the patient of extensive and expensive search for an alternate cause of the neurological dysfunction. In neurological paraneoplastic syndromes like Lambert Eaton Myasthenic syndrome associated with small cell lung cancer, evidence of autoimmunity against presynaptic neuro-muscular junction by anti voltage gated calcium channel anti bodies is well documented. 60% of patients with LEMS are associated with an underlying cancer, usually SCLC. We report a 49 year old male, with over thirty pack years of smoking, who presented with dysautonomia, constitutional symptoms and weakness of all four limbs. Investigations confirmed axonal motor neuropathy with limited stage SCLC with fibro nodular lesions right upper lobe and mediastinal lymphadenopathy. He improved dramatically following chemotherapy and radiotherapy.