Corona Virus Disease of 2019 (COVID-19) pandemic has affected more than 67.9 million individuals world-wide and led to more than 15.5 million Deaths. In the initial studies from China, 88.7% of the patient were noted to have fever, 67% of the patient had cough and 56.4% had ground glass changes on the chest imaging. With time, the presentation of patients has been found to be highly variable and unpredictable. COVID-19 is reported to present with various complications, ranging from gastrointestinal (GI) manifestations, such as loss of sensation of taste, abdominal pain, diarrhea, vomiting, pancreatitis and hepatobiliary disease, to neurological manifestations of encephalitis and stroke, and cardiovascular manifestations like myocarditis, heart failure and arrythmia. We report a rare case of COVID-19 presenting with abdominal pain from aortitis.
Sepsis is a global health burden that needs intensive medical care. Thrombocytopenia in sepsis is well known to increase morbidity as well as mortality. Several studies have been performed both in animal models and in humans to understand the mechanism by which sepsis causes thrombocytopenia. Recent studies have shown that inhibiting thrombocytopenia improves outcomes in sepsis patients. Understanding these mechanisms to identify targets in use of newer treatment modalities besides using resuscitation measures, antibiotics and removal of thrombocytopenia inducing agent could potentially help us improve outcomes in sepsis.
We report a case of acute pancreatitis that developed after four days of remdesivir therapy in a patient being treated for COVID-19. Despite improvement in patient's respiratory status, abdominal pain worsened and clinical signs and symptoms progressed to a diagnosis of acute pancreatitis 4 days after initiation of remdesivir therapy. Withdrawal of remdesivir paired with medical management of acute pancreatitis led to the resolution of pancreatitis within three days. To our knowledge, this is the first case report depicting remdesivir as a possible cause of acute pancreatitis.
Background: Hypertension is a non-communicable disease and one of the most prominent modifiable risk factors for cardiovascular diseases. 7.6 million premature deaths are attributed to high blood pressure around the world. Better adherence with antihypertensive medications improves quality and length of life. This research focuses on the extent of adherence towards prescribed antihypertensive treatment, and identify factors influencing non-adherence.Methods: Descriptive cross-sectional study design was undertaken in various health care centers (2 primary health care center and 3 hospitals) of Nepal. A total of 348 individuals (age above 30) who suffered from hypertension visiting health institutes were included in the study. Adherence was calculated using Morisky Medication Adherence scale.Results: Adherence level to the antihypertensive medication as per the morisky adherence scale, 38.8% had medium level of adherence, 37.4% had a low adherence level, and 23.9% had a high adherence level among 348 participants. From the total participants, 89 admitted to be irregular in medication use. 56% of them claimed to do so because of forgetfulness, 12.4 % because of consistent exercise and low-salt diet, 10.1% due to the lack of affordability.Conclusions: Our study had concluded that the majority of participants had medium to low levels of adherence to anti-hypertensive drugs. Forgetfulness was major cause for irregular medication. Patient education and counseling, family support also seem to be important for proper adherence to drugs. Thus, health care providers should allocate ample time in educating, counseling clients and family.Keywords: Adherence; hypertension; medication; patients
Introduction:Idecabtagene vicleucel(ide-cel) is a type of B-cell maturation antigen(BCMA)-targeting CAR-T approved for treatment of relapsed and refractory multiple myeloma(RRMM). Currently, the incidence of cardiac events associated with ide-cel remains unclear. Method:This was a retrospective single-center observational study of patients treated with ide-cel for RRMM. We included all consecutive patients who underwent standard-of-care ide-cel treatment with at least 1-month follow-up. Baseline clinical risk factors, safety profile, and responses were examined by development of a cardiac event. Result:A total of 78patients were treated with ide-cel and 11patients(14.1%) developed cardiac events: heart failure (5.1%), atrial fibrillation(10.3%), non-sustained ventricular tachycardia (3.8%) and cardiovascular death(1.3%). Only 11 of the 78 patients had repeat echocardiogram. Baseline risk factors associated with the development of cardiac events included: female sex, worse performance status, lambda light chain disease, and advanced R-ISS. Baseline cardiac characteristics were not associated with cardiac events. During index hospitalization post-CAR-T, higher grade(≥Grade 2) CRS and ICANS were associated with cardiac events. In multivariable analyses, the hazard ratio for the association of the presence of cardiac events with overall survival was 2.66(95%CI:0.85-8.26) and with progression-free survival was 1.98(95%CI:0.90-4.37). Conclusion:Ide-cel CAR-T for RRMM is associated with similar cardiac events as other types of CAR-T. Worse baseline performance status and higher-grade CRS and neurotoxicity are associated with cardiac events post-BCMA-directed CAR-T-cell therapy. Our results suggest that the presence of cardiac events may confer worse PFS or OS, although due to the small sample size, the power to detect an association was limited.
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