Congenitally corrected transposition of the great arteries (CCTGA) accounts for <1% of all cases of congenital heart defect, a pathological condition characterized by the existence of both ventriculoarterial and atrioventricular (AV) discordance in the heart. CCTGA is more commonly associated with type B interrupted aortic arch (IAA) than type A variant. This is a more intricate and unusual presentation than dextro-transposition of the major arteries with an IAA. Herein, we present a case of an extraordinarily rare congenital cardiac complex defect. CCTGA and type A IAA were found in a 34-week preterm infant weighing 2.4 kg at delivery. Antenatally, the fetal echocardiogram suggested CCTGA in the form of an apically displaced left AV valve ventricular septal defect and transposed great arteries. The pulmonary trunk appeared larger than the aorta with three abnormal vessels. This study emphasizes the usefulness of sequential imaging modalities including fetal echocardiography to determine the majority of the anatomic details.
The impact of traumatic brain injury (TBI) on health and epidemiological patterns during the COVID-19 pandemic in China remains poorly understood. This retrospective study aimed to examine the influence of COVID-19 on the epidemiological characteristics, prognosis, and rehabilitation outcomes of TBI patients. Medical records from three hospitals in Wuhan, China, were analyzed between January 2018 and December 2023 to examine TBI patients based on the International Classification of Diseases, 10th Edition. A total of 306 TBI patients were included in this study, divided into two groups: 186 patients without COVID-19 (Group 1) and 120 patients with COVID-19 (Group 2). The mean age was 39.47 ± 18 years in Group 1 and 40.95 ± 16.6 years in Group 2. Most patients were male. Road traffic accidents represent the leading cause of TBI in both groups, although it is more prevalent in Group 1 (73.7%) than in Group 2 (55.8%). There were no significant differences in injury severity or initial Glasgow Coma Scale scores between the groups. However, Group 2 showed significantly poorer recovery outcomes, as indicated by lower Functional Independence Measure and Barthel Index scores at discharge. In addition, post-surgical infection rates were higher in Group 2 (18.42%) compared to Group 1 (4.25%). This study highlights the need for further evaluation of the impact of COVID-19 on TBI epidemiology and recovery outcomes to guide improvements in health-care practices.
Atrial fibrillation (AF), cognitive impairment, and dementia are significant health concerns. The prevalence and incidence of AF have been increasing and are expected to increase continuously in the future. In recent years, emerging evidence has indicated that AF, cognitive dysfunction, and dementia are associated with one another. Given the global increase in individuals who are at risk for AF, a greater focus is needed on the primary and secondary prevention of cognitive impairment and dementia in high-risk groups. Although earlier studies hypothesized that ischemic stroke is the main cause of cognitive impairment and dementia in patients with AF, recent studies have demonstrated that AF may contribute to cognitive impairment in the absence of stroke through other mechanisms. To date, various pathomechanisms have been proposed to explain the association between AF and cognitive decline, including overt ischemic stroke, silent cerebral infarctions, impaired cerebrovascular reactivity, decreased cerebral blood perfusion, neuroinflammation, microbleeds, and shared risk factors. However, a complete understanding of these mechanisms remains elusive. In addition, whether treatments targeting AF, including anticoagulation and rhythm control strategies, can avert cognitive decline and dementia has great clinical implications. To pave the way for targeted effective interventions for cognitive protection, we provide an overview of the association between AF and cognitive impairment and the potential mechanisms underlying this association. In addition, the effectiveness of AF-related treatment strategies, including anticoagulation, sinus rhythm restoration through elective cardioversion and catheter ablation, for cognitive protection in patients with AF is also discussed in this review.
Atrial fibrillation (AF) significantly contributes to ischemic stroke, which poses a major healthcare challenge due to its significant morbidity and mortality rates. AF increases with age and is a common cause of cardioembolic strokes - a substantial economic and social burden in cerebrovascular disease management. The cornerstone of treatment for AF-related ischemic stroke lies in anticoagulation therapy. Current clinical evidence strongly supports the prolonged administration of warfarin or novel oral anticoagulants (NOACs) in non-valvular AF patients. Considering the practicality and their consistent blood levels in real-world settings, NOACs are opted over traditional therapies by an increasing number of patients; NOACs, such as apixaban and dabigatran showing promising effectiveness and lower bleeding risks compared to warfarin, an increasing number of patients are opting for NOACs over traditional therapies. Recent studies focus on determining the optimal timing for initiating anticoagulation post-stroke, as early intervention potentially reduces recurrence and complications. However, given the diverse clinical presentations of these patients, careful consideration must be given to the timing of anticoagulation initiation and the unique circumstances of special populations, including those with renal impairment, elderly adults, and patients with cerebral microbleeds. This comprehensive review delves into the complexities of anticoagulation management in AF-related ischemic stroke, with a particular focus on the optimal timing of oral anticoagulant initiation and tailored strategies for special patient subgroups. The ultimate goal of this review is to equip healthcare providers with valuable clinical insights and guidance to manage the challenges of AF-related ischemic stroke.
Chronic kidney disease (CKD) is a significant global health concern, frequently associated with cardiovascular complications resulting from autonomic nervous system dysfunction, which can be detected using electrocardiography (ECG). This study employed factor analysis to investigate the association between anthropometric measures, age, and ECG findings in patients with CKD. We conducted a cross-sectional study to evaluate the ECG findings of 25 male participants (aged 36 - 80 years) with stage 5 CKD who were randomly selected from the Nephrology Unit of a hospital in the Amazon region. All participants underwent anthropometric and blood pressure assessment before the ECG recording at a sampling rate of 1,000 Hz. Then, the participants were positioned supine and asked to breathe normally for 3 min. To analyze the ECG data, a bootstrap method was used to estimate statistical parameters from 1,000 resampled datasets. A two-step process involving principal component (PC) extraction and varimax rotation was used for factor analysis. The covariance matrix of the normalized data underwent eigenvalue decomposition. The first three PCs captured 68.7% of the total variability observed in the original dataset. The PR interval (iPR), RR interval (iRR), and corrected QT (QTc) interval contributed 0.843, 0.836, and −0.822, respectively, to PC1; body mass index (BMI) and abdominal circumference (AC) contributed 0.910 and 0.947, respectively, to PC2; and age had the largest contribution of 0.938 to PC3. In conclusion, BMI, AC, and age can be simple and reliable clinical tools for detecting underlying CKD in primary care. ECG changes in iPR, iRR, and QTc are common in patients with CKD, thus highlighting the potential role of machine learning in the early detection of cardiovascular disease.
Tetraploidy is a rare chromosomal abnormality that is typically lethal in utero, with limited data on its effects on brain development. A comprehensive neuropathologic study of a tetraploid newborn (92, XXYY) at a corrected gestational age of 30 weeks is presented. Findings included hippocampal hypoplasia, partial corpus callosum agenesis, and neuronal heterotopies. In addition, the cerebral cortex showed sparse neurons across all laminae, along with molecular and meningeal glioneuronal heterotopies. The periventricular region demonstrated dispersed germline neurons, and the cerebellum exhibited matrix cell heterotopies in the dentate nuclei and numerous migrating Purkinje cells in the white matter, indicating immaturity. These brain abnormalities may explain the severe developmental delays and intellectual impairment seen in surviving patients. Unlike other severely unbalanced chromosomal aberrations that typically result in major brain malformations, tetraploidy appears to have a less severe effect on brain development. This report expands the knowledge of brain abnormalities in tetraploidy.
Some vaccine recipients experience cardiac adverse events (AEs) following immunization (AEFIs), which include background events and vaccine-associated AEs for certain vaccines. A small subset of AEs experienced by vaccine recipients is documented in the United States Vaccine AE Reporting System (VAERS). This study retrospectively analyzed VAERS to identify associations for cardiac AEFIs. The analysis considered factors such as vaccine type, vaccine source, vaccine recipient gender, and infant age. Multiple patterns of cardiac AEFI associations were detected: (i) bradycardia and cardiac arrest for infants under 1 year of age, (ii) arrhythmia for COVID-19 and human papillomavirus vaccines, (iii) atrial fibrillation for COVID-19, influenza, and respiratory syncytial virus vaccines, (iv) myocarditis and pericarditis for anthrax, COVID-19, smallpox, and typhoid vaccines, and (v) chest discomfort, chest pain, palpitations, and tachycardia for multiple vaccines. Gender differences were observed for both myocarditis and palpitation AEFIs. Significant differences in bradycardia and cardiac arrest AEFI normalized frequencies were observed for the same infant vaccines from different manufacturers, suggesting possible manufacturing contaminants as potential causative components. In conclusion, delaying specific vaccines until infants are 1 year old, selecting alternative vaccine options, or reducing or eliminating causative components could reduce infant bradycardia and cardiac arrest AEFIs. Mathematical age relationships could model both male and female myocarditis AEs for COVID-19 vaccines, potentially applicable to other vaccines, suggesting shared etiologies. In addition, several vaccines were associated with correlated cardiac AEFI signals for chest discomfort, chest pain, palpitations, and tachycardia. The etiologies of these AEFIs could be attributed to elevated histamine levels.
Perinatal stroke encompasses a diverse group of localized brain lesions that develop during the early stages of brain maturation. While many of these injuries manifest clinically within the first days of life, some may not be noticeable until later, often within the first year of life. These injuries are referred to as presumed perinatal stroke. This review aims to provide a clinical update on the current evidence regarding the epidemiology, risk factors, clinical manifestations, diagnosis, treatment, and complications of the different types of perinatal stroke. Major databases, including PubMed, ScienceDirect, PubMed Central, and Google Scholar, were searched using Medical Subject Headings and regular keywords. The search terms used were “stroke” AND “neonate,” “stroke” AND “fetus,” “stroke” AND “perinatal,” “stroke” AND “perinatal” AND “clinical presentation,” “stroke” AND “perinatal” AND “diagnosis,” “stroke” AND “perinatal” AND “management,” “stroke” AND “perinatal” AND “outcomes.” Any form of study on perinatal stroke was included, while literature not written in or translated into English was excluded from the study. Some of the clinical features of perinatal stroke include seizures, irritability, hypotonia, lethargy, or apnea. Cerebral palsy, epilepsy, developmental delay, and mental impairment are some complications that may arise following these lesions.
About 15 - 30% of patients develop recurrent episodes of pericarditis following an acute pericarditis attack. In developed countries, most cases of pericarditis are of idiopathic etiology. First-line therapy typically includes non-steroidal antiinflammatory drugs (NSAIDs) and colchicine, with corticosteroids being the traditional second-line agents. Anti-interleukin-1 (IL-1) agents are a novel treatment option increasingly utilized due to their high efficacy as an alternative second-line therapy or for resistant cases, while pericardiectomy remains the last resort. Special populations with recurrent pericarditis (RP), including patients at the extremes of age or during pregnancy, have been understudied. In some cases, pericarditis may develop secondary to infections (including viral infections, such as coronavirus disease 2019, bacterial infections, such as tuberculosis, and fungal infections), autoimmune diseases (such as systemic lupus erythematosus, rheumatoid arthritis, vasculitis, and inflammatory bowel disease), post-cardiac injury syndromes, cancer, and other rare conditions. Non-idiopathic etiologies are associated with a higher risk of RP, chronic constrictive pericarditis, and cardiac tamponade. The general treatment algorithm may not be applicable to these special populations due to patient-related or etiological factors. For example, NSAIDs or corticosteroids are often contraindicated in older patients due to comorbidities. Bacterial or fungal purulent pericarditis requires aggressive treatment of infection followed by pericardial fluid drainage, with corticosteroids and anti-IL-1 agents contraindicated in these cases. Therefore, management often requires a multidisciplinary approach and must take place at a specialized pericardial center to optimize patient outcomes. In this review, we present current evidence on the evaluation and management of RP in the aforementioned special populations.
Acute coronavirus disease-19 (COVID-19) infection is known to be associated with adverse cardiovascular complications. However, data on its longer-term cardiovascular effects remain limited. This case-control study aims to investigate potential medium-term cardiovascular sequelae of COVID-19. A random selection of patients who tested positive for COVID-19 through nasopharyngeal swabbing constituted the case group, while the control group comprised individuals who tested negative for both swab and COVID-19 immunoglobulin G antibodies. A total of 233 subjects were recruited, including 161 cases and 72 controls. The median age was 45 years (interquartile range [IQR]: 35 - 57 years). The median follow-up duration was 173.5 (IQR: 129.0 - 193.3) days. There were no significant differences between cases and controls with respect to age, sex, cardiovascular risk factors, and comorbidities. The levels of N-terminal pro-B natriuretic peptide and troponin I at follow-up did not differ significantly between the two groups. However, the root mean square of successive differences (RMSSD) of R-R intervals was significantly lower in some cases. Neither of the groups had significant arrhythmias. There were no significant differences between the two groups in both awake and asleep blood pressure levels as well as in dipping blood pressure status. In conclusion, COVID-19 infection was associated with reduced heart rate variability (HRV) as manifested by low RMSSD. Given the established link between reduced HRV and increased risks of mortality and sudden cardiac death, these findings warrant further investigation into the long-term cardiovascular impact of COVID-19.