IntroductionDeep vein thrombosis (DVT) and pulmonary embolism (PE) are key complications of coronavirus disease 2019 . The study's primary outcome was assessing the utility of Wells DVT, Wells PE scores, and D-dimers in diagnosing DVT and PE. Secondary outcomes were the risk factors for the development of PE and DVT in COVID-19 patients. Materials and methodsWe compared COVID-19 patients with a positive and negative lower extremity (LE) duplex. A similar approach was made for patients who underwent imaging for PE. ConclusionsThe combined approach of using a Wells DVT score of 3 in suspected DVT and Wells PE score of 4 in suspected PE and D-dimers of 500 ng/ml may be used to diagnose PE and DVT in COVID-19. Venous thromboembolism (VTE) occurrence in COVID-19 is associated with non-traditional risk factors such as intubation and higher severity of systemic inflammation, and these patients may benefit from more aggressive testing for VTE.

COVID-19 is a respiratory illness that affects the human body in many different ways. The disease carries both thrombotic and hemorrhagic complications, especially in those patients who are anticoagulated to prevent the thromboembolic manifestations. In this report, we discuss a case of retroperitoneal hemorrhage in a patient treated with therapeutic anticoagulation which ultimately led to the patient’s death. The literature highlights the importance of anticoagulation because it reduces mortality in patients hospitalized with COVID-19. Although, more recent studies suggest that patients treated with therapeutic anticoagulation are at a higher risk of hemorrhage and increased mortality. Therefore, our case stresses the importance of active monitoring of these patients to detect any suspected case of hemorrhage early to reduce mortality. Overall, more research should be conducted to determine the optimal dosing of anticoagulation that balances safety and efficacy.

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Objectives: Cell transplantation is a novel promising strategy for the treatment of end-stage heart failure. In a rat model of hypertrophic cardiomyopathy, we studied the hemodynamic and molecular effects of intra-coronary delivery of MSC.Methods: Sprague-Dawley rats underwent aortic banding and were followed by echocardiography for development of heart failure. After a decrease in fractional shortening of 25% from baseline, intracoronary randomized injection of MSC (n=28) or PBS (n=20) was performed. Hemodynamic assessment, swim testing to exhaustion and measurement of inflammatory markers was performed prior to sacrifice on post-operative day 7, 14, 21 or 28.Results: MSC injection improved systolic function in the MSC group compared to the control group (mean ± SD, max dP/dt 3048 mmHg/s ± 230 vs. 2169 ± 97 at 21 days, and 3573 ± 741 vs. 1363 ± 322 at 28 days, p<0.001). LVESD was significantly reduced at 28 days in the MSC group compared to the control group (7.0 ± 0.2 vs. 7.4 ± 1.5 mm, p=0.01). Time to exhaustion was similarly increased in the MSC group compared to controls (407 ± 34 seconds vs. 264 ± 24 seconds at 21 days, and 487 ± 35 seconds vs. 306 ± 27 seconds at 28 days, p<0.001).Conclusions: In this model of hypertrophic cardiomyopathy, MSC transplantation during heart failure improved hemodynamic performance, ventricular remodeling and maximal exercise tolerance. These effects were most remarkable at 21 and 28 days. This study suggests a potential use of this treatment strategy for the management of hypertrophic heart failure.

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Pneumothorax is a rare complication among mechanically ventilated patients since low tidal volumes are used nowadays instead of traditional high tidal volumes, but the incidence is slightly higher in patients with high positive end-expiratory pressure (PEEP). Herein we describe a case series of nine patients who were on mechanical ventilation due to acute respiratory distress syndrome (ARDS) secondary to coronavirus disease 2019 (COVID-19) and developed pneumothorax in due course. A retrospective analysis was done on COVID-19 intubated patients from March 2020 to June 2020 in a community hospital in Central New Jersey, which was one of the early hit states in the United States at the beginning of the pandemic. Outcomes were studied. The demographics of patients like age, gender, and body mass index (BMI); risk factors like smoking, comorbidities especially chronic lung disease, and the treatment they received were compared. We compared the total number of days on the ventilator, the highest PEEP they received, and the ventilator day when pneumothorax developed. All the patients who developed pneumothorax had a chest tube inserted to treat it. The mortality was noted to be 100% indicating that pneumothorax is a life-threatening complication of COVID-19 and COVID-19 by itself is a risk factor for pneumothorax likely due to a change in lung mechanics. There is a need for large-scale studies to confirm that these outcomes are related to COVID-19.

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