COVID-19 and Heart Transplant: A Case Series and Review of the Literature

Coronavirus disease 2019 (COVID-19) has resulted in many challenges in patient care, especially among high-risk populations such as heart transplant recipients. Patients with heart transplant experience a significantly higher mortality rate with COVID-19 infection, and management is based on extrapolation from clinical trials done on nontransplant patients and from clinical experience. Here we report 4 cases of patients with heart transplant who presented with COVID-19 infection in late 2020. Patients presented with symptoms similar to those seen in the general population. All 4 patients were admitted to the hospital, and they were all treated with dexamethasone. In addition, 2 patients received remdesivir. Immunosuppressive medications were adjusted to maintain adequate levels of immunosuppression but at the same time allow for an adequate immune response against the infection. All patients were discharged alive from the hospital. We then performed a literature review on studies that included heart transplant patients who developed the infection and developed suggestions for a standardized management approach, which we share in this article.     

A novel technique to measure severity of pediatric pectus excavatum using white light scanning.

Background/purpose

Computed tomography (CT) derived Haller Index (HI) remains the standard for quantifying severity in patient with pectus excavatum (PE). Optical scanning described in literature reports optimistic results and new indices that correlate with HI. This study assessed the feasibility of a handheld White Light Scanner (WLS) to obtain 3D measurements and indices of PE deformity.

The relationship between the lumbosacral enlargement and the conus medullaris during the period of fetal development and adulthood

The spinal cord is situated within the vertebral canal by the third month of intrauterine life. The spinal cord possesses two symmetrical enlargements, which constitute the segments of the plexuses the cervical enlargement for the brachial plexus and the lumbosacral enlargement for the lumbar and sacral plexus. In our study, we aimed to investigate the relationship between the termination level of the lumbosacral enlargement (TLLE) and that of the conus medullaris (TLCM) during the period of fetal development and adulthood. We used a total of 75 cases 25 fetuses (male 16, female 9) whose crown-rump length ranged between 90–190 mm, 25 premature and full-term neonates (male 17, female 8) whose post-menstrual ages ranged between 33–55 weeks, and 25 adults (male 12, female 13) aged between 22–72 years. The dissection technique for fetuses, ultrasonography for premature and full-term newborns, and magnetic resonance imaging (MRI) for adults were used to determine lumbosacral enlargement and TLCM. The differences between the TLCM and the termination level of the largest part of the transverse diameter of the lumbosacral enlargement were investigated. The differences between the TLLE and TLCM were found in different ratios from the period of fetal development to adulthood. Therefore, during medical treatment and surgical procedures this should be taken into account to avoid complications.     

Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures.

OBJECTIVES: To describe an outbreak of hospital-acquired MRSA in a NICU and to identify the risk factors for, outcomes of, and interventions that eliminated it. SETTING: An 18-bed, level III-IV NICU in a community hospital. METHODS: Interventions to control MRSA included active surveillance, aggressive contact isolation, and cohorting and de-colonization of infants and HCWs with MRSA. A case-control study was performed to compare infants with and without MRSA. RESULTS: A cluster of 6 cases of MRSA infection between September and October 2001 represented an increased attack rate of 21.2% compared with 5.3% in the previous months. Active surveillance identified unsuspected MRSA colonization in 6 (21.4%) of 28 patients and 6 (5.5%) of 110 HCWs screened. They were all successfully decolonized. There was an increased risk of MRSA colonization and infection among infants with low birth weight or younger gestational age. Multiple gestation was associated with an increased risk of colonization (OR, 37.5; CI95, 3.9-363.1) and infection (OR, 5.36; CI95, 1.37-20.96). Gavage feeding (OR, 10.33; CI95, 1.28-83.37) and intubation (OR, 5.97; CI95, 1.22-29.31) were associated with increased risk of infection. Infants with MRSA infection had a significantly longer hospital stay than infants without MRSA (51.83 vs 21.46 days; P = .003). Rep-PCR with mec typing and PVL analysis confirmed the presence of a single common strain of hospital-acquired MRSA. CONCLUSION: Active surveillance, aggressive implementation of contact isolation, cohorting, and decolonization effectively eradicated MRSA from the NICU for 2 1/2 years following the outbreak.     

Outcomes of Carotid Revascularization in Patients with Contralateral Carotid Artery Occlusion

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