Electrocardiographic abnormalities in patients with sickle cell disease: A systematic review and meta-analysis

BACKGROUND

Previous studies have documented that electrocardiography (ECG) can reveal a range of abnormalities, offering valuable insights into the cardiac evaluation of patients with sickle cell disease (SCD). The objective of this study is to assess the patterns of ECG abnormalities observed in these patients with SCD, and to determine their prevalence.

METHOD

We systematically reviewed the literature using online databases of PubMed, Scopus, Web of Science, Embase, and Google Scholar to identify original studies that reported findings of standard ECG assessments in patients with SCD. Statistical analyses were performed using the random effects model. Additional analyses including sensitivity analysis and subgroup analysis were also conducted.

RESULTS

Analysis of data from 59 studies involving 897,920 individuals with SCD revealed that 75% of these patients had abnormal ECG findings (67%-81%), which were predominantly nonspecific ST-T changes, left ventricular hypertrophy, T-wave changes, prolonged corrected QT (QTc) interval, and ischemic changes. Besides, it was shown that these patients had significantly higher odds of having any ECG abnormalities (OR of 17.50, 4.68-65.49), right atrial enlargement (6.09, 1.48-25.09), left ventricular hypertrophy (3.45, 1.73-6.89), right ventricular hypertrophy (7.18, 2.28-22.57), biventricular hypertrophy (10.11, 1.99-51.38), prolonged QTc interval (5.54, 2.44-12.59), ST depression (3.34, 1.87-5.97), and T-wave changes (5.41, 1.43-20.56). Moreover, the mean of QTc interval was significantly higher among those with SCD (23.51 milliseconds, 16.08-30.94).

CONCLUSION

Our meta-analysis showed a higher prevalence of abnormal ECG findings among individuals with SCD. A significant proportion of these patients had various ECG abnormalities, suggesting a potential need for regular ECG assessments for patients with SCD.

Risk Factors for the Occurrence of Asymptomatic Brain Lesions in Patients with β-Thalassemia: a Systematic Review and Meta-Analysis

BACKGROUND

Several factors, including increased platelet aggregation, decreased platelet survival, decreased antithrombotic factors cause a hypercoagulable state in thalassemia patients. This is the first meta-analysis designed to summarize the association of age, splenectomy, gender, and serum ferritin and hemoglobin levels with the occurrence of asymptomatic brain lesions in thalassemia patients using MRI.

METHODS

This systematic review and meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. We searched four major databases and included eight articles for this review. The quality of the included studies was assessed based on the Newcastle-Ottawa Scale checklist. Meta-analysis was performed using STATA 13. Odds ratio (OR) and standardized mean difference (SMD) were considered as effect sizes for comparing the categorical and continuous variables, respectively.

RESULTS

The pooled OR for splenectomy in patients with brain lesions compared to those without lesions was 2.25 (95% CI 1.22 - 4.17, p = 0.01). The pooled analysis for SMD of age between patients with/without brain lesions was statistically significant, 0.4 (95% CI 0.07 - 0.73, p = 0.017). The pooled OR for the occurrence of silent brain lesions was not statistically significant in males compared to females, 1.08 (95% CI 0.62 - 1.87, p = 0.784). The pooled SMD of Hb and serum ferritin in positive brain lesions compared to negatives were 0.01 (95% CI -0.28, 0.35, p = 0.939) and 0.03 (95% CI -0.28, 0.22, p = 0.817), respectively, which were not statistically significant.

CONCLUSIONS

Older age and splenectomy are risk factors for developing asymptomatic brain lesions in β-thalassemia patients. Physicians should consider a careful assessment of high-risk patients for starting prophylactic treatment.

Cytomegalovirus coinfection in patients with severe acute respiratory syndrome coronavirus 2 infection: a systematic review of reported cases

BACKGROUND

Dysfunction of both the innate and the adaptive immune systems is observed in severe coronavirus disease 2019 which, together with administration of immunosuppressive drugs, could lead to cytomegalovirus coinfection or reactivation associated with a poorer outcome. The current study aimed to systematically review the pattern, presentations, clinical course and outcome of patients with severe acute respiratory syndrome coronavirus 2 and cytomegalovirus coinfection.

METHODS

Three online databases, PubMed, Scopus and Web of Science, were searched, and after excluding duplicates and irrelevant reports, eligible articles were identified. Information about patients' age and gender, comorbidities, presentations of coronavirus disease 2019 and cytomegalovirus, treatment courses and outcomes were extracted.

RESULTS

A total of 34 reports with 59 patients with coinfection were considered to be eligible for data extraction. A majority of patients were middle-aged or elderly (84.5%). More than three-fourths (79.2%) had at least one comorbidity. Cytomegalovirus viremia was documented in 43 patients. The most common end organ involved was the gastrointestinal tract in 13 patients (48.1% of 27 patients with end organ involvement), mostly as cytomegalovirus colitis, followed by the respiratory tract in 12 patients. There was a significant association between intubation and fatal outcome (p = .011).

CONCLUSION

We comprehensively reviewed published cases with coronavirus disease 2019 and cytomegalovirus reactivation. The findings may assist in appraising signs and symptoms for early suspicion, detection and treatment in patients with unusual clinical courses or with severe, prolonged or unexplained deterioration of end organ function.

Hematologic autoimmune disorders in the course of COVID-19: a systematic review of reported cases

OBJECTIVE

As COVID-19 is a new emerging disease, the hematological/immunological changes that develop in the infected patients remain unknown. This study aims to systematically review the hematologic autoimmune complications in these patients.

METHOD

Data from three online databases including Medline (via PubMed), Scopus and Web of Science were searched on 19 December 2020, and after excluding duplicate, irrelevant and inappropriate records, eligible documents were identified. Afterwards, information such as patients' history, presentations, paraclinical data, treatment course and outcome were extracted from the records.

RESULTS

A total of 58 documents were considered to be eligible for data extraction which described 94 patients with COVID-19 who developed hematologic autoimmune disorder in their course of infection. Of these patients with COVID-19, the most common hematologic autoimmune disorder was immune thrombocytopenic purpura (55 cases) followed by autoimmune hemolytic anemia (22 cases). Other hematologic autoimmune disorders include antiphospholipid syndrome, thrombotic thrombocytopenic purpura, Evans syndrome and autoimmune neutropenia.

CONCLUSION

The current study would help us to always consider an autoimmune etiology for cases with abnormal hematologic finding which further lead to an appropriate treatment of the patients, especially when the symptoms present in about 1-2 weeks after the first manifestation of the infection symptoms. Maybe, at least in this pandemic, it should be recommended to evaluate patients with unexpected and unexplained decrease in their hemoglobulin or platelet count for COVID-19. Another challenging issue is the treatment options. Given the multiorgan involvement and multifaceted nature of the infection, an individualized approach should be taken for each patient.

Facile in situ synthesis and characterization of a novel PANI/Fe3O4/Ag nanocomposite and investigation of catalytic applications

A novel magnetic hybrid nanocomposite was successfully synthesized via in situ polymerization, well characterized by FT-IR, XRD, EDX and FE-SEM analysis, and its catalytic activity shown in the synthesis of pharmaceutically important pyrans.

Design and development of a novel cellulose/γ-Fe2O3/Ag nanocomposite: a potential green catalyst and antibacterial agent

A new cellulose-based nanocomposite was synthesized, characterization and used for the synthesis of imidazoles and α-aminonitriles, and antibacterial property was investigated.

Successful balloon dilation of an abdominal coarctation of the aorta in patient with presumed Takayasu's aortitis

An 11-year-old male with a severe abdominal aortic coarctation, presumably secondary to aortitis, underwent successful percutaneous balloon dilation that resulted in near-complete relief of the obstruction. Intravascular ultrasound imaging showed a major endovascular tear immediately following dilation and satisfactorily excluded significant branch (superior mesenteric) artery compromise. Arterial remodeling was demonstrated with persistence of the gradient relief over a 12-month follow-up period.

Placement of umbilical venous catheters with use of bedside real-time ultrasonography

Real-time ultrasonography was used to assess the position of umbilical venous catheters tips in 79 newborn infants (birth weight range, 400 to 4200 gm). The position of the umbilical venous catheters determined by ultrasonography was compared with the projection of the catheter tip on the closest vertebral body shown on a standard chest radiograph. Of the catheters initially placed with radiographic guidance, 56% were repositioned because of unsatisfactory location. Ultrasonography is more precise than radiography because it allows direct visualization of the catheter tips in relation to internal vascular structures. When ultrasonography is unavailable, placement at the ninth thoracic vertebral body ensures safe positioning.

Rapid fluctuations in plasma catecholamines in monkeys under undisturbed conditions

We have demonstrated in monkeys and in man sustained synchronous oscillations in plasma levels of insulin, C-peptide, glucagon, and glucose that have periods ranging from 8 to 11 min. To identify the mechanisms of these oscillations, we studied plasma levels of catecholamines in search for periodic fluctuations. Blood was obtained at 2-min intervals from fasting, undisturbed, chair-adapted male rhesus monkeys via chronically implanted central venous catheters. Plasma levels of epinephrine, norepinephrine, and dopamine were measured by a radioenzymatic assay. Large fluctuations in plasma epinephrine were observed with an average peak-to-trough amplitude of 34 pg/ml at a mean level of 122 pg/ml. Similar fluctuations in norepinephrine and dopamine occurred and were correlated to those of epinephrine: r = 0.51 and 0.35, respectively. The most common periodicity in all three catecholamines was 6-13 min/cycle as determined by spectral analyses. Cross-correlation analyses indicated that fluctuations in the catecholamines were significantly negatively correlated with oscillations in insulin and were unrelated to fluctuations in glucagon. These fluctuations in plasma catecholamines may be related to mechanisms controlling the periodicity observed in plasma insulin and glucose.