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Wilson’s disease, also called hepatolenticular degeneration, has varied clinical manifestations and poses diagnostic challenges. Kayser-Fleischer ring, when present, is considered pathognomic of Wilson’s disease. Although its presence is most commonly seen with the neuro-psychiatric form of the disease, it can also be present in hepatic form and asymptomatic patients. We report a case of unilateral Kayser-Fleischer ring in the normal, functional eye of a patient which subsequently led to the diagnosis of Wilson’s disease in the patient. This case also highlights the examination of the normal appearing eye in all the patients presenting with complaints in only one eye.

Rural-urban disparities in peripartum cardiomyopathy (PPCM) are not well known. We examined rural-urban differences in maternal, fetal, and cardiovascular outcomes in PPCM during delivery hospitalizations. We used 2003-2020 data from the National Inpatient Sample for delivery hospitalizations in individuals with PPCM. The 9th and 10th editions of the International Classification of Disease s were used to identify PPCM and cardiovascular, maternal, and fetal outcomes. Rural and urban hospitalizations for PPCM were 1:1 propensity score-matched using relevant clinical and sociodemographic variables. Odds of in-hospital mortality were assessed using logistic regression. Among 72,880 delivery hospitalizations with PPCM, 4,571 occurred in rural locations, while 68,309 occurred in urban locations. After propensity matching, there were a total of 4,571 rural-urban pairs. There was significantly higher in-hospital mortality in urban compared to rural hospitalizations (adjusted OR 1.54, 95% CI 1.10-1.89). Urban PPCM hospitalizations had significantly higher cardiogenic shock (2.9% vs. 1.3%), mechanical circulatory support (1.0% vs. 0.6%), cardiac arrest (2.3% vs. 0.9%), and VT/VF (4.5% vs. 2.1%, all p <.05). Additionally, urban PPCM hospitalizations had worse maternal and fetal outcomes as compared to rural hospitalizations, including higher preterm delivery, gestational diabetes, and fetal death (all p<.05). Notably, significantly more rural individuals were transferred to a short-term hospital (including tertiary care centers) compared to urban individuals (13.5% vs. 3.2%, p<.0001). There are significant rural-urban disparities in delivery hospitalizations with PPCM. Worse outcomes were associated with urban hospitalizations, while rural PPCM hospitalizations were associated with increased transfers, suggesting inadequate resources and advanced sickness. [ABSTRACT FROM AUTHOR]

As the number of deaths exceeds 100,000, Coronavirus Disease 2019 (COVID-19) has now become the third leading cause of death in the United States. In severe cases, the virus acts through a surge of immune modulators causing multi-organ damage and failure. The hypothesis that new onset HFrEF contributing to higher mortality and morbidity in patients with COVID-19 has yet to be tested. We extracted transthoracic echocardiogram (TTE) reports of all COVID-19 patients (confirmed by serology) from 4 hospitals within the Steward Healthcare System done between 3/22-4/24 of patients with no known heart failure who developed signs and symptoms of clinical heart failure that prompted imaging with TTE and found to have HFrEF (EF ≤40%). Age and gender matched patients with COVID19 with normal ejection fraction and no wall motion abnormalities formed the control arm. We identified 171 patients with TTE done between 3/22-4/24. Of these, 30 patients developed new onset heart failure during their hospitalization with an EF ≤ 40%. Two thirds of the patients with HFrEF (66.7%) required hospitalization more than 7 days versus 33.3% in patients with normal EF. More than half of the heart failure patient cohort (53%) required ICU level of care compared to 40% in patients with normal EF. During their stay in the ICU, 58% of the patients with EF < 40 % required intubation and mechanical ventilation as opposed to 37% in patients with normal EF, and 53% required vasopressor support to maintain adequate mean arterial pressures (MAPs) > 65, compared to 43% in the group with EF > 60%. In-hospital mortality was 63% in the HFrEF group and 43% in patients with normal EF. Patients with COVID-19 who developed HFrEF during hospitalization had worse outcomes and a higher mortality when compared to COVID-19 patients with normal EF. [ABSTRACT FROM AUTHOR]