An ectopic coronary artery is observed in 0.05–0.1% of angiographic series, may be of tangential origin or proximal endocardial pathway, may result in a slit hole that interferes with flow, and is associated with sudden death.

A 16-year-old female presented to our ED with fever and coughing of blood for 3 days. She is known to have SLE for 5 months and takes oral prednisone. She was tested positive for COVID19. She developed hypocalcemia with clinically-diagnosed massive pulmonary embolism. She was treated with heparin and recovered.

Systemic lupus erythematosus (SLE) is an autoimmune disease that is characterized with autoantibodies production with on and off clinical course. It can affect any age or gender, but it has a particular tendency to affect young females, with a female-to-male ratio of about 9:1. 1 SLE can affect almost every organ system with a diverse scale of manifestations. The disease severity can vary from a very mild illness to a systemic life-threatening illness. [2][3][4] Although manifestations can affect almost every system in the body, cardiac and lung manifestations have a significant impact on patients' everyday life and outcome. Respiratory affection can affect the lung, pleura, or lung vasculature with various degrees of affection from an asymptomatic illness to severe respiratory compromise. | CASE HISTORY/ EXAMINATIONA 16-year-old female patient has presented to our accidents and emergency department complaining of fever and coughing of blood for 3 days. Her condition started

Background : (COVID-19) had a great impact on the world’s health systems since December 2019. A little is known about the clinical characteristics and risk factors associated with COVID-19 severity in Sudanese Patients; therefor it is necessary to summarize the clinical characteristics of patients with COVID-19 and to explore the risk factors associated with COVID-19 severity. Methods : A one-year retrospective cohort study (May 2020- May2021) was done at three isolation centers in Wad Medani. Sample contained all COVID-19 patients who are over 18 years old and were confirmed to be COVID-19 by nucleic acid testing or features Suggestive of Covid19 on Chest CT scan. Results : This study included 418 patients confirmed COVID-19 cases with a median age of 66.3±13years. 179 (64.2%) patients were men. Hypertension (n=195; 46.7%) and diabetes (n=187; 44.7%) were the most common comorbidities. The most common symptoms at COVID-19 onset were fever (n=303; 72.5%), cough (n=278; 66.5%) and dyspnea (n= 256; 61.2%). the overall mortality rate was 35.4% (n=148). The morality rate was 42.3% (n=118) among patients with severe disease. The Chi-square test and ANOVA analysis revealed that older age, anemia, neutrophilia and lymphcytopenia, higher glucose levels, HbA1c levels and creatinine levels were variables associated with severe COVID-19. In inflammatory markers, the levels of CRP and d-dimer were elevated in severe infection more than moderate and mild infections. Conclusion : Patients with these factors are more likely to deteriorate into severe infection and have higher mortality rate than those without these factors.

Ectopic origin of the right coronary artery from the left sinus of Valsalva is an extremely rare anomaly of coronary arterial morphology, often incidentally discovered and clinically silent. We, hereunder, experienced a case of ectopic origin of the right coronary artery from the left sinus of Valsalva.