Background
There is scarcity of data on outcome of COVID-19 in patients with hematological malignancies. Primary objective of study was to analyse the 14-day and 28-day mortality. Secondary objectives were to correlate age, comorbidities and remission status with outcome.
Methods
Retrospective multicentre observational study conducted in 11 centres across India. Total 130 patients with hematological malignancies and COVID-19 were enrolled.
Results
Fever and cough were commonest presentation. Eleven % patients were incidentally detected. Median age of our cohort was 49.5 years. Most of our patients had a lymphoid malignancy (
n
= 91). One-half patients (52%) had mild infection, while moderate and severe infections contributed to one-fourth each. Sixty seven patients (52%) needed oxygen For treatment of COVID-19 infection, half(
n
= 66) received antivirals. Median time to RT-PCR COVID-19 negativity was 17 days (7–49 days). Nearly three-fourth (
n
= 95) of our patients were on anticancer treatment at time of infection, of which nearly two-third (
n
= 59;64%) had a delay in chemotherapy. Overall, 20% (
n
= 26) patients succumbed. 14-day survival and 28-day survival for whole cohort was 85.4% and 80%, respectively. One patient succumbed outside the study period on day 39. Importantly, death rate at 1 month was 50% and 60% in relapse/refractory and severe disease cohorts, respectively. Elderly patients(age ≥ 60)(
p
= 0.009), and severe COVID-19 infection (
p
= 0.000) had a poor 14-day survival. The 28-day survival was significantly better for patients in remission (
p
= 0.04), non-severe infection (p = 0.00), and age < 60 years (
p
= 0.05).
Conclusions
Elderly patients with hematological malignancy and severe covid-19 have worst outcomes specially when disease is not in remission.
Diastolic dysfunction is common in children with fluid refractory septic shock, and immediate outcomes may be poorer in such patients. Increased central venous pressure after initial fluid resuscitation may be an early indicator of diastolic dysfunction and warrant urgent bedside echocardiography to guide further management.
SIMD, especially diastolic dysfunction, is common in septic shock and may increase inotrope requirement. It is reversible in majority. Sepsis patients may have asymptomatic underlying SIMD. cTnI does not correlate with the degree of SIMD.
Understanding the great vessels of the aortic arch and their variations is important for both the endovascular interventionist and the diagnostic radiologist. An understanding of the variability of the vertebral artery remains most important in angiography and surgical procedures where an incomplete knowledge of anatomy can lead to serious implications. In the present case, a bilateral variation in the origin and course of vertebral artery was observed. The left vertebral artery took origin from the arch of aorta and entered the foramen transversarium of the fourth cervical vertebra. The right vertebral artery took origin from the right subclavian artery close to its origin and entered the foramen transversarium of the third cervical vertebra. The literature on the variations of the artery is studied and its clinical significance and ontogeny is discussed.
The pterygospinous bar when present medial to the foramen ovale may not have much clinical significance but when the bar is present just below the foramen ovale, it may cause a compression of the mandibular nerve and its branches and may also obstruct the passage for the transoval approach to the neighbouring regions.
Cardiac angiosarcoma is the most common primary cardiac sarcoma in adults. Primary cardiac tumors are rare and have nonspecific clinical presentation, thus making its diagnosis challenging. Clinically, patients present with advanced disease demonstrating metastatic disease at initial presentation itself. It commonly metastasizes to lung, liver, brain, and bone; however metastases to lymph nodes, adrenal glands, spleen and skin has also been seen. We describe a case of right atrial angiosarcoma with extensive visceral metastases involving brain, lungs, liver, pancreas, kidney, and lymph nodes, demonstrated on contrast-enhanced 18F-fluoro-deoxyglucose positron emission tomography-computed tomography (FDG PET-CT). To the best of our knowledge metastases to pancreas and kidney have not been reported so far in the literature. With our report, we emphasize on the initial use of FDG PET-CT in workup of cardiac angiosarcoma for accurate staging and prognostication of this disease.
Aims and Objective: Study was undertaken to observe the variation in the innervation of muscles in the front of arm. The results were compiled. Embryological basis and clinical applications of encountered variations were tried to explain with the help of available literature.
Material and Methods:Thirty upper limbs from fifteen cadavers were dissected to observe the contents of front of arm. Musculocutaneous nerve, median nerve and innervation of the muscles of front of arm were observed.Results: Variations were observed in 13% of cases. Commonly seen variation was the absence of musculocutaneous nerve and innervation of muscles of front of arm by branches of median nerve. This variation was seen bilaterally in 3.3% of cases and unilaterally in 6.6% cases. Bilateral presence of this variation in one out of fifteen cadavers is rare finding. Variation is more common on right side as compared to the left side.
Conclusion:Bilateral absence of musculocutaneous nerve and innervation of muscles of front of arm from the branches of median nerve is a rare variation. Knowledge of such anatomical variations is of interest to the anatomist and clinician alike. Variations assume significance during surgical exploration of the axilla and can even fail nerve block of infraclavicular part of brachial plexus. Surgeons who perform procedures involving neoplasm or repairing trauma need to be aware of these variations.
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