Many recent studies have investigated the role of either Chloroquine (CQ) or Hydroxychloroquine (HCQ) alone or in combination with azithromycin (AZM) in the management of the emerging coronavirus. ...This systematic review and meta-analysis of either published or preprint observational studies or randomized control trials (RCT) aimed to assess mortality rate, duration of hospital stay, need for mechanical ventilation (MV), virologic cure rate (VQR), time to a negative viral polymerase chain reaction (PCR), radiological progression, experiencing drug side effects, and clinical worsening. A search of the online database through June 2020 was performed and examined the reference lists of pertinent articles for in-vivo studies only. Pooled relative risks (RRs), standard mean differences of 95% confidence intervals (CIs) were calculated with the random-effects model. Mortality was not different between the standard care (SC) and HCQ groups (RR = 0.99, 95% CI 0.61-1.59, I
= 82%), meta-regression analysis proved that mortality was significantly different across the studies from different countries. However, mortality among the HCQ + AZM was significantly higher than among the SC (RR = 1.8, 95% CI 1.19-2.27, I
= 70%). The duration of hospital stay in days was shorter in the SC in comparison with the HCQ group (standard mean difference = 0.57, 95% CI 0.20-0.94, I
= 92%), or the HCQ + AZM (standard mean difference = 0.77, 95% CI 0.46-1.08, I
= 81). Overall VQR, and that at days 4, 10, and 14 among patients exposed to HCQ did not differ significantly from the SC (RR = 0.92, 95% CI 0.69-1.23, I
= 67%), (RR = 1.11, 95% CI 0.26-4.69, I
= 85%), (RR = 1.21, 95% CI 0.70-2.01, I
= 95%), and (RR = 0.98, 95% CI 0.76-1.27, I
= 85% ) respectively. Exposure to HCQ + AZM did not improve the VQR as well (RR = 3.23, 95% CI 0.70-14.97, I
= 58%). The need for MV was not significantly different between the SC and HCQ (RR = 1.5, 95% CI 0.78-2.89, I
= 81%), or HCQ + AZM (RR = 1.27, 95% CI 0.7-2.13, I
= 88%). Side effects were more reported in the HCQ group than in the SC (RR = 3.14, 95% CI 1.58-6.24, I
= 0). Radiological improvement and clinical worsening were not statistically different between HCQ and SC (RR = 1.11, 95% CI 0.74-1.65, I
= 45%) and (RR = 1.28, 95% CI 0.33-4.99), I
= 54% respectively. Despite the scarcity of published data of good quality, the effectiveness and safety of either HCQ alone or in combination with AZM in treating COVID-19 cannot be assured. Future high-quality RCTs need to be carried out.PROSPERO registration: CRD42020192084.
Key Clinical Message
The role of 3D echocardiography has been increasing in the management of patients with congenital heart disease (CHD), particularly in pre‐surgical planning, catheter‐guided ...interventions, and functional assessment of the heart.
The coronavirus disease 2019 (COVID-19) pandemic has threatened global health and prompted the need for mass vaccination. We aimed to assess the efficacy and effectiveness of COVID-19 vaccines to ...prevent mortality and reduce the risk of developing severe disease after the 1st and 2nd doses. From conception to 28 June 2021, we searched PubMed, Cochrane, EBSCO, Scopus, ProQuest, Web of Science, WHO-ICTRP, and Google Scholar. We included both observational and randomized controlled trials. The pooled vaccine efficacy and effectiveness following vaccination, as well as their 95 percent confidence intervals (CI), were estimated using the random-effects model. In total, 22 of the 21,567 screened articles were eligible for quantitative analysis. Mortality 7 and 14 days after full vaccination decreased significantly among the vaccinated group compared to the unvaccinated group (OR = 0.10, (95% CI, 0.04-0.27, I
= 54%) and (OR = 0.46, 95% CI, 0.35-0.61, I
= 0%), respectively. The probability of having severe disease one or two weeks after 2nd dose decreased significantly (OR = 0.29 95% CI, 0.19-0.46, I
= 25%) and (OR = 0.08 95% CI, 0.03-0.25, I
= 74%), respectively. The incidence of infection any time after the 1st and 2nd doses diminished significantly (OR = 0.14 95% CI, 0.07-0.4, I
= 100%) and (OR = 0.179 95% CI, 0.15-0.19, I
= 98%), respectively. Also, incidence of infection one week after 2nd dose decreased significantly, (OR = 0.04, 95% CI (0.01-0.2, I
= 100%). After meta-regression, the type of vaccine and country were the main predictors of outcome non-mRNA type, ß = 2.99,
= 0.0001; country UK, ß = -0.75,
= 0.038; country USA, ß = 0.8,
= 0.02. This study showed that most vaccines have comparable effectiveness, and it is purported that mass vaccination may help to end this pandemic.
Key Clinical Message
Membranous interventricular septal (MIVS) aneurysm is a rare often asymptomatic, accidentally discovered congenital anomaly, which might be complicated with right ventricular ...obstruction, rupture, thromboembolism, and conduction abnormalities.
Ortner's syndrome (cardiovocal syndrome) is a rare cause of unilateral vocal cord paralysis that results from compression of the left recurrent laryngeal nerve by enlarged vascular structures. Most ...commonly, it is caused by an enlarged left atrium, but other rare causes include ascending aortic aneurysm or pulmonary artery aneurysm. Although very rarely encountered nowadays, bilharziasis is still one of the main causes of pulmonary artery aneurysm in endemic areas. Hereby, we report a case of Ortner's syndrome due to a large pulmonary artery aneurysm in a woman with history of bilharziasis.
Right ventricular function is one of the important predictors of survival in heart failure patients. In the past, there has been only limited knowledge regarding right-sided heart failure when ...compared to left-sided failure. However, there are more emerging data in recent years, and several studies have emphasized the unique features of the right ventricle regarding its anatomy, pathophysiology, clinical consequences, diagnostic modalities, and treatment options. Despite that, management of acute right ventricular failure is still challenging. This article summarizes an overview of acute right heart failure including pathophysiology, causes, clinical features, and diagnostic work-up with emphasis on the role of echocardiography.
Oral vitamin K antagonists (VKAs), warfarin, have been in routine clinical use for almost 70 years for various cardiovascular conditions. Direct-Acting Oral Anticoagulants (DOACs) have emerged as ...competitive alternatives for VKAs to prevent stroke in patients with non-valvular atrial fibrillation (AF) and have become the preferred choice in several clinical indications for anticoagulation. Recent guidelines have limited the use of DOACs to patients with non-valvular AF to reduce the risk of cardioembolic complications and to treat venous thromboembolism (VTE). Although emerging evidence is suggestive of its high efficacy, there was a lack of data to support DOACs safety profile in patients with mechanical valve prosthesis, intracardiac thrombi, or other conditions such as cardiac device implantation or catheter ablation. Therefore, several clinical trials have been conducted to assess the beneficial effects of using DOACs, instead of VKAs, for various non-guideline-approved indications. This review aimed to discuss the current guideline-approved indications for DOACs, advantages, and limitations of DOACs use in various clinical indications highlighting the potential emerging indications and remaining challenges for DOACs use. Several considerations are in favour of switching from warfarin to DOACs including superior efficacy, better adverse effect profile, fewer drug-drug interactions, and they do not require frequent international normalized ratio (INR) monitoring. Large randomized controlled trials are required to determine the safety and efficacy of their use in various clinical indications.
Background
Despite the marked improvement in the aortic dissection repair techniques, residual dissected aorta with a patent false lumen remains an issue. So, the aim of our study is to observe the ...effect of inserting the Thoraflex Hybrid Graft on the aortic diameters in patients with type A aortic dissection involving the arch and descending aorta. Patients with type I aortic dissection who had aortic dissection repair using the Thoraflex Hybrid Graft in University Hospitals Birmingham were studied. Radiological assessment with computed tomography of the aorta was done at the level of the diaphragm to measure the true lumen, false lumen and total aortic diameters. Significance of change of diameters at early post-operative as compared to the pre-operative period was analysed.
Results
Eight cases were done in the acute setting, while 14 cases were done in the chronic setting. The ratio of true lumen to the total aortic diameter has significantly increased in the follow-up period as compared to the pre-operative period (
P
= 0.031). Whereas false lumen to total aortic diameter ratio has significantly decreased (
P
= 0.024). Subgroup analysis revealed that these changes were not significantly altered by whether the dissection was acute or chronic.
Conclusions
The Thoraflex Hybrid Graft will induce positive aortic remodelling with expansion of true lumen and will diminish the false lumen. But we could not find a significant difference between acute or chronic cases due to small sample size.
Endothelial dysfunction with subsequent thrombosis and, less commonly, vasculitis has been implicated during the active phase of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) ...infection. However, less has been described during the recovery phase or as late sequelae. Here, we report a case of acute anterior wall ST-elevation myocardial infarction in a female patient with no medical history of cardiovascular risk factors as a post-infectious complication of coronavirus disease 2019 (COVID-19). Coronary angiography revealed total occlusion of her left anterior descending, right coronary arteries, and tight stenosis in the left circumflex artery. Successful revascularization with a staged percutaneous coronary intervention was achieved. To date, there is not much data regarding the late cardiovascular sequelae of COVID-19 and its possible mechanisms. Prolonged follow-up, even for mild cases of COVID-19, is advised for early diagnosis and treatment of long-term complications of COVID-19.
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