Takotsubo Cardiomyopathy Associated With the Usage of Nebulised Adrenaline for Acute Stridor:A Case Report

A gentleman in his 70s with previously treated oropharyngeal squamous cell carcinoma presented acutely with worsening stridor. Flexible laryngoscopy on initial assessment demonstrated bilateral vocal cord palsy, and he was subsequently resuscitated with high-flow oxygen and nebulised adrenaline. On his third day of admission, antero-lateral T-wave inversions were incidentally found on a pre-operative electrocardiogram, and a transthoracic echocardiogram showed mid-apical akinesia. After a negative inpatient coronary angiogram, he was diagnosed with Takotsubo cardiomyopathy attributed to nebulised adrenaline therapy. This case report is the first to our knowledge to report an instance of this in a patient with acute airway obstruction caused by bilateral vocal cord palsy and no prior cardiac history.</p

The Duration, Dynamics, and Determinants of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibody Responses in Individual Healthcare Workers

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibody measurements can be used to estimate the proportion of a population exposed or infected and may be informative about the risk of future infection. Previous estimates of the duration of antibody responses vary. Methods We present 6 months of data from a longitudinal seroprevalence study of 3276 UK healthcare workers (HCWs). Serial measurements of SARS-CoV-2 anti-nucleocapsid and anti-spike IgG were obtained. Interval censored survival analysis was used to investigate the duration of detectable responses. Additionally, Bayesian mixed linear models were used to investigate anti-nucleocapsid waning. Results Anti-spike IgG levels remained stably detected after a positive result, for example, in 94% (95% credibility interval [CrI] 91–96%) of HCWs at 180 days. Anti-nucleocapsid IgG levels rose to a peak at 24 (95% CrI 19–31) days post first polymerase chain reaction (PCR)-positive test, before beginning to fall. Considering 452 anti-nucleocapsid seropositive HCWs over a median of 121 days from their maximum positive IgG titer, the mean estimated antibody half-life was 85 (95% CrI 81–90) days. Higher maximum observed anti-nucleocapsid titers were associated with longer estimated antibody half-lives. Increasing age, Asian ethnicity, and prior self-reported symptoms were independently associated with higher maximum anti-nucleocapsid levels and increasing age and a positive PCR test undertaken for symptoms with longer anti-nucleocapsid half-lives. Conclusions SARS-CoV-2 anti-nucleocapsid antibodies wane within months and fall faster in younger adults and those without symptoms. However, anti-spike IgG remains stably detected. Ongoing longitudinal studies are required to track the long-term duration of antibody levels and their association with immunity to SARS-CoV-2 reinfection. </jats:sec