Palanisamy, Nithish Nanda

Background/Objectives: High-risk percutaneous coronary interventions (HR-PCIs) often require mechanical circulatory support (MCS) to maintain hemodynamic stability. Intra-aortic balloon pump (IABP) and percutaneous left ventricular assist device (PLVAD) are two commonly used MCS devices that differ in their mechanisms. We aimed to evaluate and compare the clinical outcomes associated with IABP and PLVAD use in HR-PCIs without cardiogenic shock. Methods: We conducted a search of PubMed, Scopus, Cochrane, Mendeley, Web of Science, and Embase to identify relevant randomized controlled trials and cohort studies, and we included 13 studies for the systematic review and meta-analysis. The primary goal was to define the difference in early mortality (in-hospital and 30-day mortality), major bleeding, and major adverse cardiovascular event (MACE) components (cardiogenic shock, acute kidney injury (AKI), and stroke/TIA) in IABP and PLVAD. We used a random-effects model with the Mantel–Haenszel statistical method to estimate odds ratios (ORs) and 95% confidence intervals. Results: Among 1 trial and 12 cohort studies (35,554 patients; 30,351 IABP and 5203 PLVAD), HR-PCI with IABP was associated with a higher risk of early mortality (OR = 1.53, 95% CI [1.21, 1.94]) and cardiogenic shock (OR = 2.56, 95% CI [1.98, 3.33]) when compared to PLVAD. No significant differences were found in the rates of arrhythmia, major bleeding, AKI, stroke/TIA, or hospital length of stay. Conclusions: In high-risk PCIs, PLVAD use is associated with lower early mortality and cardiogenic shock risk compared to IABP, with no significant differences in other major outcomes.

Introduction: Chronic lymphocytic leukaemia (CLL), the most common adult leukaemia in Western countries, poses unique management challenges, particularly when complicated by opportunistic infections. This report presents a rare case of CLL with concurrent Mycobacterium avium and Scedosporium apiospermum infections—pathogens increasingly recognized for causing severe disease in immunocompromised individuals. Their coexistence highlights the need for heightened awareness of diverse infectious complications in CLL patients. Case description: We present a case of a 78-year-old male with CLL receiving chemotherapy, who developed burning pain in the tongue and oral mucosa, accompanied by a non- productive cough. He was initially diagnosed with pneumonia, but further investigation revealed co-infection involving M. avium and S. apiospermum. Discussion: The coexistence of M. avium and S. apiospermum underscores the complexity of infectious complications in CLL. The patient’s chemotherapy was halted due to active pneumonitis observed on imaging in order to improve his leukocyte count. Antifungal therapy was not initiated due to a lack of evidence of invasive fungal infection. Antimycobacterial therapy for M. avium complex was initiated. Conclusion: This case highlights the necessity of a multidisciplinary approach and continued research to optimize management strategies and improve outcomes in CLL patients with dual infections.