'Coumadin ridge' in the left atrium demonstrated on three dimensional transthoracic echocardiography.

An echogenic band like structure was seen in the left atrium on two dimensional transthoracic echocardiography (2D TTE). Full volume three dimensional (3D) TTE and colour Doppler established the surrounding anatomical landmarks, and demonstrated the absence of obstruction related to this band. 3D TTE confirmed that this band like structure was consistent with the ridge between the left atrial appendage and left superior pulmonary vein ('warfarin/coumadin ridge').     

The COVID PIVOT – Re-orienting Child and Youth Mental Health Care in the Light of Pandemic Restrictions

Psychiatric Quarterly - The COVID pandemic required significant changes in the provision of youth mental health services during the period of lockdown/stay at home orders. Things which were...     

A review of COVID-19 convalescent plasma use in COVID-19 with focus on proof of efficacy

Convalescent plasma (CP) therapy is rapidly becoming an established consideration in the treatment of COVID-19 patients though there is a need to critically review this area for proof of efficacy. Neutralizing antibodies (NAb) present in CP generated in response to SARS-CoV-2 infection directed against the receptor-binding domain (RBD) of the spike protein are considered to play main role in viral clearance. CP infusion may also help in the modulation of immune response by its immunomodulatory effect. The FDA allows for administration of CP to COVID-19 patients. The present published literature in COVID-19 is limited to case series and randomised controlled trial where plasma therapy was used in moderate, severe and critically ill patients. Though multiple uncertainties exist regarding to its efficacy, appropriate donor selection and NAb titres, the efficacy data of CP use inCOVID-19 is limited having shown hope with early and severe to critically ill COVID-19 patients.

     

In Vivo Evaluation and Dosimetry Estimate for a High Affinity Affibody PET Tracer Targeting PD-L1

Molecular Imaging and Biology - In vivo imaging of programmed death ligand 1 (PD-L1) during immunotherapy could potentially monitor changing PD-L1 expression and PD-L1 expression heterogeneity...     

Impact of the CHA2DS2-VASc score on anticoagulation recommendations for atrial fibrillation

BackgroundThe Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, Stroke (CHADS₂) score is used to predict the need for oral anticoagulation for stroke prophylaxis in patients with atrial fibrillation. The Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category (CHA₂DS₂-VASc) schema has been proposed as an improvement. Our objective is to determine how adoption of the CHA₂DS₂-VASc score alters anticoagulation recommendations.MethodsBetween 2004 and 2008, 1664 patients were seen at the University of Virginia Atrial Fibrillation Center. We calculated the CHADS₂ and CHA₂DS₂-VASc scores for each patient. The 2006 American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines for atrial fibrillation management were used to determine anticoagulation recommendations based on the CHADS₂ score, and the 2010 European Society of Cardiology guidelines were used to determine anticoagulation recommendations based on the CHA₂DS₂-VASc score.ResultsThe average age was 62 ± 13 years, and 34% were women. Average CHADS₂ and CHA₂DS₂-VASc scores were 1.1 ± 1.1 and 1.8 ± 1.5, respectively (P <.0001). The CHADS₂ score classified 33% as requiring oral anticoagulation. The CHA₂DS₂-VASc score classified 53% as requiring oral anticoagulation. For women, 31% had a CHADS₂ score ≥ 2, but 81% had a CHA₂DS₂-VASc score ≥ 2 (P =  .0001). Also, 32% of women with a CHADS₂ score of zero had a CHA₂DS₂-VASc score ≥ 2. For men, 25% had a CHADS₂ score ≥ 2, but 39% had a CHA₂DS₂-VASc score ≥ 2 (P <.0001).ConclusionCompared with the CHADS₂ score, the CHA₂DS₂-VASc score more clearly defines anticoagulation recommendations. Many patients, particularly older women, are redistributed from the low- to high-risk categories.