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Background Objective: What is the association between COVID-19 infection and QTc changes? Coronavirus SARS-COV2 uses angiotensin-converting enzyme receptors 2 (ACE2) on host cells to enter into human cells. These receptors are expressed on the heart cells among other major cells. This is one of the most accepted theories for direct cardiac cell injury of COVID-19disease and associated cardiorespiratory manifestations. COVID-19 infection leads to unstable myocardial cell membranes, by causing hypoxia, myocarditis, myocardial ischemia, and abnormal host immune response. This is the main reason behind Arrhythmia and EKG changes during COVID19 infection. But the specific effect on QTc has not been studied well so far, so our research try to study this connection. Method: This is an observational retrospective hospital chart review involving 320 adult participants diagnosed with COVID-19 infection at our facility. After applying the exclusion criteria, 130 participants remained, who were distributed into two groups. One group with long QTc and one group with normal QTc. Data was collected and demographics were recorded using Excel and SPSS, then compared using a student’s t-test for independent groups. The quantitative data are summarized by the mean and standard deviation (SD). Statistical significance was taken as P Result: A total of 63 participants (48.4% of total 130 participants) met the criteria for long QTc, and a total of 67 participants(51.5%) had normal QTc (P < 0.001). There was no statistically significant mortality outcome (0.8% vs. 3.8%, P = 0.21). Conclusion: Our study showed 48.4% participants having an increase in QTc during COVID-19 infection, (20% of 320 total admissions). This observation is very important to help healthcare providers to gaina better understanding of this disease.

The Venovo venous stent (BD/Bard Peripheral Vascular) is indicated to treat iliofemoral veno-occlusive disease. We present our own experience with the Venovo venous stent in treating iliac vein compression (ILVC).In this retrospective cohort, we included consecutive patients treated with the Venovo venous stent for ILVC at our center. Stent deployment and sizing were guided by intravascular ultrasound (IVUS). Minimal luminal areas at the compression before and after treatment were measured by IVUS. Clinical improvement was determined by symptoms reported by patients and the Clinical Etiologic Anatomic and Pathophysiologic (CEAP) score. The primary safety endpoint was freedom from acute venothromboembolic disease, stent migration, perforation, acute/subacute closure, and vascular complications. The primary safety endpoint was target-lesion revascularization at 1 year.A total of 50 consecutive patients (57 Venovo stents, 36 women, mean age, 59.8 ± 16.3 years) were included. IVUS-measured mean percent stenosis at the compression site was 64.8% ± 12.8%. Mean total stent length and diameter were 78.0 ± 54.0 mm and 17.1 ± 1.9 mm, respectively. The primary safety endpoint was met in all subjects. Procedural technical success was 100% (successful deployment with no complications). At 1 year, 83.8% of patients reported improvement in their symptoms. Freedom from total occlusion at 1 year was 100% (data available for n = 30 patients). Target-lesion revascularization (TLR) was 2% at 1 year due to 1 patient who had stent explantation from worsening ipsilateral left leg and back pain.In this single-center experience, the Venovo venous stent was safe and effective in treating ILVC with 98% freedom from TLR at a follow-up of 1 year. Improvement in symptoms was reported in the majority of patients.

Endarterectomy of common femoral artery lesions (CFA) carries favorable long-term results and is currently still considered the gold standard for treating these lesions. Although routine stenting has been considered an option for treating the CFA, it has yielded conflicting results and is currently reserved for a bailout of suboptimal endovascular results. Newer therapies with atherectomy or lithoplasty in conjunction with pharmacologic anti-proliferative therapies are promising with less bailout stenting and dissections but randomized trials are needed to confirm their effectiveness and safety.

The left internal mammary artery (LIMA) bypass grafts to the left anterior descending artery (LAD) are superior to saphenous venous grafts because of…, This case reports on iatrogenic intramural hematoma of the left internal mammary artery (LIMA) identified on intravascular ultrasound. This case illustrates the importance of intravascular imaging to identify the presence and extent of an intraluminal hematoma that is not visualized on angiography and that was the cause of ischemic symptoms following LIMA injection. (Level of Difficulty: Advanced.), Graphical abstract

Herbal medication use is prevalent and increasing in the general population. A comprehensive review of complementary and alternative medicine use including herbal medications and supplements is often overlooked by physicians. Patients generally believe that all herbal products are safe without any side-effects. Herbal medications may have complex pharmacodynamics and can be associated with various psychiatric symptoms. The general population, as well as physicians, may be unaware of the risks and side-effects associated with herbal supplement use and further research may be needed. The objective is to describe a case report of acute onset of symptoms of hypomania associated with the increasing use of herbal supplements. A 49-year-old man developed symptoms of hypomania after a two-month history of daily use of a combination of more than 25 herbal supplements and daily cannabis use. Hypomania symptoms were temporally associated with the use of multiple herbal supplements that included ginseng. We recommend that a thorough history of medication use including herbal supplements and other alternative medications and a collateral report from family members and other providers including herbalists be obtained on all patients presenting with psychiatric symptoms. Further research is needed to identify the pharmacodynamics, risks, and adverse effects, and drug and food interactions of each herb.

Background Treatment of common femoral artery (CFA) disease has been traditionally surgical. Recent data indicate that an endovascular option is feasible in treating CFA disease but there remains significant controversy about the endovascular versus surgical approach to treatment. Newer modalities of therapy have emerged to treat the CFA including atherectomy and drug coated balloons. We retrospectively reviewed data on the long-term outcome of endovascular treatment of CFA from 2 medical centers. Methods Consecutive patients with CFA disease treated by 6 operators using endovascular techniques from January 1, 2012 to December 31, 2017 were reviewed and analyzed. Two-year follow up was completed using medical records. Demographic, clinical, procedural and angiographic variables were collected. The primary endpoint of the study was target lesion revascularization (TLR). Secondary endpoints included target vessel revascularization (TVR), mortality, unplanned major and minor amputations and 30-day periprocedural adverse events . Descriptive analysis was performed on all variables. Kaplan-Meier for freedom from TLR was plotted. The study was approved by the Ethics Committee at our center. Results A total of 89 patients (116 limbs) were included at Index. There were males 57.3%, diabetics 42.7%. Mean age was 65.1 ± 16.3 years. Critical limb ischemia (CLI) was present in 27.7%. Disease distribution was classified by the Medina classification: 1–0-0 (CFA only) 48.3%, 1–0-1 (CFA + profunda) 6.9%, 1–1-1 (CFA+ profunda + origin of superficial femoral artery) 16.4%, 1–1-0 (CFA and origin of SFA) 28.4%. Denovo disease was present in 70.7%. Atherectomy was used in 104/116 limbs (89.7%). Drug coated balloons (DCB) in 15.5%, and stenting in 22.4%. Baseline stenosis 81.2 ± 13.1%, lesion length was 42.0 ± 14.5 mm. Final stenosis was 13.3 ± 11.0. Major bleeding occurred in 2.6%. At 2-year mortality was 9.0% (none related to procedure), CLI was 5.9% and no unplanned major or minor amputations. At 2-year KM analysis showed a probability of freedom from TLR of 72.2%. At 2-year the following TLRs were noted for various devices used: PTA 50%, orbital atherectomy 0%, jetstream 29.2%, laser 36.4%, and SilverHawk/TurboHawk 23.1% ( p = 0.0476). Conclusion Endovascular treatment of CFA predominantly with atherectomy in this cohort, is feasible and with acceptable outcomes considering a low percentage of DCB use. A randomized trial is needed to validate these findings and explore the added role of DCB and atherectomy on clinical outcomes when compared to endarterectomy .

The Venovo Venous stent (BD, Bard) was recently approved by the Food and Drug Administration to treat iliofemoral veno-occlusive disease. We present our own experience with the Venovo Venous stent in treating iliac vein compression (ILVC). In this retrospective cohort, consecutive patients treated

Background: Deep venous thrombosis (DVT), even though resolved, may damage the valves and may lead to chronic venous insufficiency (CVI). We designed the present study to examine the thrombotic markers or other ultrasound features in the absence of active thrombosis in patients presenting with features suggestive of CVI. Materials and Methods: It was a cross-sectional study of 50 DVT patients. We collected a detailed history of presenting symptoms (onset, progression, and duration) and associated history of aggravating factors. After classifying the patients, color Doppler investigation for DVT and venous incompetence and blood investigations such as Factor V, D-Dimer, total cholesterol, total triglycerides, homocysteine, high-density lipoproteins, low-density lipoproteins (LDL), and very LDL were done. Results: We found a raised Factor V significantly more in patients classified as severe under clinical classification compared with nonsevere (19% and 0%; P = 0.05) and in patients with a high Venous Severity Clinical Score (VSCS) compared to those with a low VSCS score (17% and 0%; P = 0.03). We also found that perforators were significantly more in patients with a high VSCS score (88% and 58%; P = 0.02), in patients with a primary venous etiology compared with those without any venous etiology (97% and 1%; P < 0.0001), in patients with obstruction/reflux compared to those without any pathology (95% and 0%; P < 0.0001), and in patients with severe clinical classification compared with nonsevere patient (95% and 55%; P = 0.002). Conclusions: Clinical or subclinical DVT, an important cause of CVI, may not always be seen on ultrasound, especially after resolution. However, they may have the presence of blood parameters (Factor V and hyperhomocysteinemia) suggestive of DVT; these can be used as proxy markers for the current or previous DVT.

Neutrophilic eccrine hidradenitis (NEH) is a dermatosis affecting the eccrine glands in particular characterized by acute, self-limited, inflammatory papules and plaques and has been commonly described in patients with cancer – particularly acute myeloid leukemia (AML) – who are on chemotherapy. We present the case of a febrile neutropenic patient receiving chemotherapy for AML and presented with well-defined erythematous macules and papule suggestive of NEH. This report emphasizes the necessity of a prompt diagnosis in order to prevent the use of multiple antibiotics and inadvertent use of other drugs as it is a self-limiting condition.

Objectives: Teachers are among the professions reporting highest level of work-related stress, the study was undertaken to evaluate the levels of stress amongst school teachers in a public school of rural western Maharashtra Methods: Prospective survey based study was carried out amongst school teachers of rural western Maharashtra using Copenhagen Psychosocial Questionnaire (COPSOQ).The survey was carried out on 3 scheduled visits over a period of 2 months after the Institutional Ethical committee approval. Total 110 Primary and secondary school teachers, satisfying inclusion and exclusion criteria were randomly selected for the study. All the questions in the Copenhagen Psychosocial Questionnaire (COPSOQ) were graded according to 1 (Always-0), 2 (Sometimes-25), 3 (Often-50), 4 (Seldom-75) and 5 (Never-100). The scale value was calculated as the simple average. More the average score less the stress and vice versa Results & Conclusion: Inability to understand the meaning and importance of work, improper clarity about the job, inability to cope with the problems were found to be the factors always contributing to stress of teachers.