RESUMO
In this survey study of institutions across the US, marked variability in evaluation, treatment, and follow-up of adolescents 12 through 18 years of age with mRNA coronavirus disease 2019 (COVID-19) vaccine-associated myopericarditis was noted. Only one adolescent with life-threatening complications was reported, with no deaths at any of the participating institutions.
Assuntos
COVID-19 , Miocardite , Adolescente , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Humanos , Miocardite/epidemiologia , Miocardite/etiologia , RNA MensageiroRESUMO
OBJECTIVES: To characterize the clinical course and outcomes of children 12-18 years of age who developed probable myopericarditis after vaccination with the Pfizer-BioNTech (BNT162b2) coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccine. STUDY DESIGN: A cross-sectional study of 25 children, aged 12-18 years, diagnosed with probable myopericarditis after COVID-19 mRNA vaccination as per the Centers for Disease Control and Prevention criteria for myopericarditis at 8 US centers between May 10, 2021, and June 20, 2021. We retrospectively collected the following data: demographics, severe acute respiratory syndrome coronavirus 2 virus detection or serologic testing, clinical manifestations, laboratory test results, imaging study results, treatment, and time to resolutions of symptoms. RESULTS: Most (88%) cases followed the second dose of vaccine, and chest pain (100%) was the most common presenting symptom. Patients came to medical attention a median of 2 days (range, <1-20 days) after receipt of Pfizer mRNA COVID-19 vaccination. All adolescents had an elevated plasma troponin concentration. Echocardiographic abnormalities were infrequent, and 92% showed normal cardiac function at presentation. However, cardiac magnetic resonance imaging, obtained in 16 patients (64%), revealed that 15 (94%) had late gadolinium enhancement consistent with myopericarditis. Most were treated with ibuprofen or an equivalent nonsteroidal anti-inflammatory drug for symptomatic relief. One patient was given a corticosteroid orally after the initial administration of ibuprofen or an nonsteroidal anti-inflammatory drug; 2 patients also received intravenous immune globulin. Symptom resolution was observed within 7 days in all patients. CONCLUSIONS: Our data suggest that symptoms owing to myopericarditis after the mRNA COVID-19 vaccination tend to be mild and transient. Approximately two-thirds of patients underwent cardiac magnetic resonance imaging, which revealed evidence of myocardial inflammation despite a lack of echocardiographic abnormalities.
Assuntos
Vacinas contra COVID-19/genética , COVID-19/prevenção & controle , Imagem Cinética por Ressonância Magnética/métodos , Miocardite/etiologia , SARS-CoV-2/imunologia , Vacinação/efeitos adversos , Vacinas Sintéticas/efeitos adversos , Adolescente , COVID-19/epidemiologia , COVID-19/genética , Vacinas contra COVID-19/efeitos adversos , Criança , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Miocardite/diagnóstico , Miocardite/epidemiologia , Pandemias , Estudos Retrospectivos , Estados Unidos/epidemiologia , Vacinas de mRNARESUMO
Nail gun injuries primarily occur in the extremities of adult males as a consequence of accidental occupational trauma. Such injury involving the thorax is much less common, and penetrating cardiac injury secondary to pneumatic nail gun discharge is rare. Although potentially lethal, most cases with cardiac trauma are survivable with expedient surgical intervention. Despite improvements in engineered safety mechanisms, the incidence of nail gun injuries has risen as use of the devices has increased. The widespread availability of these tools to nonprofessional consumers exposes a broader population to the potential hazards associated with these devices. We describe the presentation and successful management of the first reported case of penetrating cardiac nail gun injury in a young child.
Assuntos
Materiais de Construção/efeitos adversos , Traumatismos Cardíacos/etiologia , Ventrículos do Coração/lesões , Ferimentos Penetrantes/etiologia , Pré-Escolar , Feminino , Armas de Fogo , Humanos , Tomografia Computadorizada por Raios XRESUMO
OBJECT: The authors describe the utility of and outcomes after endoscopic transnasal craniotomy and skull reconstruction in the management of skull base pathologies. METHODS: The authors conducted a observational study of patients undergoing totally endoscopic, transnasal, transdural surgery. The patients included in the study underwent treatment over a 12-month period at 2 tertiary medical centers. The pathological entity, region of the ventral skull base resected, and size of the dural defect were recorded. Approach-related complications were documented, as well as CSF leaks, infections, bleeding-related complications, and any minor complications. RESULTS: Thirty consecutive patients were assessed during the study period. The patients had a mean age of 45.5 +/- 20.2 years and a mean follow-up period of 182.4 +/- 97.5 days. The dural defects reconstructed were as large as 5.5 cm (mean 2.49 +/- 1.36 cm). One patient (3.3%) had a CSF leak that was managed endoscopically. Two patients had epistaxis that required further care, but there were no complications related to intracranial infections or bleeding. Some minor sinonasal complications occurred. CONCLUSIONS: Skull base endoscopic reconstructive techniques have significantly advanced in the past decade. The use of pedicled mucosal flaps in the reconstruction of large dural defects resulting from an endoscopic transnasal craniotomy permits a robust repair. The CSF leak rate in this study is comparable to that achieved in open approaches. The ability to manage the skull base defects successfully with this approach greatly increases the utility of transnasal endoscopic surgery.
Assuntos
Craniotomia/métodos , Base do Crânio/cirurgia , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Procedimentos de Cirurgia Plástica/métodos , Retalhos CirúrgicosRESUMO
We report a case of new interferon-associated ocular complication during treatment with combination of pegylated interferon plus ribavirin for chronic hepatitis C infection. Our patient developed choroidal neovascularization in addition to the classic interferon associated retinopathy. Choroidal neovascularization has not been reported before in association with interferon induced retinopathy. We describe our management to control the ocular symptoms and the retinal lesions with one year follow up. We also provide literature report on the natural history, the pathophysiology and the variable characteristics of interferon associated retinopathy versus hepatitis C related ophthalmopathy.