Coronavirus Disease 19 (COVID-19) has led to a global pandemic and has been the center of attention across the entire medical community. This novel virus was initially thought to affect primarily the respiratory system, but now it is evident that it has a multitude of effects on the human body. Our point of interest is to establish the effect of COVID-19 infection on the conducting system of the heart. We present a case series of four patients who developed complete heart block (CHB) shortly after being infected with COVID-19 without any previous known risk factors of complete heart block. There have only been a few previous case reports on the occurrence of CHB in COVID-19 patients highlighting the importance and the need of our case series to the literature of cardiovascular outcomes in COVID-19 patients. Our case series highlight that COVID-19 can indeed affect the conduction system of the heart and cause CHB in patients who then recovered spontaneously further elucidating the transient nature of cardiovascular effects caused by the novel virus.

Background:  Nearly one-third of the world's population dies from cardiovascular disorders, the majority of which are caused by stroke and coronary artery problems and 80 percent of these fatalities occur in impoverished countries. This study was conducted to determine the frequency of ventricular septal rupture in patients with acute ST-elevation myocardial infarction presenting to cardiology unit Hayatabad Medical Complex Peshawar. Methods: This was descriptive cross sectional research study at the Department of Cardiology, MTI-Hayatabad Medical Complex, Peshawar, from January to July 2020. Detailed history was obtained including duration of symptoms, co-morbidities present and occupation. A thorough clinical examination was done for signs of heart failure and ventricular septal rupture. Patients’ demographics, clinical and laboratory parameters were recorded on a pro forma. All the data was analyzed statistically by using SPSS version 24.0. Results: A total of 179 patients were included in our study. Ventricular Septal Rupture (VSR), was recorded in 7 (3.9%) patients having Acute ST elevation of MI. In our study age, obesity, reperfusion therapy, location of MI and history of previous shock were observed to be non-significantly (p˂0.05) associated with high incidence of Ventricular Septal Rupture in patients having Acute ST elevation of MI. Conclusion: According to our findings, individuals with PI-VSR have a significant risk of acute-phase death. Furthermore, a significant incidence of acute-phase fatalities has been related to female gender and severe cardiac failure upon admission.

We present a case series of 5 patients who were found to have COVID-19 encephalitis. There is still no disease defining test for diagnosis so the mainstay of diagnosis is the exclusion of all common causes of encephalitis. Brain MRI and CSF analysis perform an ancillary in the diagnostic tools.

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COVID-19 is a novel virus which causes a variety of clinical manifestations in the body some of which are still yet to be discovered. The main aim of our study is to highlight the neurological manifestations of COVID-19 as it is still new to the medical world and to emphasize the fact that the physicians have to be vary of the possibility that patients affected with COVID-19 can present with encephalitis. Only a few studies are available so far regarding the neurological manifestations of this novel virus which highlights the need of this study. We present a case series of four patients who were found to have COVID-19 encephalitis. There is still no disease defining test for diagnosis so the mainstay of diagnosis is exclusion of all the common causes of encephalitis. Brain MRI and CSF analysis performs an ancillary in the diagnostic tools. Our study also supports the use of IV Tocilizumab (4-8 mg/kg) and IV methylprednisolone (0.5-2 mg/kg) as possible treatment options with good results as the patients described in our case series responded well to these medications.

IntroductionWorldwide, there are more than 424 million confirmed cases of COVID-19. Most of the hospitalized critical COVID-19 patients manifested neurological signs and symptoms and higher mortality. The majority of COVID-19 fatalities occurred mostly in patients with advanced age and underlying medical comorbidities. This is the first local retrospective study in Qatar, which reported neurologic manifestations (48.5%) of hospitalized COVID-19 patients. The primary objective of this study is to evaluate acute neurological manifestations in COVID-19 hospitalized patients in the country. MethodsThis is a retrospective, observational study of 413 hospitalized COVID-19 patients. They were admitted to three different COVID-19 designated hospitals (Hazm Mebaireek, Ras Laffan, and Cuban tertiary care Hospitals) under the Hamad Medical Corporation, Qatar from 1st January 2020, to 31 January 2021. We evaluated electronic medical records of these patients and data were collected while their neurological manifestations were confirmed by two trained neurologists. These neurologic manifestations were categorized into three major groups: central nervous system (CNS), peripheral nervous system (PNS), and neuromuscular system. ResultsOf 413 patients, 94% (389) were male and 6% (24) were female; the mean age was 52 years. Among all different nationalities of COVID-19 patients, 20.3% (84) were Indian, 12.5% (52) were Bangladeshi, 10.1% (42) were Qatari and 9.2% (38) were Nepali. The most common symptoms at the onset of COVID-19 illness were as follows: 77.5% (321) had a fever, 67.4% (279) experienced cough, 58.7% (243) experienced shortness of breath and 26.1% (108) developed a sore throat. Overall 48.5% (201) patients developed different neurologic manifestations. The most common neurologic symptoms were myalgia (28%; 116), headache (10.4%; 43), dizziness (5.8%; 24) and hemiparesis due to strokes (5.3%; 22). In this study, the most common risk factors were hypertension (47.6%), diabetes (46.9%), obesity (21%), chronic kidney disease (10%), ischemic heart disease (9.7%), and smoking (6.8%). About 45.2% (187) patients were admitted to MICU and 8.5% (35) died due to COVID-19 complications. Significant other extrapulmonary multiorgan system involvement were skeletal muscle injury (39.4%), kidney injury (36.7%), liver injury (27.5%), myocardial injury (23.9%), rhabdomyolysis (15.7%) heart failure (11.4%) and acute pancreatitis (11.1%). DiscussionThe most common neurologic signs and symptoms were myalgia, headache, dizziness, and strokes, mainly due to large vessel thrombosis, lacunar, and posterior circulation strokes. ConclusionsPatients with COVID-19 are at high risk of developing neurological manifestations. The most common COVID-19-related acute neurological manifestations were myalgia, headache, dizziness, and acute ischemic stroke. Prompt recognition, early diagnosis, and appropriate management of these manifestations could potentially lead to better patient outcomes in COVID-19 patients.Categories: Internal Medicine, Neurology...

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