Iatrogenic Right Sided Infective Endocarditis in Children with CHD

Background: Right sided endocarditis (IE) occurs predominantly in intravenous drug abusers, and occasionally acquired in hospital as a result of contaminated intravascular devices. The iatrogenic IE of tricuspid valve in children treated with intravenous (IV) injections for various unrelated conditions is not reported in literature. Objective: Aim is to report clinical outcome, microbiological and echocardiographic presentation of iatrogenic right sided IE in 4 children. Materials and methods: In a span of 3 months four children, age ranging from 1 month to 5 years, three females and one male, who presented with prolonged history of fever formed the material for this study. Two cases had ventricular septal defect (VSD), one had a small atrial septal defect (ASD) and one patient had tetralogy of Fallot (TOF). The blood culture grew coagulase negative staphylococcus in two patients and gram negative bacilli in the one month infant. The diagnosis of tricuspid valve endocarditis was established by transthoracic echocardiography (TTE) in all the four patients. In addition to vegetation on tricuspid valve, the vegetation was also detected in inferior vena cava (IVC) in one case and in another case a large vegetation was seen closing the VSD. Discussion: Right sided endocarditis accounts for only 5 - 10% of cases of IE. It has been estimated that up to 76% of cases of endocarditis among IV drug abusers involve the right heart, compared with only 9% in non-addict patients. The bacterial endocarditis is extremely rare in cases of ASD and TOF. This series of four cases is notable for the iatrogenic IE of tricuspid valve in children treated in the reputed hospitals with IV injections and IV fluids for various unrelated non cardiac conditions. The infection in this series occurred upon previously normal tricuspid valve. Three patients died (75%) and only one survived. Conclusions: Right sided endocarditis can occur in CHD patients when proper aseptic precautions are not taken while treating with IV injections. The blood culture and TTE play an important role in diagnosis and management of right sided IE

Brugada-type Electrocardiographic Pattern Induced by Electrocution

Heart is one of the most frequently affected organs in electrocution. Electrical injury can cause life-threatening cardiac complications such as asystole, ventricular fibrillation, and myocardial rupture. In this case report, we describe a 22-yr-old male patient who sustained electric burn injury and presented with electrocardiogram showing transient Brugada type pattern

Mechanisms of T cell organotropism

F.M.M.-B. is supported by the British Heart Foundation, the Medical Research Council of the UK and the Gates Foundation

Association of Chest CT Severity Scores and Vaccination Status in COVID-19 Disease: A Cross-sectional Study

Introduction: Coronavirus Disease 2019 (COVID-19) has emerged as a pandemic with substantial morbidity and mortality. While global efforts towards mitigating the infection are focused on the vaccination of population, studies are warranted to prove the efficacy of vaccine in prevention of infection or reducing the severity of infection in affected patients. The 25-point High Resolution Computed Tomography (HRCT) severity score has proved to be an effective tool in estimating the severity of lung infection and correlates with laboratory parameters and disease outcome. The HRCT scores hence provide an objective evidence to prove the efficacy of vaccines in vaccinated individuals by assessing the extent of lung involvement. Aim: To compare the chest CT severity score in vaccinated and unvaccinated COVID-19 infected patients. Materials and Methods: This cross-sectional study was conducted in the Department of Radiology, at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India. The data of HRCT scores and vaccination status was collected during the month of April 2021 from patients who were suspected to have COVID-19 infection and underwent a chest HRCT scan. The severity of lung infection in vaccinated and unvaccinated individuals was compared based on the HRCT scores and the association between these variables were analysed. The association between the respective variables were studied using Fischer’s-exact and Kruskal-Wallis tests. Results: The study involved a total of 178 subjects (males were 98), where 127 (71.3%) were unvaccinated and 51 (28.6%) were vaccinated with one or both doses {Covaxin (Bharat Biotech) vaccine or Covishield (Oxford-AstraZeneca) vaccine approved by Emergency Use Authorisation (EUA)}. The frequency of disease was least in 14 (7.9%) among fully vaccinated subjects. Severe COVID-19 associated pneumonia with severity score of 18 or more was seen in 7% of unvaccinated individuals, while none of the partial/fully vaccinated individuals had severe disease. The median CT severity score was significantly higher among unvaccinated patients compared to partially and fully vaccinated patients (p-value=0.001). Fully vaccinated patients had almost low CT severity score indicating mild form of disease. Conclusion: To the best of authors knowledge, this study is the first to describe the chest CT severity scores of vaccinated individuals in comparison with the unvaccinated COVID-19 infected patients. The disease severity was significantly higher among unvaccinated patients compared to partially and fully vaccinated patients. The present study has provided substantial evidence of vaccine efficacy in reducing the disease severity in COVID-19 infected patients.</jats:p