Conduction system disorders and electro-cardiographic findings in COVID-19 deceased patients in 2021,Shiraz,Iran

BACKGROUND Cardiac conduction disorders and electrocardiographic(ECG)changes may occur as a manifestation of coronavirus disease 2019(COVID-19),especially in severe cases.AIM To describe conduction system disorders and their association with other electrocardiographic parameters in patients who died of COVID-19.METHODS In this cross-sectional study,electrocardiographic and clinical data of 432 patients who expired from COVID-19 between August 1st,2021,and December 1st,2021,in a tertiary hospital were reviewed.RESULTS Among 432 patients who died from COVID-19,atrioventricular block(AVB)was found in 40(9.3%).Among these 40 patients,28(6.5%)suffered from 1st degree AVB,and 12(2.8%)suffered from complete heart block(CHB).Changes in ST-T wave,compatible with myocardial infarction or localized myocarditis,appeared in 189(59.0%).Findings compatible with myocardial injury,such as fragmented QRS and prolonged QTc,were found in 91 patients(21.1%)and 28 patients(6.5%),respectively.In patients who died of COVID-19,conduction disorder was unrelated to any underlying medical condition.Fragmented QRS,axis deviation,and ST-T changes were significantly related to conduction system disorder in patients who died of COVID-19(P value<0.05).CONCLUSION Conduction system disorders are associated with several other ECG abnormalities,especially those indicative of myocardial ischemia or inflammation.Most patients(73.14%)who died of COVID-19 demonstrated at least one ECG abnormality parameter.Since a COVID-19 patient's ECG gives important information regarding their cardiac health,our findings can help develop a risk stratification method for at-risk COVID-19 patients in future studies.

Measures of empathy in children and adolescents:A systematic review of questionnaires

BACKGROUND Empathy has long been considered a multidimensional construct,encompassing cognitive,affective and behavioral domains.Deficits in empathic competences in early childhood contribute to psychopathology,and have been variably implicated in several clinical conditions,such as autism spectrum disorders(ASD)and conduct disorders.AIM To identify and describe empirically validated questionnaires assessing empathy in children and adolescents and to provide a summary of related theoretical perspectives on empathy definitional issues.METHODS A systematic review of the literature was conducted.Three bibliographic databases were searched.A total of 47 studies were selected for final analysis and 16 distinct measures were identified and described.RESULTS Questionable to excellent levels of internal consistency were observed,while few studies assessed test-retest reliability.Although construct definitions only partially overlapped,affective and cognitive domains of empathy were the commonest internal factors that were often separately evaluated.New facets of the construct(i.e.,somatic empathy and sympathy)and specific clinical populations(i.e.,ASD)could be specifically addressed through more recent instruments.CONCLUSION The combination of different assessment methods is recommended in order to foresee further improvements in this field and try to overcome the problem of limited convergence with more objective measures.

Skin reactions caused by bone-anchored hearing aid(BAHA) implantation

Objective: To report a case of intractable skin reactions caused by bone-anchored hearing aid (BAHA) implantation to improve our under-standing and treatment of BAHA implantation-caused skin reactions. Methods:We reported a case of severe skin reactions caused by BAHA implantation. Related literature were also reviewed. Results:We found grade IV skin reactions, including hyperplasia around the implant, which led to the removal of the BAHA implant 10 months after implantation. The findings indicated poor skin hygiene, allergy to titanium and inadequate surgicals skills as the possible causes of the skin reaction. Conclusion: Skin adverse reactions, usually rare in BAHA implantation patients, may cause implant removal and implantation failure. We suggest to further investigate the mechanisms underlying titanium allergy. Copyright ? 2016, PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Efficacy and Safety of the Atrial Septal Defect Closure for Patients with Absent or Malaligned Aortic Rim Using a Figulla Flex II Device Flared and Straddling Behind the Aorta

Background:Although transcatheter closure of atrial septal defect(ASD)is safe and effective for patients with sufficient rim,ASD patients with absent and/or malaligned aortic and/or superior rim have higher risks of device embolization and cardiac erosion.We have treated such high-risk patients using a Figulla Flex II(FFII)device shaped flared and straddling behind the aorta because this method would avoid such serious complications.However,its long-term efficacy and safety remain unclear.Therefore,the midterm efficacy and safety of this method were studied.Methods:We retrospectively evaluated the outcome of 47 consecutive patients with such rim(age 6–73 years,weight 17–75 kg,31 females)treated with this method at our hospital between February 2016 and September 2019.To make the flared and straddling shape,we selected a FFII 4–6 mm larger than the balloon sizing diameter by stop-flow technique.We also studied the device shape,the disc pressure to the Valsalva wall and their changes over 6 months by transesophageal echocardiography.Results:All procedures were successful,and leakage disappeared within 1 year.During a mean follow up of 37±12 months,complications included a transient sinus node dysfunction and one I°atrioventricular block within 3 months.Whole device shape changed from bulky to thin:the device waist and thickness significantly decreased by around 1.5 mm and 3.5 mm,respectively(p<0.05),but the two discs remained flared and straddling behind the aorta over 6 months;therefore,the disc edges seldom pressed the Valsalva wall perpendicularly,even though the inner plane of either disc often slightly pressed the wall.Conclusions:ASD closure using a FFII shaped flared and straddling behind the aorta is probably effective and safe for patients with absent and/or malaligned aortic and/or superior rim although requiring care for conduction disorders.

Sudden Cardiac Death and Cardiac Sodium Channel Diseases

Sudden cardiac death(SCD),accounting for a substantial part of the forensic autopsy,is a leading cause of mortality worldwide.Lethal arrhythmia due to sodium channel diseases is recognized as one of the most prevalent etiologies of SCD.In these disorders,defective cardiomyocytes,including the pacemaker and the working cardiomyocytes,would manifest as abnormal electrical activity and morphology,thereby predisposing individuals to SCD.It is always a problem for forensic pathologists to adjudicate a sudden death caused by sodium channel diseases since structural changes in those cases are often inconspicuous.With the advent of the molecular autopsy,forensic pathologists can conduct targeted gene testing to identify the risk of SCD for family members of the probands.This review aims to discuss the relationship between SCD and sodium channel diseases,clarify the underlying mechanisms,and provide prophylactic suggestions for the relatives of SCD patients at risk.