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Introduction: Left bundle branch area pacing is an alternative to biventricular pacing. In this study, we aim to summarize the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP). Objectives: The study summarizes the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP). Background: Cardiac resynchronization therapy (CRT) reduced mortality and hospitalizations in heart failure (HF) patients with a left ventricular ejection fraction (LVEF) ≤ 35% and concomitant LBBB. Recently LBBAP has been studied as a more physiological alternative to achieve CRT. Method: A search of PubMed, EMBASE, and Cochrane databases were performed to identify studies examining the role of LBBAP for CRT in heart failure. Comprehensive meta‐analysis version 4 was used for meta‐regression to examine variables that contribute to data heterogeneity. Result: Eighteen studies, 17 observational and one randomized controlled trial (RCT) were examined. A total of 3906 HF patients who underwent CRT (2036 LBBAP vs. 1870 biventricular pacing [BVP]) were included. LBBAP was performed successfully in 90.4% of patients. Compared to baseline, LBBAP was associated with a reduction in QRS duration (MD: −47.23 ms 95% confidence interval [CI]: −53.45, −41.01), an increase in LVEF (MD: 15.22%, 95% CI: 13.5, 16.94), and a reduction in NYHA class (MD: −1.23, 95% CI: −1.41, −1.05). Compared to BVP, LBBAP was associated with a significant reduction in QRS duration (MD: −20.69 ms, 95% CI: −25.49, −15.88) and improvement in LVEF (MD: 4.78%, 95% CI: 3.30, 6.10). Furthermore, LBBAP was associated with a significant reduction in HF hospitalization (odds ratio [OR]: 0.44, 95% CI: 0.34, 0.56) and all‐cause mortality (OR: 0.67, 95% CI: 0.52, 0.86) compared to BVP. Conclusion: LBBAP was associated with improved ventricular electrical synchrony compared to BVP, as well as better echocardiographic and clinical outcomes. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has altered innumerable lives. Although recent mass vaccinations offer a glimmer of hope, the rising death toll and new variants continue to dominate the current scenario. As we begin to understand more about SARS-CoV-2 infections, the territory of reinfections with COVID-19 remains unexplored. In this review, we will discuss several aspects of reinfection: (a) How is COVID-19 reinfection characterized? (b) Does prior literature differentiate between reinfection and reactivation? (c) What SARS-CoV-2 strains do the vaccines target and can they protect against new strains? Larger and longer timeline studies are needed to understand reinfection risks. With the ongoing distribution of the SARS-CoV-2 vaccines to provide protection, the understanding of the possibility for SARS-CoV-2 reinfection remains critical. Abbreviations CDC: Centers for Disease ControlSARS-CoV-2: Severe acute respiratory syndrome coronavirus 2COVID-19: Coronavirus disease 2019RT-PCR: Reverse Transcription Polymerase Chain ReactionPASC: Post-Acute Sequelae of SARS-CoV-2 infection [ABSTRACT FROM AUTHOR]

Drug reaction with eosinophilia with systemic symptoms (DRESS) syndrome is a rare drug reaction often presenting with both cutaneous manifestations and potentially life-threatening internal organ involvement. The precise incidence of DRESS is still unclear as it is easily missed due to its highly variable clinical presentation. However, with an expected mortality rate of approximately 10 percent, it is important for clinicians to be familiar with pharmacologic etiologies commonly implicated in the pathogenesis. We present a case of DRESS syndrome attributed to cross-reactivity between two commonly used anticonvulsants-lacosamide and lamotrigine. [ABSTRACT FROM AUTHOR]

We present the case of an adolescent with an intramuscular ancient schwannoma of the axillary nerve which, to the best of our knowledge, has not been reported before. Due to its deep location, intramuscular schwannoma has less clinical signs and hence, is difficult to diagnose. Ancient schwannoma, characterised by degeneration due to long course, is rare and can be mistaken for malignancy due to heterogeneous intensity and degeneration evident on MRI and nuclear atypia on histopathology. It is important to differentiate it from malignancy based on a clinically benign swelling with a long history, well-encapsulated mass on MRI with the split fat sign and absence of significant mitotic activity despite nuclear atypia. The aim of surgery should be enucleation of the tumour while preserving the function of the parent nerve. [ABSTRACT FROM AUTHOR]

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder resulting in fibrofatty replacement of the myocardium. Genetic mutations in genes encoding for desmosome proteins result in a ventricular myocardium prone to arrhythmias and heart failure. Although ARVC is known for a few decades, most of the outcomes in pregnancy are reported recently. Pregnancy leads to significant physiological changes with excess mechanical stress on the myocardium. All the retrospective studies suggest that pregnancy is well tolerated in these patients despite the high risk of arrhythmias and heart failure. Our review focuses on the most up-to-date evidence on the management of ARVC patients during the antepartum and postpartum period. [ABSTRACT FROM AUTHOR]

COVID-19 caused by severe acute respiratory syndrome coronavirus 2, which originated in Wuhan (China), transformed into a worldwide pandemic. The short span associated with the spread of the virus and its varied manifestations presents a steep learning curve for many clinicians on the front-line of treatment. Cardiology is one such affected area. This paper details the signs and symptoms of cardiovascular disease resulting from COVID-19, including its proposed pathophysiology, signs and symptoms, treatments and outcomes under investigation. The consensus is that COVID-19 patients with cardiovascular injury have a shorter duration from symptom onset to deterioration, higher mortality and higher prevalence in older populations. Diagnosis and intervention for patients with underlying cardiovascular comorbidities is critical. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) is not just a disease of the respiratory system. The virus can affect the gastrointestinal (GI) tract as well. Recognizing the various manifestations in every organ system is important because these manifestations can contribute to community-based transmission. Methods:We outline the evidence of the pathophysiology of COVID-19 in the GI tract, the effects of the virus on the gut and liver, the presence of the virus in stool samples, and the potential for fecal-oral transmission of COVID-19. Most of the literature sources used in this paper are case studies from China following the surge of COVID-19 infection. Results: In patients with COVID-19, GI symptoms such as anorexia, nausea, vomiting, diarrhea, and abdominal pain have presented in conjunction with respiratory symptoms such as fever, shortness of breath, and cough. Evidence also shows acute hepatocellular injury, indicated by elevated liver enzymes such as alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase. Fecal-oral transmission of COVID-19 is suspected because of the presence of COVID-19 RNA in stool samples of COVID-19-positive patients. Conclusion: Even without the presence of respiratory symptoms, several GI symptoms are associated with COVID-19 infection, as well as possible fecal-oral transmission. Therefore, COVID-19 infection should be considered for patients presenting with primarily GI symptoms. [ABSTRACT FROM AUTHOR]

Coronavirus Disease 2019, caused by the virus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), is a pandemic first discovered in Wuhan, China which has claimed over 1.7 million lives to date across the globe as of 24 December 2020. As the virus spreads across the world affecting millions of patients, there has been a massive movement to discover readily available and effective treatment options including vaccines. One of the limiting factors in treating the disease is its varied presentation and effect in patients, ranging from asymptomatic patients to those left in intensive care units, intubated and fighting for their lives. There are numerous clinical trials and small-scale studies underway to investigate potential treatment options. However, very few studies and drugs demonstrated efficacy while many more are under investigation, leaving care teams dependent on supportive care coupled with experimental treatment options. In this review, we summarize the various treatment options explored to treat COVID-19, discussing possible the mechanisms of fighting the virus. [ABSTRACT FROM AUTHOR]

Nontuberculous mycobacteria are rare causes of cardiac implantable electronic device (CIED)‐related infections and may lead to device‐related endocarditis, so preventing them is key. We present a case of CIED‐related pocket infection due to Mycobacterium fortuitum which highlights the challenges in management of such infections. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has altered numerous lives and accounted for significant mortality and morbidity throughout the world and, especially, the USA. During the pandemic, from mid-March to July 2020, around one-fourth of the US population filed for unemployment benefits. Objective: In this article, we discuss the economic ramifications exposed in the American healthcare system's current model by the COVID-19 crisis. Methods: In this review, we analyze 18 articles to look at how access to health insurance has affected how Americans receive medical care during the coronavirus pandemic. Results: The large-scale job losses related to the pandemic translates directly into millions of Americans also losing employer-sponsored health insurance (ESI) coverage. With the pandemic disproportionately affecting minority populations, these communities now bear the additional toll of not receiving appropriate care. Conclusion: Due to the pandemic, it is probable that a significant portion of Americans that are uninsured are less likely to seek medical care for COVID-19 symptoms. While the disease can manifest as a mild respiratory illness in most, others can experience more severe disease and require acute, intensive medical care. The lack of health insurance in this instance can be potentially fatal. Given that COVID-19 has disproportionately affected minority communities across the USA, it is important to highlight the correlation between access to medical care and COVID-19 infection rates. Communities that are of lower socioeconomic status are less likely to have health insurance and follow up with medical care due to out-of-pocket costs, which in turn leads to a higher case fatality rate due to COVID-19. [ABSTRACT FROM AUTHOR]

Objectives: The global COVID‐19 pandemic has caused rapid and monumental changes around the world. Older people, who already experience higher rates of social isolation and loneliness, are more susceptible to adverse effects as a result of the social distancing protocols enacted to slow the spread of COVID‐19. Based on prior outbreaks, we speculate the detrimental outcomes and offer solutions. Methods: Reviewing the literature on the detrimental effects of social isolation and loneliness and higher mortality in the older population. Utilizing psychological study outcomes from prior major outbreaks such as in SARS, Ebola, H1N1 influenza, and Middle East respiratory syndrome offer predictions and the susceptibility in the geriatric age group. Results: Organizations such as the WHO, Centers for Disease Control, and American Association of Retired Persons have put measures in place to provide networking on a local, regional, and national level. These efforts are designed to start mitigating such detrimental effects. A necessary follow‐up to this pandemic will be gathering data on unique populations such as the geriatric community, to better mitigate adverse outcomes given the certainty that COVID‐19 will not be the last global viral outbreak. Conclusions: The results of worsened social isolation and loneliness is associated with significantly increased morbidity and mortality in the geriatric population. Various solutions including virtual interactions with loved ones, engaging in physical activity, continuing any spiritual or religious prayers remotely, and community services to provide aid for the older population are all efforts to minimize social isolation and loneliness. [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak that began in 2019 and spread rapidly across the globe has been observed to cause acute lung injury and multiorgan system failure. While common symptoms are flu-like, this population has been observed to decompensate at an alarmingly rapid rate to severe hypoxia. SARS-CoV-2 infects host cells by targeting the angiotensin-converting enzyme 2 (ACE2) receptor, which is present on endothelial cells in the lung, heart, kidney, and gastrointestinal tissue. The pathophysiology of acute respiratory distress syndrome (ARDS) in SARS-CoV-2 infection has a component of lung perfusion dysregulation and is described as a "cytokine storm" that causes increased vascular permeability and disease severity. Older adults and those with comorbid conditions, particularly hypertension, diabetes, and history of ischemic heart disease, are especially vulnerable. These high-risk populations are often on angiotensin-modulating therapies, which are theorized to increase ACE2 expressivity, but current evidence for or against discontinuation is equivocal. The standard for SARS-CoV-2 testing is through reverse transcription polymerase chain reaction, which has presented problems due to low sensitivity and possible co-infection with other pathogens. Treatment for ARDS in the setting of SARS-CoV-2 should follow pre-established goals of care and the wishes of the patient and family members or caregivers and consider the high risk for polypharmacy, cognitive decline, malnutrition, and depression, particularly in older adults. Treatment recommendations have outlined ventilation goals to minimize further lung injury. Compassionate use of pharmacologic therapies such as remdesivir has shown promise, and further clinical trials of anticytokine agents are underway. [ABSTRACT FROM AUTHOR]

The novel coronavirus disease 2019 (COVID-19) first reported in Wuhan, China, in 2019 has evolved into a pandemic and public health emergency, leading to extensive fatalities and halting global economies. Older adults have emerged as a critically vulnerable population as earlier data suggests a disproportionately increased incidence of COVID-19 in this population, as well as worse health outcomes. Disease attenuating behaviors such as social distancing has been encouraged and mandated across different countries leading to downstream economic ramifications. This paper seeks to outline the economic implications of COVID-19 in the U.S. (particularly in terms of vocational, retail, and service industries), highlighting the role of nursing homes in disease dissemination. We also discuss potential costs associated with COVID-19 management focusing on the senior population who rely on Medicare benefits for health insurance. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), a novel virus that causes COVID‐19 infection, has recently emerged and caused a deadly pandemic. Studies have shown that this virus causes worse outcomes and a higher mortality rate in older adults and those with comorbidities such as hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and chronic kidney disease (CKD). A significant percentage of older American adults have these diseases, putting them at a higher risk of infection. Additionally, many adults with hypertension, diabetes, and CKD are placed on angiotensin‐converting enzyme (ACE) inhibitors and angiotensin II receptor blockers. Studies have shown that these medications upregulate the ACE‐2 receptor, the very receptor that the SARS‐CoV‐2 virus uses to enter host cells. Although it has been hypothesized that this may cause a further increased risk of infection, more studies on the role of these medications in COVID‐19 infections are necessary. In this review, we discuss the transmission, symptomatology, and mortality of COVID‐19 as they relate to older adults, and possible treatments that are currently under investigation. J Am Geriatr Soc 68:926–929, 2020 [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic poses an ever-increasing threat to older Americans, especially those in nursing homes. The compact nature of these facilities and the morbidities shared by this population make them susceptible to the virus and its symptoms. Because of this, the CDC has published guidelines directed at isolation and quarantine measures specifically created to protect this patient population. These measures are comprehensive and provide examples and management of situations, such as admissions and outbreaks, that these facilities must deal with and be ready to face on a regular basis. In this review, we discuss the guidelines for isolation and quarantine as it pertains to the nursing home population, and some of the unintended effects these protocols may have on this population. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 utilizes the angiotensin-converting enzyme 2 (ACE-2) receptor of cells in order to gain entry and continue infection. Recent literature has focused on acute respiratory distress syndrome (ARDS) and other associated pulmonary complications; however, only a scarce amount of literature exists on neurological complications. Such complications also pose a high morbidity in these patients. The exact pathogenesis of nervous system involvement by COVID-19 still remains poorly understood. The aim of this article is to review the neurological symptoms seen in COVID-19 infection and discuss the probable pathogenesis, management and outcome of associated neurological complications. [ABSTRACT FROM AUTHOR]

The article discusses the United Nations defines human trafficking as the recruitment, transportation, transfer, harboring, or receipt of persons by improper means for an improper purpose including forced labor or sexual exploitation. Topics include time progressed, information has uncovered including a history of sexual trafficking, drug and alcohol use, as well as posttraumatic stress; and the views of Jane Doe, a presumed African American female, on street.

Thrombocytopenia has many mechanisms with broad differentials. A detailed history and physical, with timely diagnostic testing, is necessary to parse out the underlying etiology. Clinicians should maintain a high suspicion for drug-induced thrombocytopenia when there is an acute drop in the platelet level after exposure to commonly implicated drugs. Drug-induced thrombocytopenia is not well defined, as reporting is voluntary and not critically reviewed. Oftentimes, the culprit is not the drug itself, but a drug metabolite, which is difficult to prove with drug-dependent antibody testing. Here we present a case where naproxen led to hemarthrosis secondary to drug-induced thrombocytopenia. [ABSTRACT FROM AUTHOR]

Peripherally inserted central catheters (PICCs), a form of central venous catheter (CVC) inserted into the cephalic or basilic veins, are most commonly used for administration of long-term antibiotics or for total parenteral nutrition. PICCs are associated with fewer complications than traditional CVCs; however, they have been implicated in accidental malpositioning, leading to both atrial and ventricular arrhythmias. We present a case of atrial fibrillation possibly triggered by migration of the tip of the PICC deep into the right atrium. Retraction of the tip resulted in resolution of the arrhythmia. [ABSTRACT FROM AUTHOR]

B Learning Objectives: b Hyperthyroidism is known to cause arterial thrombosis, it has been implicated in rare cases of myocardial infarction. Emergent cardiac catheterization revealed a large thrombus extending from left main to left anterior descending artery (LAD) with 80% occlusion of the proximal LAD not amenable to intervention. B Results: b We believe that hyperthyroid state due to autoimmune thyroiditis and heterozygous variant of C677T may have precipitated a pro-thrombotic state leading to an imminent occlusion of LAD which hence forth led to a STEMI in a young female with no obvious risk factors. [Extracted from the article]

Introduction: Accurate diagnosis of pulmonary hypertension (PH) is made using invasive right heart catheterization (RHC). Prior studies have shown the utility of imaging techniques like computerized tomography (CT) as alternatives to predict PH. Hypothesis: To determine the predictive ability of CT measured main pulmonary artery diameter (PA) to aortic diameter (AO) ratio in identifying PH. Methods: A retrospective observational study conducted in 211 consecutive patients who had RHC and CT chest within 6 months of each other between the years 2012-2015. Two expert radiologists measured main PA diameter at the bifurcation and AO diameter from the same CT image. Furthermore, we conducted a sub-group analysis to see if the ratio performs better in assessing PH in chronic kidney disease patients. Linear correlation and logistic regression analysis was used to examine the association between PA:AO ratio by CT scan with invasive hemodynamics. Receiver operator characteristic analysis was used to evaluate the ability of using PA:AO ratio to predict PH. Resting PH was defined as mean pulmonary artery pressure of ≥25 mmHg. CKD was defined as GFR between 15- 60 mL/min/ 1.73 m2 and no indication for dialysis. Results: Mean time between CT and RHC 3 days with minimum of 5.06 months (-152 days) to 5.56 months (167 days). Intraclass correlation coefficient between the two radiologists was 0.86 (95% CI of 0.75-0.92) with a P <0.01. CT measured PA:AO is highly correlated with mPAP after adjustment of age, race and gender (r=0.37, P <0.001). In a multivariate logistic model, every 0.15 U (1±SD) increase in PA:AO ratio was associated with 2.99 times higher (95% CI 1.99-4.49, P <0.01) odds of having PH , while in CKD subgroup, every 0.15 U (1±SD) increase in PA:AO ratio was associated with 11.9 times higher odds of having PH (95% CI 2.10-67.6, P =0.005), adjusting for age, race and gender. Conclusion: CT derived PA:AO ratio is predictive of PH. [ABSTRACT FROM AUTHOR]