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Fernandez R, Green H, Paulik O, Christopher K, Haigh S, Whitaker R, Sikhosana N. Falls in an Australian Hospital During the COVID-19 Pandemic: A Study of Patient Safety Incident Reports. J Patient Saf 2025; 21:220-225. [PMID: 40152700 DOI: 10.1097/pts.0000000000001336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 02/20/2025] [Indexed: 03/29/2025]
Abstract
OBJECTIVE Inpatient falls pose a significant challenge in hospitals, impacting patient safety and resources. This retrospective study aimed to analyze the impact of the COVID-19 pandemic on fall incidents in a major metropolitan tertiary referral and teaching hospital in New South Wales (NSW), Australia. METHODS Utilizing clinical informatics, data from Clinical Health Information Exchange (CHIE) database, electronic medical records (eMR), and the NSW Health Incident Information Management System (IIMS)/Incident Management System Plus (IMS+) were collected. Inpatient falls reported at the study hospital between July and December 2019, 2020, and 2021 for patients aged 18 years and above were included. Extracted data encompassed patient demographics, medical history, fall characteristics, contributing factors, and fall incident harm scores. Descriptive and inferential statistics were undertaken using SPSS V 25, and inductive content analysis was used to analyze the narratives relating to the contributing factors for falls. RESULTS A total of 1399 inpatient falls were reported during the study period. Falls per 1000 occupied bed days (OBD) varied: 3.83 in 2019, 3.41 in 2020, and 4.35 in 2021. A significant increase in fall incidents was observed in 2021 compared to 2020. Most falls occurred on a weekday, particularly between 1400 and 2159 hours. Medicine departments reported the highest number of falls, followed by aged care units. Incident harm scores at level 3, indicating moderate injury, were prevalent across all 3 years. Contributing factors to falls according to the IIMS/IMS+ criteria were diverse, with "Patient complexity/acuity," "Patient engagement and compliance," "Hazard/unsafe," and "Clinical risk screening/assessment" emerging prominently. In addition, 7 distinct themes contributing to inpatient falls were identified through inductive analysis. CONCLUSIONS The study highlighted increased inpatient falls (4.35 falls per 1000 OBDs) during the July to December 2021 study period. Understanding fall patterns is vital for improving safety protocols. Emphasising incident reporting, staff training, environmental adjustments, and mobility-related risk management is crucial to reducing inpatient falls and fall-related injury during restricted visitor access during pandemics.
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Affiliation(s)
- Ritin Fernandez
- School of Nursing and Midwifery, University of Newcastle, Gosford, New South Wales, Australia
- The Centre for Transformative Nursing, Midwifery, and Health Research: A JBI Centre of Excellence, University of Newcastle, Newcastle, Australia
| | - Heidi Green
- The Centre for Transformative Nursing, Midwifery, and Health Research: A JBI Centre of Excellence, University of Newcastle, Newcastle, Australia
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Olivia Paulik
- Aged Care Ward, St George Hospital, Kogarah, New South Wales, Australia
| | - Kate Christopher
- Clinical Governance & Risk Manager, St George Hospital, Kogarah, New South Wales, Australia
| | - Shona Haigh
- Patient Safety Manager, St George Hospital, Kogarah, New South Wales, Australia
| | - Robyn Whitaker
- Grad Dip Physio, Aged Care Ward, St George Hospital, Kogarah, New South Wales, Australia
| | - Nqobile Sikhosana
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, New South Wales, Australia
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Dehghani MR, Moeini M, Masoumi M, Rezaei Y. Prognostic Value of Fragmented QRS on Admission Electrocardiogram among Patients Hospitalized with COVID-19: A Single-Center Report, Systematic Review, and Meta-Analysis. ACTA CARDIOLOGICA SINICA 2025; 41:323-334. [PMID: 40416568 PMCID: PMC12099251 DOI: 10.6515/acs.202505_41(3).20241111d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 11/11/2024] [Indexed: 05/27/2025]
Abstract
Background The novel coronavirus disease 2019 (COVID-19) is associated with life-threatening complications. Electrocardiogram (ECG) changes associated with COVID-19 have also been reported in the majority of critically ill patients. Methods In this study, we aimed to investigate the prevalence of fragmented QRS (fQRS) and its prognostic value in hospitalized patients with COVID-19. In addition, we performed a systematic review and meta-analysis of the literature to evaluate the effect of fQRS on the outcomes of COVID-19 patients. Results A total of 310 patients with a mean age of 65.7 ± 14.5 years were followed up for 3 months, of whom 139 (44.8%) had fQRS on their ECGs. The rates of in-hospital mortality (8.8% vs. 8.6%), rehospitalization during follow- up (13.7% vs. 12.3%), and 90-day mortality (6.5% vs. 5.3%) were comparable between the patients with and without fQRS, respectively. In the meta-analysis, 9 studies in addition to our study reported outcomes, with a total of 2928 patients with a mean age of 53.8 years, and 1431 (48.9%) were males. The rate of fQRS was 0.31 (95% confidence interval [CI], 0.23-0.38; I2 = 95.21%). In addition, the pooled proportion of in-hospital mortality reported by 5 studies was 0.31 (95% CI, 0.12-0.51; I2 = 98.36). The rate of in-hospital mortality was higher among patients with fQRS compared to those without fQRS (odds ratio, 2.33; 95% CI, 1.52-3.58; p = 0.0001; I2 = 74%). Conclusions The rate of fQRS on ECG was relatively high in COVID-19 patients, and according to the meta-analysis, it was associated with worse outcomes in hospitalized COVID-19 patients.
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Affiliation(s)
- Mohammad Reza Dehghani
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia
| | - Mehdi Moeini
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia
| | - Mehdi Masoumi
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences
- Behyan Clinic, Pardis New Town, Tehran, Iran
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Azeem B, Khurram L, Sharaf B, Khan A, Habiba A, Asim R, Khelani M, Ali H, Ansari AH, Muhammad TS, Naveed MA, Dogar M, Saleh A, Ashraf H. Unmasking Arrhythmia Mortality: A 25-Year Analysis of Trends and Disparities in the United States (1999-2023). Clin Cardiol 2025; 48:e70109. [PMID: 40035357 PMCID: PMC11877330 DOI: 10.1002/clc.70109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 02/17/2025] [Accepted: 02/19/2025] [Indexed: 03/05/2025] Open
Abstract
BACKGROUND Arrhythmias are a significant cause of cardiovascular mortality in the U.S. This study examines trends in arrhythmia-related mortality from 1999 to 2023, focusing on gender, racial, regional disparities, and specific arrhythmic conditions. OBJECTIVE To analyze trends and disparities in arrhythmia-related mortality among U.S. adults aged ≥ 35 years from 1999 to 2023, with a focus on the impact of sex, race, geographic location, and urbanization. METHODS We analyzed mortality data from the CDC WONDER database, focusing on deaths where arrhythmias were a contributing cause. Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, state, and region. The annual percentage change (APC) and average annual percentage change (AAPC) were estimated using Joinpoint regression. RESULTS A total of 5,050,271 arrhythmia-related deaths were recorded, with the overall AAMR increasing from 111.4 in 1999 to 137.3 in 2023. Mortality rates declined significantly from 1999 to 2009 (APC: -1.04%; p = 0.003) but rose sharply from 2009 to 2018 (APC: 1.69%; p = 0.003), peaking in 2021 during the COVID-19 pandemic (APC: 8.63%; p < 0.001). A subsequent decline was observed from 2021 to 2023 (APC: -3.91%; p = 0.044). Males consistently exhibited higher AAMRs than females (137.2 vs. 95.3), as did non-Hispanic White individuals compared to other racial groups. Geographic disparities revealed higher mortality rates in Nonmetropolitan areas and the Midwest, with the highest AAMR observed in Oregon and the lowest in Hawaii. CONCLUSION Despite an overall decline in arrhythmia-related mortality, recent increases, especially in West Virginia and among certain racial groups, highlight the need for targeted public health interventions.
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Affiliation(s)
- Bazil Azeem
- Department of Internal MedicineShaheed Mohtarma Benazir Bhutto Medical College LyariKarachiPakistan
| | - Laiba Khurram
- Department of Internal MedicineShaheed Mohtarma Benazir Bhutto Medical College LyariKarachiPakistan
| | - Bakhtawar Sharaf
- Department of Internal MedicineShaheed Mohtarma Benazir Bhutto Medical College LyariKarachiPakistan
| | - Arwa Khan
- Department of Internal MedicineShaheed Mohtarma Benazir Bhutto Medical College LyariKarachiPakistan
| | - Ayesha Habiba
- Department of Internal MedicineShaheed Mohtarma Benazir Bhutto Medical College LyariKarachiPakistan
| | - Rabia Asim
- Department of Internal MedicineShaheed Mohtarma Benazir Bhutto Medical College LyariKarachiPakistan
| | - Muskan Khelani
- Department of Internal MedicineShaheed Mohtarma Benazir Bhutto Medical College LyariKarachiPakistan
| | - Hamza Ali
- Department of Internal MedicineShaheed Mohtarma Benazir Bhutto Medical College LyariKarachiPakistan
| | - Abdul Hadi Ansari
- Department of Internal MedicineShaheed Mohtarma Benazir Bhutto Medical College LyariKarachiPakistan
| | - Tazheen Saleh Muhammad
- Department of Internal MedicineShaheed Mohtarma Benazir Bhutto Medical College LyariKarachiPakistan
| | - Muhammad Abdullah Naveed
- Department of Internal MedicineDow Medical College, Dow University of Health SciencesKarachiPakistan
| | - Mata‐e‐Alla Dogar
- Department of Internal MedicineShaheed Mohtarma Benazir Bhutto Medical College LyariKarachiPakistan
| | - Aalaa Saleh
- Faculty of MedicineLebanese UniversityBeirutLebanon
| | - Hamza Ashraf
- Department of MedicineAllama Iqbal Medical CollegeLahorePakistan
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Barriga Guzman R, Tolu-Akinnawo O, Awoyemi T, Chima-Kalu R, Adeleke O, Ezekwueme F, Obarombi JT, Gwira-Tamattey E, Abib O, Odeyinka O, Anuforo AC. A Systematic Review of Case Reports of New-Onset Atrial Fibrillation in COVID-19 Patients. Cureus 2025; 17:e78938. [PMID: 40091918 PMCID: PMC11910693 DOI: 10.7759/cureus.78938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2025] [Indexed: 03/19/2025] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic posed a significant global public health challenge, affecting millions of individuals. While some COVID-19 patients remain asymptomatic, others experience severe complications, including multiorgan failure and death. Emerging evidence indicates that COVID-19 is associated with substantial cardiovascular complications, notably an increased risk of arrhythmias, with atrial fibrillation (AF) being particularly prevalent among hospitalized patients. This review analyzes case reports of new-onset AF in COVID-19 patients, synthesizing data on patient demographics, comorbidities, clinical presentations, and outcomes. The cases reviewed indicate that affected patients were predominantly male, covered a broad age range, and frequently had underlying conditions such as hypertension, type 2 diabetes mellitus, and hyperlipidemia. The main outcomes observed included a high incidence of severe complications such as ischemic stroke, acute respiratory failure, myocarditis, and heart failure. Mortality rates were notably elevated among patients with COVID-19-related AF, particularly in those requiring intensive care or mechanical ventilation. The findings emphasize the significant cardiovascular burden of COVID-19, with a focus on its association with increased AF risk. By integrating case-based evidence, this review highlights the complex interplay between COVID-19 and AF, underscoring the need for early recognition and targeted treatment strategies to mitigate cardiovascular complications and improve patient outcomes in this vulnerable population.
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Affiliation(s)
- Rocio Barriga Guzman
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, USA
| | | | - Toluwalase Awoyemi
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, GBR
| | | | | | - Francis Ezekwueme
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Joshua T Obarombi
- Department of Internal Medicine, College Research and Innovation Hub, University of Ibadan, Ibadan, NGA
| | - Edwin Gwira-Tamattey
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Oluwole Abib
- Department of Internal Medicine, Piedmont Athens Regional, Athens, USA
| | - Oladipo Odeyinka
- Department of General Medicine, College of Medicine, University of Ibadan, Ibadan, NGA
| | - Anderson C Anuforo
- Department of Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
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Héja M, Fekete I, Márton S, Horváth L, Fekete K. Impact of COVID-19 pandemic on acute stroke care in a tertiary stroke centre. Sci Rep 2024; 14:31408. [PMID: 39733029 PMCID: PMC11682369 DOI: 10.1038/s41598-024-83016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 12/10/2024] [Indexed: 12/30/2024] Open
Abstract
The aim of this study was to evaluate how COVID-19 affected acute stroke care and outcome in patients with acute ischemic or hemorrhagic stroke. We performed a retrospective analysis on patients who were admitted with acute ischemic (AIS) or hemorrhagic (ICH) stroke from September 2020 to May 2021 with and without COVID-19. We recorded demographic and clinical data, imaging parameters, functional outcome and mortality at one year. Beside descriptive statistics we performed χ2-probe, Mann-Witney U-test, Student t-probe and multivariate testing. We found a 29%-reduction in the number of AIS cases during the pandemic. The number of the large vessel occlusions /LVOs/ (N = 83, 41.7%), from them 37 (17.7%) had mechanical thrombectomy (MT), was higher than before the COVID-19 period (p = 0.02 and p = 0.001, respectively). From all patients needing acute revascularization therapy (N = 137) 118 patients received it, among them 20 (16.9%) had COVID-19. Those positive for COVID-19 were more likely to have a higher median NIHSS score at baseline and at 24 h (p = 0.02 and p = 0.03, respectively). They also had a lower rate of favourable outcome at discharge (15% vs. 41.8%; p = 0.024) and at three months (25% vs. 52%, p = 0.02), longer median hospitalization (p < 0.0001), and a higher mortality rate (52% vs. 25%; p = 0.03). The incidence of symptomatic intracerebral hemorrhage (sICH) did not differ between the groups. Regarding the ICH patients, NIHSS score at 24 h (p = 0.036), mortality at 3 months (p = 0.004) and at one year (p = 0.00) were higher in the COVID-19 group. We concluded that the pandemic resulted fewer admission due to AIS with an increased number of LVOs and MTs. AIS patients with concomitant SARS-CoV-2 infection have more severe strokes and unfavorable long term outcome. The risk of sICH was not increased in COVID-19 positive patients therefore reperfusion therapies appear to be safe and beneficial for some individuals. Patients with ICH and comorbid COVID-19 have a very poor prognosis.
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Affiliation(s)
- Máté Héja
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - István Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sándor Márton
- Faculty of Arts, Institute of Political Science and Sociology, University of Debrecen, Debrecen, Hungary
| | - László Horváth
- Department of Pharmaceutical Surveillance and Economics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Klára Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Gopinathannair R, Olshansky B, Chung MK, Gordon S, Joglar JA, Marcus GM, Mar PL, Russo AM, Srivatsa UN, Wan EY. Cardiac Arrhythmias and Autonomic Dysfunction Associated With COVID-19: A Scientific Statement From the American Heart Association. Circulation 2024; 150:e449-e465. [PMID: 39397661 PMCID: PMC11734731 DOI: 10.1161/cir.0000000000001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
Cardiac arrhythmias are commonly noted in patients during infections with and recovery from COVID-19. Arrhythmic manifestations span the spectrum of innocuous and benign to life-threatening and deadly. Various pathophysiological mechanisms have been proposed. Debate continues on the impact of incident and exacerbated arrhythmias on the acute and chronic (recovery) phase of the illness. COVID-19 and COVID-19 vaccine-associated myocardial inflammation and autonomic disruption remain concerns. As the pandemic has transformed to an endemic, with discovery of new SARS-CoV-2 variants, updated vaccines, and potent antiviral drugs, vigilance for COVID-19-associated arrhythmic and dysautonomic manifestations remains. The objective of this American Heart Association scientific statement is to review the available evidence on the epidemiology, pathophysiology, clinical presentation, and management of cardiac arrhythmias and autonomic dysfunction in patients infected with and recovering from COVID-19 and to provide evidence-based guidance. The writing committee's consensus on implications for clinical practice, gaps in knowledge, and directions for future research are highlighted.
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Dumargne H, Patural H, Charbonnieras F, Charier D, Biscarrat C, Chivot M, Argaud L, Cour M, Dargent A. Exploration of COVID-19 associated bradycardia using heart rate variability analysis in a case-control study of ARDS patients. Heart Lung 2024; 68:74-80. [PMID: 38941770 DOI: 10.1016/j.hrtlng.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Bradycardia and dysautonomia observed during SARS-Cov2 infection suggests involvement of the autonomic nervous system (ANS). Limited data exists on ANS dysregulation and its association with outcomes in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (C-ARDS) or other etiologies (NC-ARDS). OBJECTIVES We aimed to explore sympathovagal balance, assessed by heart rate variability (HRV), and its clinical prognostic value in C-ARDS compared with NC-ARDS. METHODS A single-center, prospective case-control study was conducted. Consecutive patients meeting ARDS criteria between 2020 and 2022 were included. HRV was assessed using 1-hour electrographic tracing during a stable, daytime period. RESULTS Twenty-four patients with C-ARDS and 19 with NC-ARDS were included. Age, sex and ARDS severity were similar between groups. The median heart rate was markedly lower in the C-ARDS group than in the NC-ARDS group (60 [53-72] versus 101 [91-112] bpm, p<.001). Most of HRV parameters were significantly increased in patients with C-ARDS. HRV correlated with heart rate only in patients with C-ARDS. A positive correlation was found between the low-to high-frequency ratio (LF/HF) and length of intensive care unit stay (r = 0.576, p<.001). CONCLUSION This study confirmed that C-ARDS was associated with marked bradycardia and severe ANS impairment, suggesting a sympathovagal imbalance with vagal overtone. Poor outcomes appeared to be more related to sympathetic rather than parasympathetic hyperactivation.
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Affiliation(s)
- Hugo Dumargne
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Hugues Patural
- Centre Hospitalier Universitaire de Saint Etienne, Service de réanimation pédiatrique, Saint-Etienne, France; INSERM, SAINBIOSE U1059, 42055 Saint-Etienne, France
| | - François Charbonnieras
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Cardiologie soins intensifs, 69004 Lyon, France
| | - David Charier
- INSERM, SAINBIOSE U1059, 42055 Saint-Etienne, France; Centre Hospitalier Universitaire de Saint Etienne, Service d'Anesthésie-Réanimation, Saint-Etienne, France
| | - Charlotte Biscarrat
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Matthieu Chivot
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Martin Cour
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Auguste Dargent
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Anesthésie-Réanimation Médecine Intensive-Réanimation, 69495 Pierre-Bénite, Lyon, France; APCSe VetAgro Sup UPSP 2016.A101, 69280 Marcy l'Etoile, France.
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Shen NN, Wang JL, Liu XW, Fu YP, Chen XF. A pooled analysis of the incidence and mortality risk of atrial fibrillation in patients with COVID-19. PeerJ 2024; 12:e18330. [PMID: 39430559 PMCID: PMC11490229 DOI: 10.7717/peerj.18330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 09/25/2024] [Indexed: 10/22/2024] Open
Abstract
Background There exist serious cardiovascular complications subsequent to SARS-Cov2 infection (COVID-19); however, the association between COVID-19 and atrial fibrillation (AF) remains to be elucidated. We aimed to assess the prevalence of AF among COVID-19 patients and its associated risk of death. Methods The present systematic review was performed in accordance with the PRISMA guidelines. The protocol was registered with CRD42022306523. A comprehensive literature search was performed across PubMed, Embase, and Cochrane databases to identify studies reporting on the prevalence of pre-existing or new-onset fibrillation (AF), and/or the associated clinical outcomes in patients with COVID-19 from January 2020 to December 2023. The random-effect model was used to estimate the prevalence of AF and its related mortality. Results A total of 80 studies, including 39,062,868 COVID-19 patients, were identified in the present investigation. The prevalence rates of pre-existing AF or new-onset AF were 10.5% (95% CI [9.3-11.7%]) or 10.3% (95% CI [6.2-14.5%]), respectively. Subgroup analysis revealed a two fold higher incidence of AF in older patients (≥65 years) compared to younger patients (<65 years) (14.4% vs. 6.4%). The highest rate of AF was observed in Europeans (10.7%, 95% CI [10.2-11.2%]), followed by Northern Americans (10.0%, 95% CI [8.2-11.7%]), while Asians demonstrated a lower prevalence (2.7%, 95% CI [2.2-3.3%]). Notably, severe COVID-19 patients displayed a significantly elevated prevalence of AF at 14.l% (95% CI [13.3-14.9%]), which was approximately 2.5-fold higher than that in non-severe patients (5.2%, 95% CI [4.8-5.5%]). Both pre-existing (HR: 1.83, 95% CI [1.49-2.17]) and new-onset AF (HR: 3.47, 95% CI [2.26-5.33]) were associated with an increased mortality risk among COVID-19 patients. Furthermore, the effect on mortality risk was more significant in Asians (HR: 5.33, 95% CI [1.62-9.04]), compared to Europeans (HR: 1.68, 95% CI [1.24-2.13]) and North Americans (HR: 2.01, 95% CI [1.18-2.83]). Conclusion This study comprehensively investigated the association between AF and COVID-19 in a real-world setting. Notably, a high prevalence of AF was observed among older individuals, severe COVID-19 patients, and in Europe and Northern America. Moreover, co-existing AF was found to be associated with an increased risk for mortality. Further investigations are warranted to improve the management and outcomes of COVID-19 patients with AF.
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Affiliation(s)
- Nan-Nan Shen
- Department of Pharmacy, Affiliated Hospital of Shaoxing University, Shao Xing, Zhejiang, China
| | - Jia-Liang Wang
- Department of Pharmacy, Affiliated Hospital of Shaoxing University, Shao Xing, Zhejiang, China
| | - Xin-Wen Liu
- Department of Pharmacy, Affiliated Hospital of Shaoxing University, Shao Xing, Zhejiang, China
| | - Yong-Ping Fu
- Department of Cardiology, Affiliated Hospital of Shaoxing University, Shao Xing, Zhejiang, China
| | - Xue-Fang Chen
- Department of Medical Laboratory Science, Affiliated Hospital of Shaoxing University, Shao Xing, Zhejiang Province, Shaoxing, China
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Kole C, Stefanou Ε, Karvelas N, Schizas D, Toutouzas KP. Acute and Post-Acute COVID-19 Cardiovascular Complications: A Comprehensive Review. Cardiovasc Drugs Ther 2024; 38:1017-1032. [PMID: 37209261 PMCID: PMC10199303 DOI: 10.1007/s10557-023-07465-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE OF REVIEW The risk of cardiovascular complications due to SARS-CoV-2 are significantly increased within the first 6 months of the infection. Patients with COVID-19 have an increased risk of death, and there is evidence that many may experience a wide range of post-acute cardiovascular complications. Our work aims to provide an update on current clinical aspects of diagnosis and treatment of cardiovascular manifestations during acute and long-term COVID-19. RECENT FINDINGS SARS-CoV-2 has been shown to be associated with increased incidence of cardiovascular complications such as myocardial injury, heart failure, and dysrhythmias, as well as coagulation abnormalities not only during the acute phase but also beyond the first 30 days of the infection, associated with high mortality and poor outcomes. Cardiovascular complications during long-COVID-19 were found regardless of comorbidities such as age, hypertension, and diabetes; nevertheless, these populations remain at high risk for the worst outcomes during post-acute COVID-19. Emphasis should be given to the management of these patients. Treatment with low-dose oral propranolol, a beta blocker, for heart rate management may be considered, since it was found to significantly attenuate tachycardia and improve symptoms in postural tachycardia syndrome, while for patients on ACE inhibitors or angiotensin-receptor blockers (ARBs), under no circumstances should these medications be withdrawn. In addition, in patients at high risk after hospitalization due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis. In this work we provide a comprehensive review on acute and post-acute COVID-19 cardiovascular complications, symptomatology, and pathophysiology mechanisms. We also discuss therapeutic strategies for these patients during acute and long-term care and highlight populations at risk. Our findings suggest that older patients with risk factors such as hypertension, diabetes, and medical history of vascular disease have worse outcomes during acute SARS-CoV-2 infection and are more likely to develop cardiovascular complications during long-COVID-19.
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Affiliation(s)
- Christo Kole
- Cardiology Department, Sismanoglio General Hospital of Attica, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Εleni Stefanou
- Artificial Kidney Unit, General Hospital of Messinia, Kalamata, Greece
| | - Nikolaos Karvelas
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Ameri A, Pourseyedi F, Davoodian P, Safa O, Hassanipour S, Fathalipour M. Efficacy and safety of deferoxamine in moderately ill COVID-19 patients: An open label, randomized controlled trial. Medicine (Baltimore) 2024; 103:e39142. [PMID: 39183421 PMCID: PMC11346869 DOI: 10.1097/md.0000000000039142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Deferoxamine is a potent iron chelator that could remove iron from the virus, and severe acute respiratory syndrome coronavirus 2 requires iron to replication. Also, deferoxamine has antioxidant and cytokine-modulating effects. Therefore, we evaluated the efficacy and safety of deferoxamine in patients with moderate coronavirus disease 2019 (COVID-19). METHODS In this randomized controlled trial, patients with moderate COVID-19 were randomly assigned in a 1:1 ratio to the deferoxamine group (received a solution of 500 mg deferoxamine divided into 4 doses a day through a nebulizer for 7 days) and the control group. The main outcomes were viral clearance, oxygen saturation (SPO2), body temperature, and respiratory rate (RR). Intensive care unit admission, hospital length of stay, and hospital mortality were also assessed. RESULTS A total of 62 patients, with 30 in the deferoxamine group and 32 in the control group, were randomly assigned. There was no statistically significant improvement in viral clearance after the intervention ended in the deferoxamine group (36.7%) compared to the control group (34.4%). The results showed there was no significant difference between the analyzed groups in terms of SPO2, body temperature, RR, and the number of patients with a worse prognosis (SPO2 < 96%, temperature ≥ 37.5 °C, or RR ≥ 16/min) at the end of the study. There were no significant differences seen between the groups in terms of intensive care unit admission, hospital length of stay, hospital mortality, and the occurrence of adverse medication events during the follow-up period. CONCLUSION Deferoxamine had no significant impact on improving moderately ill patients with COVID-19. However, it was well-tolerated in the patients, and this intervention demonstrated a safe profile of adverse events.
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Affiliation(s)
- Ali Ameri
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farnaz Pourseyedi
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Parivash Davoodian
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Omid Safa
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Fathalipour
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Endocrinology and Metabolic Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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11
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Bhuiya T, Shah PP, Lau WH, Park T, Munshi RF, Hai O, Zeltser R, Makaryus AN. Emergence of Atrial Fibrillation and Flutter in COVID-19 Patients: A Retrospective Cohort Study. Healthcare (Basel) 2024; 12:1682. [PMID: 39273707 PMCID: PMC11395266 DOI: 10.3390/healthcare12171682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/20/2024] [Accepted: 08/20/2024] [Indexed: 09/15/2024] Open
Abstract
COVID-19 is associated with various cardiovascular complications, including arrhythmias. This study investigated the incidence of new-onset atrial fibrillation (AFB) and atrial flutter (AFL) in COVID-19 patients and identified potential risk factors. We conducted a retrospective cohort study at a tertiary-care safety-net community hospital including 647 patients diagnosed with COVID-19 from March 2020 to March 2021. Patients with a prior history of AFB or AFL were excluded. Data on demographics, clinical characteristics, and outcomes were collected and analyzed using chi-square tests, t-tests, and binary logistic regression. We found that 69 patients (10.66%) developed AFB or AFL, with 41 patients (6.34%) experiencing new-onset arrhythmias. The incidence rates for new-onset AFB and AFL were 5.4% and 0.9%, respectively. Older age (≥65 years) was significantly associated with new-onset AFB/AFL (OR: 5.43; 95% CI: 2.31-12.77; p < 0.001), as was the development of sepsis (OR: 2.73; 95% CI: 1.31-5.70; p = 0.008). No significant association was found with patient sex. Our findings indicate that new-onset atrial arrhythmias are a significant complication in COVID-19 patients, particularly among the elderly and those with sepsis. This highlights the need for targeted monitoring and management strategies to mitigate the burden of atrial arrhythmias in high-risk populations during COVID-19 infection.
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Affiliation(s)
- Tanzim Bhuiya
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 191104, USA
| | - Paras P Shah
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Wing Hang Lau
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Timothy Park
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Rezwan F Munshi
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Ofek Hai
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Roman Zeltser
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Amgad N Makaryus
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, USA
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
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12
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Cao X, Xie YL, Yi JY, Liu ZL, Zhang DD, Yue YY, Li TN, Zhou CL, Mu H. The clinical characteristics analysis of serum markers for the cardiovascular system in early-stage COVID-19 patients. Front Cardiovasc Med 2024; 11:1401586. [PMID: 39131705 PMCID: PMC11310024 DOI: 10.3389/fcvm.2024.1401586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024] Open
Abstract
Background This study aimed to investigate alterations in serum markers [creatine kinase-MB (CKMB), cardiac troponin T (cTnT), myoglobin (Myo), B-type natriuretic peptide (BNP), D-dimer (DD), procalcitonin (PCT) and interleukin-6 (IL6)] in early Omicron variant infection and analyzed their correlation with clinical parameters. Methods Retrospective analysis of 1,138 mild/asymptomatic cases at Tianjin First Central Hospital, including age, gender, serum markers and nucleic acid test results. Statistical analysis used SPSS software, version 24.0. Results Elevated cTnT, BNP (125-400), and DD (0.55-1.10) levels were prevalent at 12.92%, 15.64%, and 14.50%, respectively. Females had significantly higher proportions with slightly elevated BNP (19.34%) and DD (19.69%) levels. Patients over 35 had a higher proportion of slight elevation in BNP (20.00%). Abnormal levels of serum markers were significantly associated with older age, increased PCT and IL6 levels, as well as delayed nucleic acid clearance. Additionally, levels of immunoglobulin G (IgG) were notably reduced in these cases. Patients with prolonged nucleic acid clearance (>14 days) had higher BNP and DD levels upon admission. Logistic regression identified PCT (OR = 237.95) as the most significant risk factor for abnormal serum markers for cardiovascular system injury. Conclusion Early Omicron infection might do subclinical damage to the cardiovascular system. Elevated cTnT, BNP and DD levels were correlated with age, gender, inflammatory factors, and IgG. Notably, high PCT level emerged as the most robust predictor of abnormal serum biomarkers.
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Affiliation(s)
- Xi Cao
- Department of Clinical Laboratory, Tianjin First Central Hospital, Tianjin, China
| | - Yong-Li Xie
- Department of Clinical Laboratory, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin, China
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, Tianjin, China
| | - Jian-ying Yi
- Department of Clinical Laboratory, Tianjin First Central Hospital, Tianjin, China
| | - Zhi-li Liu
- Department of Clinical Laboratory, The Third Central Hospital, Tianjin, China
| | - Dong-dong Zhang
- Department of Clinical Laboratory, Tianjin First Central Hospital, Tianjin, China
| | - Ying-ying Yue
- Department of Clinical Laboratory, Tianjin First Central Hospital, Tianjin, China
| | - Tian-ning Li
- Department of Clinical Laboratory, Tianjin First Central Hospital, Tianjin, China
| | - Chun-lei Zhou
- Department of Clinical Laboratory, Tianjin First Central Hospital, Tianjin, China
| | - Hong Mu
- Department of Clinical Laboratory, Tianjin First Central Hospital, Tianjin, China
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13
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Shukla N, Shamim U, Agarwal P, Pandey R, Narayan J. From bench to bedside: potential of translational research in COVID-19 and beyond. Brief Funct Genomics 2024; 23:349-362. [PMID: 37986554 DOI: 10.1093/bfgp/elad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) have been around for more than 3 years now. However, due to constant viral evolution, novel variants are emerging, leaving old treatment protocols redundant. As treatment options dwindle, infection rates continue to rise and seasonal infection surges become progressively common across the world, rapid solutions are required. With genomic and proteomic methods generating enormous amounts of data to expand our understanding of SARS-CoV-2 biology, there is an urgent requirement for the development of novel therapeutic methods that can allow translational research to flourish. In this review, we highlight the current state of COVID-19 in the world and the effects of post-infection sequelae. We present the contribution of translational research in COVID-19, with various current and novel therapeutic approaches, including antivirals, monoclonal antibodies and vaccines, as well as alternate treatment methods such as immunomodulators, currently being studied and reiterate the importance of translational research in the development of various strategies to contain COVID-19.
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Affiliation(s)
- Nityendra Shukla
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mall Road, Near Jubilee Hall, New Delhi, 110007, India
| | - Uzma Shamim
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mall Road, Near Jubilee Hall, New Delhi, 110007, India
| | - Preeti Agarwal
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mall Road, Near Jubilee Hall, New Delhi, 110007, India
| | - Rajesh Pandey
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mall Road, Near Jubilee Hall, New Delhi, 110007, India
| | - Jitendra Narayan
- CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), Mall Road, Near Jubilee Hall, New Delhi, 110007, India
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14
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Gutierrez-Camacho JR, Avila-Carrasco L, Gamón-Madrid A, Muñoz-Torres JR, Murillo-Ruiz-Esparza A, Garza-Veloz I, Trejo-Ortiz PM, Mollinedo-Montaño FE, Araujo-Espino R, Rodriguez-Sanchez IP, Delgado-Enciso I, Martinez-Fierro ML. Evaluation of the Effect of Influenza Vaccine on the Development of Symptoms in SARS-CoV-2 Infection and Outcome in Patients Hospitalized due to COVID-19. Vaccines (Basel) 2024; 12:765. [PMID: 39066403 PMCID: PMC11281370 DOI: 10.3390/vaccines12070765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/01/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND COVID-19 is an infectious disease caused by SARS-CoV-2. It is unclear whether influenza vaccination reduces the severity of disease symptoms. Previous studies have suggested a beneficial effect of influenza vaccination on the severity of COVID-19. The aim of this study was to evaluate the possible protective effect of the influenza vaccine on the occurrence of SARS-CoV-2 infection symptoms and prognosis in patients hospitalized with COVID-19. METHODS This was a retrospective cohort study of patients who tested positive for SARS-CoV-2, identified by quantitative real-time polymerase chain reaction. Chi-square tests, Kaplan-Meier analysis, and multivariate analysis were performed to assess the association between influenza vaccination and the presence of symptoms in hospitalized patients with COVID-19 and their outcome. RESULTS In this study, 1712 patients received positive laboratory tests for SARS-CoV-2; influenza vaccination was a protective factor against the presence of characteristic COVID-19 symptoms such as polypnea, anosmia, dysgeusia, and fever (p < 0.001). Influenza-vaccinated patients had fewer days of hospitalization (p = 0.029). CONCLUSIONS The findings of this study support that influenza vaccination is associated with a decrease in the number of symptoms in patients hospitalized due to COVID-19, with fewer days of hospitalization, but not with the outcome of disease.
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Affiliation(s)
- Jose Roberto Gutierrez-Camacho
- Doctorado en Ciencias con Orientación en Medicina Molecular, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico; (J.R.G.-C.); (A.G.-M.); (J.R.M.-T.); (I.G.-V.); (P.M.T.-O.); (F.E.M.-M.); (R.A.-E.)
| | - Lorena Avila-Carrasco
- Doctorado en Ciencias con Orientación en Medicina Molecular, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico; (J.R.G.-C.); (A.G.-M.); (J.R.M.-T.); (I.G.-V.); (P.M.T.-O.); (F.E.M.-M.); (R.A.-E.)
| | - Araceli Gamón-Madrid
- Doctorado en Ciencias con Orientación en Medicina Molecular, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico; (J.R.G.-C.); (A.G.-M.); (J.R.M.-T.); (I.G.-V.); (P.M.T.-O.); (F.E.M.-M.); (R.A.-E.)
| | - Jose Ramon Muñoz-Torres
- Doctorado en Ciencias con Orientación en Medicina Molecular, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico; (J.R.G.-C.); (A.G.-M.); (J.R.M.-T.); (I.G.-V.); (P.M.T.-O.); (F.E.M.-M.); (R.A.-E.)
| | | | - Idalia Garza-Veloz
- Doctorado en Ciencias con Orientación en Medicina Molecular, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico; (J.R.G.-C.); (A.G.-M.); (J.R.M.-T.); (I.G.-V.); (P.M.T.-O.); (F.E.M.-M.); (R.A.-E.)
| | - Perla M. Trejo-Ortiz
- Doctorado en Ciencias con Orientación en Medicina Molecular, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico; (J.R.G.-C.); (A.G.-M.); (J.R.M.-T.); (I.G.-V.); (P.M.T.-O.); (F.E.M.-M.); (R.A.-E.)
| | - Fabiana E. Mollinedo-Montaño
- Doctorado en Ciencias con Orientación en Medicina Molecular, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico; (J.R.G.-C.); (A.G.-M.); (J.R.M.-T.); (I.G.-V.); (P.M.T.-O.); (F.E.M.-M.); (R.A.-E.)
| | - Roxana Araujo-Espino
- Doctorado en Ciencias con Orientación en Medicina Molecular, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico; (J.R.G.-C.); (A.G.-M.); (J.R.M.-T.); (I.G.-V.); (P.M.T.-O.); (F.E.M.-M.); (R.A.-E.)
| | - Iram P. Rodriguez-Sanchez
- Laboratorio de Fisiologia Molecular y Estructural, Facultad de Ciencias Biologicas, Universidad Autonoma de Nuevo Leon, San Nicolas de Los Garza 66450, Mexico;
| | - Ivan Delgado-Enciso
- Department of Molecular Medicine, School of Medicine, Cancerology State Institute, IMSS-Bienestar, University of Colima, Colima 28040, Mexico;
| | - Margarita L. Martinez-Fierro
- Doctorado en Ciencias con Orientación en Medicina Molecular, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico; (J.R.G.-C.); (A.G.-M.); (J.R.M.-T.); (I.G.-V.); (P.M.T.-O.); (F.E.M.-M.); (R.A.-E.)
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15
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Shao HH, Yin RX. Pathogenic mechanisms of cardiovascular damage in COVID-19. Mol Med 2024; 30:92. [PMID: 38898389 PMCID: PMC11186295 DOI: 10.1186/s10020-024-00855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND COVID-19 is a new infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). Since the outbreak in December 2019, it has caused an unprecedented world pandemic, leading to a global human health crisis. Although SARS CoV-2 mainly affects the lungs, causing interstitial pneumonia and severe acute respiratory distress syndrome, a number of patients often have extensive clinical manifestations, such as gastrointestinal symptoms, cardiovascular damage and renal dysfunction. PURPOSE This review article discusses the pathogenic mechanisms of cardiovascular damage in COVID-19 patients and provides some useful suggestions for future clinical diagnosis, treatment and prevention. METHODS An English-language literature search was conducted in PubMed and Web of Science databases up to 12th April, 2024 for the terms "COVID-19", "SARS CoV-2", "cardiovascular damage", "myocardial injury", "myocarditis", "hypertension", "arrhythmia", "heart failure" and "coronary heart disease", especially update articles in 2023 and 2024. Salient medical literatures regarding the cardiovascular damage of COVID-19 were selected, extracted and synthesized. RESULTS The most common cardiovascular damage was myocarditis and pericarditis, hypertension, arrhythmia, myocardial injury and heart failure, coronary heart disease, stress cardiomyopathy, ischemic stroke, blood coagulation abnormalities, and dyslipidemia. Two important pathogenic mechanisms of the cardiovascular damage may be direct viral cytotoxicity as well as indirect hyperimmune responses of the body to SARS CoV-2 infection. CONCLUSIONS Cardiovascular damage in COVID-19 patients is common and portends a worse prognosis. Although the underlying pathophysiological mechanisms of cardiovascular damage related to COVID-19 are not completely clear, two important pathogenic mechanisms of cardiovascular damage may be the direct damage of the SARSCoV-2 infection and the indirect hyperimmune responses.
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Affiliation(s)
- Hong-Hua Shao
- Department of Infectious Diseases, HIV/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People's Hospital of Nanning, No. 1 Erli, Changgang Road, Nanning, Guangxi, 530023, People's Republic of China
| | - Rui-Xing Yin
- Department of Infectious Diseases, HIV/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People's Hospital of Nanning, No. 1 Erli, Changgang Road, Nanning, Guangxi, 530023, People's Republic of China.
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, People's Republic of China.
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16
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Ameri A, Farashahinejad M, Davoodian P, Safa O, Hassaniazad M, Parsaii M, Heidari B, Hassanipour S, Akhlaghi B, Fathalipour M. The efficacy and safety of ginger (Zingiber officinale) rhizome extract in outpatients with COVID-19: A randomized double-blind placebo-control clinical trial. Medicine (Baltimore) 2024; 103:e38289. [PMID: 39259072 PMCID: PMC11142819 DOI: 10.1097/md.0000000000038289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/13/2024] [Accepted: 04/26/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Ginger, a potent antiviral, anti-inflammatory, and antioxidant remedy, is a potential therapeutic option for COVID-19. However, there was not enough clinical evidence about ginger and COVID-19. We evaluated the efficacy and safety of ginger on clinical and paraclinical features in outpatients with COVID-19. METHODS In this randomized controlled trial, the outpatients with confirmed COVID-19 were randomly assigned in a 1:1 ratio to receive ginger (1000 mg 3 times a day for 7 days) or placebo. The primary outcome was viral clearance after the end of the intervention. Oxygen saturation (SPO2), body temperature, respiratory rate (RR), hospital admission, and the incidence of adverse events were also assessed. RESULTS A total of 84 patients (42 in the ginger and 42 in the control groups) were randomized. The viral clearance was not statistically improved in the ginger group (41.6%) compared to the placebo group (42.8%). The findings indicated that SPO2, body temperature, and RR had no significant difference between the groups at the end of the intervention. The imaging finding indicated pulmonary infiltrate significantly reduced on the 7th day of the intervention in the ginger group. The percentage of patients with SPO2 <96% in the ginger group decreased over the study compared to the placebo group. Moreover, the need for hospital admission and the incidence of adverse drug events were not different between the groups over the follow-up period. CONCLUSIONS Ginger had no significant impact on the clinical and paraclinical parameters of patients. However, this intervention demonstrated a safe profile of adverse events and reduced pulmonary infiltrate. TRIAL REGISTRATION The trial was registered as IRCT20200506047323N1.
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Affiliation(s)
- Ali Ameri
- Student Research Committee, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Farashahinejad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Parivash Davoodian
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Omid Safa
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Hassaniazad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohsen Parsaii
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Behnoosh Heidari
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Boshra Akhlaghi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammad Fathalipour
- Endocrinology and Metabolic Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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17
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Oragui CC, Dilibe A. Fatal Arrhythmic Complications of Multisystemic Inflammatory Syndrome (MIS-C) in a Pediatric Patient. Cureus 2024; 16:e60927. [PMID: 38784686 PMCID: PMC11115374 DOI: 10.7759/cureus.60927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/25/2024] Open
Abstract
In 2019, the emergence of the coronavirus disease 2019 (COVID-19) virus triggered a global pandemic, reminiscent of the magnitude witnessed during the flu pandemic of 1918. Initially, children often presented with either asymptomatic or mild upper respiratory tract infection symptoms. However, in the post-acute phase, a distinct syndrome affecting multiple organ systems emerged, sharing similarities with Kawasaki's disease. This syndrome was later classified as multisystem inflammatory syndrome in children (MIS-C) by the Pediatric Intensive Care Society in April 2020. Notably, cardiac manifestations and complications associated with COVID-19 constitute a significant source of morbidity and mortality, characterized by left ventricular dysfunction, cardiac conduction abnormalities, and arrhythmias. Although cases of arrhythmias with MIS-C are rare in the literature, we present a unique case involving a 14-year-old without known cardiac risk factors who presented with conduction abnormalities and fatal arrhythmias secondary to MIS-C.
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Affiliation(s)
- Chika C Oragui
- Pediatrics, Pediatric Intensive Care Unit (PICU), Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, USA
| | - Arthur Dilibe
- Internal Medicine, ECU Health, East Carolina University, Greenville, USA
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18
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El Hajjar AH, El Helou MC, Bayat A, Cantillon D, Singh T, Taigen T, Moudgil R. Ventricular Tachycardia as a Late Complication of COVID-19 in a Young Patient With No History of Cardiovascular Disease. CJC Open 2024; 6:721-724. [PMID: 38846438 PMCID: PMC11150940 DOI: 10.1016/j.cjco.2024.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/22/2024] [Indexed: 06/09/2024] Open
Affiliation(s)
- Abdel Hadi El Hajjar
- Section of Clinical Cardiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michel Chedid El Helou
- Section of Clinical Cardiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Aqieda Bayat
- Section of Clinical Cardiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel Cantillon
- Section of Electrophysiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Tamanna Singh
- Section of Clinical Cardiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Tyler Taigen
- Section of Electrophysiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rohit Moudgil
- Section of Clinical Cardiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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19
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Tarzimanova AI, Bragina AE, Sokolova EE, Vargina TS, Pokrovskaya AE, Safronova TA, Loriya IZ, Cherkesov IV, Cherepanov AG, Ponomareva LA, Vanina DD, Krylova KE, Ziskina NK, Podzolkov VI. Predictors of Premature Ventricular Contractions Development in Patients With SARS-CoV-2 Infection. J Clin Med Res 2024; 16:243-250. [PMID: 38855779 PMCID: PMC11161186 DOI: 10.14740/jocmr5160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/16/2024] [Indexed: 06/11/2024] Open
Abstract
Background Epidemiological studies have demonstrated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients often develop atrial fibrillation, premature ventricular contractions (PVCs), and conduction disorders. The manifestation of ventricular cardiac arrhythmias accentuates the risk of sudden cardiac death. Methods A retrospective study was conducted on the cohort of 1,614 patients admitted for coronavirus disease 2019 (COVID-19). Patients were categorized into two groups based on the occurrence of PVCs. Group I comprised 172 patients diagnosed with PVCs of Lown-Wolf class II - IV upon hospital admission; group II (control group) consisted of 1,442 patients without this arrhythmia. Each patient underwent comprehensive clinical, laboratory, and instrumental evaluations. Results The emergence of PVCs in individuals afflicted with COVID-19 was associated with a 5.879-fold heightened risk of lethal outcome, a 2.904-fold elevated risk of acute myocardial infarction, and a 2.437-fold increased risk of pulmonary embolism. Upon application of diagnostic criteria to evaluate the "cytokine storm", it was discovered that the occurrence of the "cytokine storm" was notably more frequent in the group with PVCs, manifesting in six patients (3.5%), compared to 16 patients (1.1%) in the control group (P < 0.05). The mean extent of lung tissue damage in group I was significantly greater than that of patients in group II (P < 0.05). Notably, the average oxygen saturation level, as measured by pulse oximetry upon hospital admission was 92.63±3.84% in group I and 94.20±3.50% in group II (P < 0.05). Conclusions The presence of PVCs in COVID-19 patients was found to elevate the risk of cardiovascular complications. Significant independent predictors for the development of PVCs in patients with SARS-CoV-2 infection include: age over 60 years (risk ratio (RR): 4.6; confidence interval (CI): 3.2 - 6.5), a history of myocardial infarction (RR: 3.5; CI: 2.6 - 4.6), congestive heart failure (CHF) with reduced left ventricular ejection fraction (RR: 5.5; CI: 3.9 - 7.6), respiratory failure (RR: 2.3; CI: 1.7 - 3.1), and the presence of a "cytokine storm" (RR: 4.5; CI: 2.9 - 6.0).
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Affiliation(s)
- Aida I. Tarzimanova
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anna E. Bragina
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina E. Sokolova
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tatiana S. Vargina
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anna E. Pokrovskaya
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tatiana A. Safronova
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Irakli Zh. Loriya
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Igor V. Cherkesov
- Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alexander G. Cherepanov
- Institute of Linguistics and Intercultural Communication, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Liubov A. Ponomareva
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Daria D. Vanina
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Kseniya E. Krylova
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nadezhda K. Ziskina
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Valery I. Podzolkov
- The Second Internal Medicine (Second Faculty Therapy) Department, N.V. Sklifosovskiy Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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20
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Mizera MM, Seref-Ferlengez Z, Tarasova A, Mostafa E, Kamara E, Kim SJ. Increased 90-Day Mortality and Morbidity Among Patients Recovering From Elective Primary Arthroplasty During the COVID-19 Pandemic in New York City. Orthopedics 2024; 47:135-140. [PMID: 37921527 DOI: 10.3928/01477447-20231027-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
All elective procedures were stopped in March 2020 because of the coronavirus disease 2019 (COVID-19) pandemic. We report the 90-day mortality and complications of patients who underwent primary arthroplasty before the stopping of elective procedures at a single academic medical center. A retrospective cohort study was conducted including patients who underwent elective primary arthroplasty between December 2019 and mid-March 2020. Their 90-day postoperative mortality and medical complications were statistically compared with those of a historical cohort from the same operative period in 2019. The 2020 and 2019 cohorts included 372 and 410 patients, respectively. Except for the prevalence of diabetes, there was no significant difference between the two cohorts regarding baseline characteristics or preoperative health. The 2020 cohort had statistically significant higher rates of pneumonia (2.7% vs 0.7%; P=.03), readmission (9.1% vs 5.4%; P=.04), pulmonary embolism (1.6% vs 0.2%; P=.04), and 90-day mortality (1.1% vs 0%; P=.04). The 2020 cohort also had a trend for increased rates of deep venous thrombosis (1.1% vs 0.7%; P=.7) and cardiac complications (1.9% vs 0.5%; P=.07) and no change in emergency department visits (14.0% vs 11.7%; P=.3). There were 7 confirmed cases of COVID-19 in the 2020 cohort and 1 death. This study demonstrates that patients who underwent primary arthroplasty procedures at our institution close to the time of the first wave of the COVID-19 pandemic experienced a statistically significant increase in mortality, pneumonia, pulmonary embolism, and readmission compared with a historical cohort. As elective procedures have resumed during the ongoing pandemic, providers and patients should be aware of these increased risks. [Orthopedics. 2024;47(3):135-140.].
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21
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Shu H, Li Q, Zhang X, Zhao G, Cui Y, Zhu X. Fatal arrhythmia associated with novel coronavirus 2019 infection: Case report and literature review. Medicine (Baltimore) 2024; 103:e37894. [PMID: 38640277 PMCID: PMC11029986 DOI: 10.1097/md.0000000000037894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE The novel coronavirus of 2019 (COVID-19) has inflicted significant harm on the cardiovascular system. Patients presenting with fatal chronic arrhythmias after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are rare, arrhythmia caused by SARS-CoV-2 infection need to be taken seriously. PATIENT CONCERNS Three female patients were admitted to the hospital with syncopal symptoms. Previously, they had been identified to have COVID-19 infection and none of the patients had a preexisting history of arrhythmia, and upon hospital admission, no electrolyte imbalances associated with arrhythmias were observed. However, following SARS-CoV-2 infection, patients exhibit varying degrees of syncope symptoms. DIAGNOSES A high-degree atrioventricular block was diagnosed after a comprehensive evaluation of the patient's clinical manifestations and electrocardiogram (ECG) performance. INTERVENTIONS We performed ECG monitoring of the patient and excluded other causes of arrhythmia. The patient was discharged from the hospital after permanent pacemaker implantation and symptomatic treatment. OUTCOMES The outpatient follow-ups did not reveal a recurrence of syncope or complications related to the pacemaker in any of the three patients. LESSONS Some patients did not exhibit any obvious respiratory symptoms or signs following SARS-CoV-2 infection. This suggests that the cardiac conduction system may be the preferred target for some SARS-CoV-2 variants. Therefore, in addition to investigating the causes of malignant arrhythmias, special attention should be paid to SARS-CoV-2 infection in patients with developing arrhythmias. Additionally, permanent pacemaker implantation may be the most suitable option for patients who already have malignant arrhythmias.
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Affiliation(s)
- Hongyun Shu
- Department of Cardiovascular Medicine, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Guangdong, China
- Guangzhou Medical University, Guangzhou, China
| | - Qiaowen Li
- Institute of Gerontology, Guangzhou Geriatric Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoyong Zhang
- Department of Cardiovascular Medicine, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Guangdong, China
| | - Guojun Zhao
- Department of Cardiovascular Medicine, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Guangdong, China
- Guangzhou Medical University, Guangzhou, China
| | - Yaqian Cui
- Department of Cardiovascular Medicine, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Guangdong, China
- Guangzhou Medical University, Guangzhou, China
| | - Xiyan Zhu
- Department of Cardiovascular Medicine, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Guangdong, China
- Guangzhou Medical University, Guangzhou, China
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22
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Gerber N, Lutrario C, Rosenthal M, Platt S, Holzer R, Flynn P. Coronary artery dilation in non-hospitalised children with asymptomatic or mild COVID-19. Cardiol Young 2024; 34:854-858. [PMID: 37905350 DOI: 10.1017/s1047951123003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Infection with Sars-CoV-2 is known to cause cardiac injury and coronary artery changes in moderate to severe acute COVID-19 and post-acute multisystem inflammatory syndrome in children (MIS-C). However, little is known about the potential for cardiac involvement, in particular coronary artery dilation, in asymptomatic or mild cases of COVID-19. METHODS A retrospective review of children ≤ 18 years of age with a history of asymptomatic or mild COVID-19 disease who underwent echocardiography after Sars-CoV-2 infection is conducted. Patients were excluded if they had been hospitalised for COVID-19/MIS-C or had a history of cardiac disease that could affect coronary artery dimension. Coronary artery dilation was defined as the Boston Z-score greater than 2.0. RESULTS One hundred and fifty-seven patients met inclusion criteria with a mean age of 9.4 years (+/- 5.4 years). Eighty-four (54%) patients were identified as having COVID-19 through positive antibody testing. All patients underwent electrocardiogram and echocardiogram as part of their cardiology evaluation. One hundred and thirty-five (86%) patients had a normal evaluation or only a minor variant on electrocardiogram, while 22 patients had abnormalities on echocardiogram, 4 of which demonstrated coronary artery dilation based on the Boston Z-score. CONCLUSIONS Much of the literature for post-infectious screening and follow-up focuses on patients with a history of moderate to severe COVID-19 disease, emphasising the need for surveillance for the potential development of myocarditis. In this study, 4 out of 157 (2.5%) children with a history of asymptomatic or mild COVID-19 disease without MIS-C were found to have some degree of coronary artery dilation. The significance of this finding currently remains unknown.
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Affiliation(s)
- Nicole Gerber
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medicine, New York, NY, USA
| | - Christopher Lutrario
- Department of Pediatrics, New York-Presbyterian Hospital / Weill Cornell Medicine, New York, NY, USA
| | - Michelle Rosenthal
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medicine, New York, NY, USA
| | - Shari Platt
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medicine, New York, NY, USA
| | - Ralf Holzer
- Division of Pediatric Cardiology, New York-Presbyterian Hospital / Weill Cornell Medicine, New York, NY, USA
- Department of Pediatrics, New York-Presbyterian Hospital / Weill Cornell Medicine, New York, NY, USA
| | - Patrick Flynn
- Division of Pediatric Cardiology, New York-Presbyterian Hospital / Weill Cornell Medicine, New York, NY, USA
- Department of Pediatrics, New York-Presbyterian Hospital / Weill Cornell Medicine, New York, NY, USA
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23
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Weisleder H, Jacobson E, Frishman WH, Dhand A. Cardiac Manifestations of Viral Infections, Including COVID-19: A Review. Cardiol Rev 2024; 32:124-130. [PMID: 36730913 DOI: 10.1097/crd.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Viral infections have been linked to a variety of cardiac pathology, which may include acute myocarditis, dilated cardiomyopathy, heart failure, cardiogenic shock, pericarditis, acute coronary syndromes, and arrhythmias. We performed a systematic review of literature focusing on the cardiovascular effects of various viral infections, as well as providing an update on the current understanding of the pathophysiology of Coronavirus disease-2019 (COVID-19). Cardiac manifestations of viral illnesses are usually self-limiting, have variable clinical presentations, and require sufficient clinical suspicion for diagnosis and optimal management.
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Affiliation(s)
| | | | | | - Abhay Dhand
- From the New York Medical College, Valhalla, NY
- Department of Medicine and Surgery, Westchester Medical Center, Valhalla, NY
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24
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Yu L, Liu Y, Feng Y. Cardiac arrhythmia in COVID-19 patients. Ann Noninvasive Electrocardiol 2024; 29:e13105. [PMID: 38339786 PMCID: PMC10858328 DOI: 10.1111/anec.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/07/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) was first introduced in December 2019, which is known as severe acute respiratory syndrome caused by coronavirus-2 (SARS-CoV-2) that is a serious and life-threatening disease. Although pneumonia is the most common manifestation of COVID-19 and was initially introduced as a respiratory infection, in fact, the infection of COVID-19 is a subset of complications and damage to various organs. There are several reports of cardiac involvement with COVID-19. A wide range of cardiac complications may occur following COVID-19 infection, including systolic heart failure, myocarditis, pericarditis, atrial and ventricular arrhythmias, and thromboembolic events. There are various hypotheses about the pathophysiology of cardiovascular involvement by this virus. At the top of these hypotheses is the release of cytokines to the heart. Although there are other assumptions, considering that one of the causes of death in patients with COVID-19 is arrhythmia. It is necessary to know correctly about its pathophysiology and etiology. Therefore, in this study, we have reviewed the articles of recent years in the field of pathophysiology and etiology of arrhythmia in patients with COVID-19 infection. The purpose of this study was to provide a basis for a correct and more comprehensive understanding of the pathogenesis of arrhythmia in patients with COVID-19 infection.
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Affiliation(s)
- Lei Yu
- Department of CardiologyJinan Third People's HospitalJinanChina
| | - Ying Liu
- Department of CardiologyShandong Second Provincial General HospitalJinanChina
| | - Yanjing Feng
- Department of CardiologyShandong Second Provincial General HospitalJinanChina
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25
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Blumenfeld O, Rosenberg A, Reuven M, Caspi I, Sharoni E, Leviner DB. The effect of COVID-19 vaccination on 30-day mortality after cardiac surgery - Insights from the Israel national registries. Infect Prev Pract 2024; 6:100334. [PMID: 38235125 PMCID: PMC10792629 DOI: 10.1016/j.infpip.2023.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/01/2023] [Indexed: 01/19/2024] Open
Abstract
Background We compared the effect of perioperative COVID-19, before and after vaccination, on 30-day mortality after cardiac surgery. Methods Data was extracted from several national registries. The study period was March 1st, 2020-March 31st, 2022. Results 2594 adult patients underwent cardiac surgery before the availability of a universal COVID-19 vaccine. 33 patients were diagnosed with COVID-19 prior to surgery (mean age 58.3±10.0, mean length of time 73.6±60.1 days) and 7 patients were diagnosed with COVID-19 0-14 days after surgery (age 66.4±7.6). These were compared to 4426 patients who underwent cardiac surgery after the availability of a universal vaccine: 469 patients were diagnosed with COVID-19 prior to surgery (age 62.1±10.1, length of time 175.8±158.2) and 32 patients diagnosed with COVID-19 0-14 days after surgery (age 60.8±14.5). In patients diagnosed with COVID-19 prior to surgery, there was no excess 30-day mortality either before or after vaccination (1 (3.0%) vs. 57 (2.2%), respectively, P<0.8, and 8 (1.7%) vs. 87 (2.2%), respectively, P<0.5). Patients diagnosed with COVID-19 after surgery, but before vaccination, had significantly higher 30-day mortality compared to COVID-19 negative patients (2 (28.6%) vs. 56 (2.2%) respectively, P<0.0001). This excess mortality disappeared after universal vaccination (1 (3.1%) vs. 94 (2.1%) respectively, P<0.7). Conclusions COVID-19, when diagnosed in the early post-operative period, was a risk factor for mortality before available vaccinations, but not after vaccination was widely available. Pre-surgery screening and post-surgical isolation is essential until vaccines are available. This data may be useful for patient management in future respiratory pandemics.
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Affiliation(s)
- Orit Blumenfeld
- Israel Center for Disease Control, Ministry of Health, Ramat-Gan, Israel
| | - Alina Rosenberg
- Israel Center for Disease Control, Ministry of Health, Ramat-Gan, Israel
| | - Michal Reuven
- Israel Center for Disease Control, Ministry of Health, Ramat-Gan, Israel
| | - Inbar Caspi
- Internal Medicine Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Erez Sharoni
- Department of Cardiac Surgery, Carmel Medical Center, Haifa, Israel
- The Ruth & Baruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dror B. Leviner
- Department of Cardiac Surgery, Carmel Medical Center, Haifa, Israel
- The Ruth & Baruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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26
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Du L, Zhao J, Xie N, Xie H, Xu J, Bao X, Zhou Y, Liu H, Wu X, Hu X, He T, Xu S, Zheng Y. Protective effect and mechanism of Qingfei Paidu decoction on myocardial damage mediated by influenza viruses. Front Pharmacol 2024; 15:1309682. [PMID: 38476329 PMCID: PMC10927722 DOI: 10.3389/fphar.2024.1309682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/12/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction: Significant attention has been paid to myocardial damage mediated by the single-stranded RNA virus. Qingfei Paidu decoction (QFPDD) has been proved to protect the damage caused by the influenza virus A/PR/8/1934 (PR8), but its specific mechanism is unclear. Methods: Molecular biological methods, together with network pharmacology, were used to analyze the effects and underlying mechanism of QFPDD treatment on PR8-induced myocardial damage to obtain insights into the treatment of COVID-19-mediated myocardial damage. Results: Increased apoptosis and subcellular damage were observed in myocardial cells of mice infected by PR8. QFPDD treatment significantly inhibited the apoptosis and subcellular damage induced by the PR8 virus. The inflammatory factors IFN-β, TNF-α, and IL-18 were statistically increased in the myocardia of the mice infected by PR8, and the increase in inflammatory factors was prevented by QFPDD treatment. Furthermore, the expression levels or phosphorylation of necroptosis-related proteins RIPK1, RIPK3, and MLKL were abnormally elevated in the group of infected mice, while QFPDD restored the levels or phosphorylation of these proteins. Our study demonstrated that HIF-1α is a key target of QFPDD in the treatment of influenza virus-mediated injury. The HIF-α level was significantly increased by PR8 infection. Both the knockdown of HIF-1α and treatment of the myocardial cell with QFPDD significantly reversed the increased inflammatory factors during infection. Overexpression of HIF-1α reversed the inhibition effects of QFPDD on cytokine expression. Meanwhile, seven compounds from QFPDD may target HIF-1α. Conclusion: QFPDD can ameliorate influenza virus-mediated myocardial damage by reducing the degree of cell necroptosis and apoptosis, inhibiting inflammatory response and the expression of HIF-1α. Thus, our results provide new insights into the treatment of respiratory virus-mediated myocardial damage.
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Affiliation(s)
- Lijuan Du
- Department of Physiology and Pathophysiology, Health Science Center, Ningbo University, Ningbo, China
- Faculty of Physical Education, Ningbo University, Ningbo, Zhejiang, China
| | - Jing Zhao
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Nanxi Xie
- The Research Center for Traditional Chinese Medicine, Shanghai Institute of Infectious Diseases and Biosecurity, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huangze Xie
- Department of Physiology and Pathophysiology, Health Science Center, Ningbo University, Ningbo, China
| | - Jiating Xu
- Department of Physiology and Pathophysiology, Health Science Center, Ningbo University, Ningbo, China
| | - Xiaoming Bao
- Department of Cardiology, Ningbo No.2 Hospital, Ningbo, Zhejiang, China
| | - Yingsong Zhou
- Faculty of Physical Education, Ningbo University, Ningbo, Zhejiang, China
| | - Hui Liu
- The Research Center for Traditional Chinese Medicine, Shanghai Institute of Infectious Diseases and Biosecurity, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao Wu
- The Research Center for Traditional Chinese Medicine, Shanghai Institute of Infectious Diseases and Biosecurity, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Hu
- Department of Physiology and Pathophysiology, Health Science Center, Ningbo University, Ningbo, China
| | - Tianyi He
- Department of Physiology and Pathophysiology, Health Science Center, Ningbo University, Ningbo, China
| | - Shujun Xu
- Department of Physiology and Pathophysiology, Health Science Center, Ningbo University, Ningbo, China
| | - Yuejuan Zheng
- The Research Center for Traditional Chinese Medicine, Shanghai Institute of Infectious Diseases and Biosecurity, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Center for Traditional Chinese Medicine and Immunology Research, School of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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27
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Niu H, Li J, Teng C, Lu X, Jin C, Cai P, Shi A, Shen X, Chen Q, Chen M, Yuan Y, Li P. The incidence and impact of atrial fibrillation on hospitalized Coronavirus disease-2019 patients. Clin Cardiol 2024; 47:e24240. [PMID: 38402574 PMCID: PMC10894524 DOI: 10.1002/clc.24240] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Since 2019, Coronavirus disease-2019 (COVID-19) has raised unprecedented global health crisis. The incidence and impact of atrial fibrillation (AF) on patients with COVID-19 remain unclearly defined. METHODS We conducted a retrospective cohort study using ICD-10 codes to identify patients with a primary diagnosis of COVID-19 with or without AF in National Inpatient Sample Database 2020. We compared the outcome of COVID-19 patients with a concurrent diagnosis of AF with those without. HYPOTHESIS AF will adversely affect the prognosis of hospitalized COVID-19 patients. RESULTS A total of 211 619 patients with a primary diagnosis of COVID-19 were identified. Among these patients, 31 923 (15.08%) had a secondary diagnosis of AF. Before propensity score matching, COVID-AF cohort was older (75.8 vs. 62.2-year-old, p < .001) and had more men (57.5% vs. 52.0%, p < .001). It is associated with more comorbidities, mainly including diabetes mellitus (43.7% vs. 39.9%, p < .001), hyperlipidemia (54.6% vs. 39.8%, p < .001), chronic kidney disease (34.5% vs. 17.0%, p < .001), coronary artery disease (35.3% vs. 14.4%, p < .001), anemia (27.8% vs. 18.6%, p < .001), and cancer (4.8% vs. 3.4%, p < .001). After performing propensity score match, a total of 31 862 patients were matched within each group. COVID-AF cohort had higher inpatient mortality (22.2% vs. 15.3%, p < .001) and more complications, mainly including cardiac arrest (3.9% vs. 2.3%, p < .001), cardiogenic shock (0.9% vs. 0.3%, p < .001), hemorrhagic stroke (0.4% vs. 0.3%, p = .025), and ischemic stroke (1.3% vs. 0.7%, p < .001). COVID-AF cohort was more costly, with a longer length of stay, and a higher total charge. CONCLUSION AF is common in patients hospitalized for COVID-19, and is associated with poorer in-hospital mortality, immediate complications and increased healthcare resource utilization.
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Affiliation(s)
- Haiming Niu
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Jianwei Li
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Catherine Teng
- Division of Cardiology, Department of MedicineUniversity of Texas Health Science CenterSan AntonioTexasUSA
| | - Xiaojia Lu
- Department of Cardiology, Mount Sinai Beth IsraelIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Chengyue Jin
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMassachusettsUSA
| | - Ao Shi
- Faculty of MedicineSt. George University of LondonLondonUK
| | - Xiaoqing Shen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Qiqi Chen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Miaolian Chen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Yong Yuan
- Department of CardiovasculogyZhongshan People's HospitalZhongshanP.R. China
| | - Pengyang Li
- Division of Cardiology, Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
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28
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Hamsley S, Pour-Ghaz I, Alkhatib D, Norman H, Kombathula R, Nayyar M, McCaslin DA, Khouzam RN, Yedlapati N, Dalal A. Novel Cardiovascular and Pulmonary Findings in the Noninvasive Ischemic Assessment of Patients With Coronavirus 2019 (COVID-19). Curr Probl Cardiol 2024; 49:102047. [PMID: 37640180 DOI: 10.1016/j.cpcardiol.2023.102047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
In the past several years, the coronavirus pandemic has introduced multiple medical disciplines to various new forms of disease previously unknown and has shown us a unique presentation of already existing diseases. We continue to understand the long-term effects of the pandemic on the population's health and continue to find new unique features previously unknown. This paper presents the unique feature of lung uptake abnormalities discovered on nuclear stress testing for cardiac perfusion defects, a consistent finding in multiple individuals with recent COVID-19 or ongoing infection.
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Affiliation(s)
- Susanna Hamsley
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Issa Pour-Ghaz
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN.
| | - Deya Alkhatib
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Hallie Norman
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Rachana Kombathula
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Mannu Nayyar
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - David A McCaslin
- Methodist Le Bonheur Healthcare, Sutherland Cardiology, Memphis, TN
| | - Rami N Khouzam
- Heart and Vascular Care, Grand Strand Medical Center, Myrtle Beach, SC
| | - Neeraja Yedlapati
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Ajay Dalal
- Methodist Le Bonheur Healthcare, Sutherland Cardiology, Memphis, TN
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Lotfi A, Hajian P, Abbasi L, Gargari MK, Fard NNG, Naderi D. A Review on Role of Inflammation in Coronavirus Disease. Endocr Metab Immune Disord Drug Targets 2024; 24:1488-1505. [PMID: 38303532 DOI: 10.2174/0118715303265274231204075802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/25/2023] [Accepted: 10/25/2023] [Indexed: 02/03/2024]
Abstract
The respiratory illness known as COVID-19 is caused by the novel coronavirus, SARS-CoV-2. While the precise pathogenic mechanism of COVID-19 remains unclear, the occurrence of a cytokine storm subsequent to viral infection plays a pivotal role in the initiation and advancement of the disease. The infection of SARS-CoV-2 induces a state of immune system hyperactivity, leading to an excessive production of inflammatory cytokines. Consequently, the identification of the various signaling pathways implicated in the inflammation induced by COVID-19 will enable researchers to investigate new targets for therapeutic intervention.
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Affiliation(s)
| | - Pouran Hajian
- Department of Anesthesiology, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Laleh Abbasi
- Guilan University of Medical Sciences, Rasht, Iran
| | | | - Najmeh Nameh Goshay Fard
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Delaram Naderi
- Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Siddique YA, Chaudhry R, Ahmad M, Sebai A, Sharma L, Hassouba M, Virk GS. The Trend of Arrhythmias in Patients With COVID-19: A Complication or Late Manifestation? Cureus 2023; 15:e50746. [PMID: 38239526 PMCID: PMC10794791 DOI: 10.7759/cureus.50746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
Patients diagnosed with coronavirus disease (CVD) who experience cardiovascular complications or have pre-existing cardiovascular disease are at an increased risk of death. The primary heart-related consequences associated with COVID-19 encompass venous thromboembolism, shock, heart failure, arrhythmias, myocarditis, acute myocardial infarction, and acute cardiac damage. The coronavirus has the potential to induce cardiovascular complications or exacerbate pre-existing CVD through various mechanisms. These mechanisms include dysregulation of the renin-angiotensin-aldosterone system; direct viral toxicity; damage to endothelial cells; formation of blood clots and subsequent inflammation, a phenomenon known as thromboinflammation; an excessive immune response known as cytokine storm; and an imbalance between the demand and supply of oxygen in the body. In this study, we comprehensively analyze the cardiovascular symptoms, histology, and underlying mechanisms associated with COVID-19. Our aim is to contribute to the identification of future research objectives and aid in the advancement of therapeutic management approaches.
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Affiliation(s)
- Yusuf A Siddique
- Basic Sciences, St. George's University School of Medicine, True Blue, GRD
| | | | | | - Ahmad Sebai
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Lubhani Sharma
- Family Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Mohamed Hassouba
- Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, USA
| | - Ghazala S Virk
- Internal Medicine, Avalon University School of Medicine, Ohio, USA
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Ameri A, Farashahinejad M, Davoodian P, Safa O, Kusha A, Dadvand H, Hassanipour S, Fathalipour M. Efficacy and safety of licorice (Glycyrrhiza glabra) in moderately ill patients with COVID-19: a randomized controlled trial. Inflammopharmacology 2023; 31:3037-3045. [PMID: 37847472 DOI: 10.1007/s10787-023-01352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
Licorice extract (glycyrrhizin), a potent antiviral, anti-inflammatory, and antioxidant remedy, is a potential therapeutic option for COVID-19. We evaluated the efficacy and safety of licorice in patients with moderate COVID-19. In this study, 60 patients with confirmed COVID-19 were randomly assigned in a 1:1 ratio to receive licorice (at a dose of 760 mg three times a day for seven days) or control groups. The primary outcomes were SPO2, body temperature, and respiratory rate (RR) after the end of the intervention. The findings indicated that SPO2, body temperature, and RR had no significant difference between the groups at the end of the intervention. However, CRP and ALT improved in the licorice group toward the baseline. The number of patients with worse prognoses, LOS, mortality, and the incidence of adverse events were not different between the groups at the end of the study. Licorice had no beneficial effect on the clinical symptoms of COVID-19. Moreover, this intervention demonstrated a safe profile of adverse events. The confirmation of the results of this preparatory trial requires more detailed multiple-center trials with a larger sample size.
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Affiliation(s)
- Ali Ameri
- Student Research Committee, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Farashahinejad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Parivash Davoodian
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Omid Safa
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Kusha
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Habib Dadvand
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Fathalipour
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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Zakynthinos GE, Tsolaki V, Oikonomou E, Vavouranakis M, Siasos G, Zakynthinos E. New-Onset Atrial Fibrillation in the Critically Ill COVID-19 Patients Hospitalized in the Intensive Care Unit. J Clin Med 2023; 12:6989. [PMID: 38002603 PMCID: PMC10672690 DOI: 10.3390/jcm12226989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/28/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
New-onset atrial fibrillation (NOAF) is the most frequently encountered cardiac arrhythmia observed in patients with COVID-19 infection, particularly in Intensive Care Unit (ICU) patients. The purpose of the present review is to delve into the occurrence of NOAF in COVID-19 and thoroughly review recent, pertinent data. However, the causality behind this connection has yet to be thoroughly explored. The proposed mechanisms that could contribute to the development of AF in these patients include myocardial damage resulting from direct virus-induced cardiac injury, potentially leading to perimyocarditis; a cytokine crisis and heightened inflammatory response; hypoxemia due to acute respiratory distress; disturbances in acid-base and electrolyte levels; as well as the frequent use of adrenergic drugs in critically ill patients. Additionally, secondary bacterial sepsis and septic shock have been suggested as primary causes of NOAF in ICU patients. This notion gains strength from the observation of a similar prevalence of NOAF in septic non-COVID ICU patients with ARDS. It is plausible that both myocardial involvement from SARS-CoV-2 and secondary sepsis play pivotal roles in the onset of arrhythmia in ICU patients. Nonetheless, there exists a significant variation in the prevalence of NOAF among studies focused on severe COVID-19 cases with ARDS. This discrepancy could be attributed to the inclusion of mixed populations with varying degrees of illness severity, encompassing not only patients in general wards but also those admitted to the ICU, whether intubated or not. Furthermore, the occurrence of NOAF is linked to increased morbidity and mortality. However, it remains to be determined whether NOAF independently influences outcomes in critically ill COVID-19 ICU patients or if it merely reflects the disease's severity. Lastly, the management of NOAF in these patients has not been extensively studied. Nevertheless, the current guidelines for NOAF in non-COVID ICU patients appear to be effective, while accounting for the specific drugs used in COVID-19 treatment that may prolong the QT interval (although drugs like lopinavir/ritonavir, hydrochlorothiazide, and azithromycin have been discontinued) or induce bradycardia (e.g., remdesivir).
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Affiliation(s)
- George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
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Ntchana A, Shrestha S, Pippin M. Cardiovascular Complications of COVID-19: A Scoping Review of Evidence. Cureus 2023; 15:e48275. [PMID: 38054135 PMCID: PMC10695704 DOI: 10.7759/cureus.48275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 12/07/2023] Open
Abstract
This scoping review sought to identify the nature and extent of clinical evidence regarding the acute and long-term cardiovascular complications associated with COVID-19. Forty-nine studies published between 2020 and 2023 were selected for review. The studies were divided into two groups. The referential group included 22 studies. The second group of 27 studies was used for a detailed review to assess the strength of the evidence. The aggregate evidence indicates that the most common cardiac complications associated with COVID-19 include but are not limited to acute pericarditis, acute myocardial injury, acute myocarditis, various arrhythmias, microvascular angiopathy, left ventricular dysfunction, heart failure, acute cardiac injury, and acute coronary syndrome. Clinical and epidemiological implications of the findings are investigated, and future research recommendations are proposed.
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Affiliation(s)
- Armand Ntchana
- Family Medicine-Alexandria, Louisiana State University Health Sciences Center, Alexandria, USA
| | - Sanjay Shrestha
- Family Medicine-Alexandria, Louisiana State University Health Sciences Center, Alexandria, USA
| | - Micah Pippin
- Family Medicine-Alexandria, Louisiana State University Health Sciences Center, Alexandria, USA
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Yazıcı R, Güney İ. Evaluation of the changes in electrocardiographic ventricular repolarization parameters after COVID-19 recovery in hemodialysis patients. Ther Apher Dial 2023; 27:875-881. [PMID: 37429638 DOI: 10.1111/1744-9987.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/24/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Coronavirus disease-2019 (COVID-19) has cardiac manifestations. Data about electrocardiogram (ECG) changes after COVID-19 recovery is limited in hemodialysis patients. We aimed to investigate the changes in ventricular repolarization parameters after COVID-19 recovery in hemodialysis patients. METHODS Fifty-five hemodialysis patients who recovered from COVID-19 infection were included. QT interval, Tp-e interval, corrected QT (QTc), QTc dispersion, and Tp-e dispersion values were determined on the patients' ECGs, taken before COVID-19 and at least 1 month after recovery. The patients' data before COVID-19 infection and after recovery were compared. RESULTS It was found that longest QTc (QTcmax) and QTc dispersion values after recovery were prolonged compared with pre-infection period (427 ± 28 ms vs. 455 ± 26 ms, p = 0.000 and 39 ± 16 ms vs. 65 ± 20 ms, p = 0.000). CONCLUSION In our hemodialysis patients, ventricular repolarization parameters increased after COVİD-19 recovery. In hemodialysis patients, already predisposed to arrhythmic deaths, arrhythmia risk after COVİD-19 recovery may become more pronounced.
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Affiliation(s)
- Raziye Yazıcı
- Department of Internal Medicine, Division of Nephrology, Konya Beyhekim Training and Research Hospital, Konya, Turkey
| | - İbrahim Güney
- Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Konya City Hospital, Konya, Turkey
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Tayal S, Bhatnagar S. Role of molecular mimicry in the SARS-CoV-2-human interactome for pathogenesis of cardiovascular diseases: An update to ImitateDB. Comput Biol Chem 2023; 106:107919. [PMID: 37463554 DOI: 10.1016/j.compbiolchem.2023.107919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
Mimicry of host proteins is a strategy employed by pathogens to hijack host functions. Domain and motif mimicry was explored in the experimental and predicted SARS-CoV-2-human interactome. The host first interactor proteins were also added to capture the continuum of the interactions. The domains and motifs of the proteins were annotated using NCBI CD Search and ScanProsite, respectively. Host and pathogen proteins with a common host interactor and similar domain/motif constitute a mimicry pair indicating global structural similarity (domain mimicry pair; DMP) or local sequence similarity (motif mimicry pair; MMP). 593 DMPs and 7,02,472 MMPs were determined. AAA, DEXDc and Macro domains were frequent among DMPs whereas glycosylation, myristoylation and RGD motifs were abundant among MMP. The proteins involved in mimicry were visualised as a SARS-CoV-2 mimicry interaction network. The host proteins were enriched in multiple CVD pathways indicating the role of mimicry in COVID-19 associated CVDs. Bridging nodes were identified as potential drug targets. Approved antihypertensive and anti-inflammatory drugs are proposed for repurposing against COVID-19 associated CVDs. The SARS-CoV-2 mimicry data has been updated in ImitateDB (http://imitatedb.sblab-nsit.net/SARSCoV2Mimicry). Determination of key mechanisms, proteins, pathways, drug targets and repurposing candidates is critical for developing therapeutics for SARS CoV-2 associated CVDs.
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Affiliation(s)
- Sonali Tayal
- Computational and Structural Biology Laboratory, Department of Biological Sciences and Engineering, Netaji Subhas University of Technology, Dwarka, New Delhi 110078, India
| | - Sonika Bhatnagar
- Computational and Structural Biology Laboratory, Department of Biological Sciences and Engineering, Netaji Subhas University of Technology, Dwarka, New Delhi 110078, India.
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Fan L, Ding X. Potential Effects of Traditional Chinese Medicine on COVID-19 and Cardiac Injury: Mechanisms and Clinical Evidence. J Multidiscip Healthc 2023; 16:2863-2872. [PMID: 37771609 PMCID: PMC10522495 DOI: 10.2147/jmdh.s424078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023] Open
Abstract
Coronavirus disease 2019 is a "Public Health Emergency of International Concern" from 30 January 2020 to 5 May 2023. While battling Coronavirus disease 2019, the Chinese government has actively promoted the collaborative treatment model of Western medicine and traditional Chinese medicine, and clinical and scientific research has applied appropriate and rigorous methodology. Severe acute respiratory syndrome coronavirus 2 infection may damage the cardiovascular system via an unclarified pathogenic mechanism. The National Health Commission of China recommends 'three formulas and three medicines' for the treatment of coronavirus disease 2019, which have been shown to be most effective in the treatments. Data from randomized controlled trials of 'three formulas and three medicines' suggested that the traditional Chinese medicine is safe and can alleviate the symptoms of cardiac injury. Therefore, we further evaluate the benefits and safety of traditional Chinese medicine treatment for Coronavirus disease 2019 patients with cardiac injury across the care continuum.
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Affiliation(s)
- Leilei Fan
- Department of Cardiovascular, Yellow River Central Hospital, Zhengzhou, 450004, People’s Republic of China
| | - Xue Ding
- Department of Medical, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
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Sivri F, Şencan M, Ceyhan BÖ, Içen YK, Coskun M, Aksoy F. Prognostic value of R wave peak time in COVID-19 pneumonia. J Electrocardiol 2023; 80:91-95. [PMID: 37285643 PMCID: PMC10212595 DOI: 10.1016/j.jelectrocard.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND R wave peak time (RWPT) is also known as intrinsicoid deflection time or ventricular activation time. It shows the conduction time from the endocardium in the ventricle to the epicardium. It provides diagnostic and prognostic information for many cardiovascular diseases, such as RWPT prolongation, left ventricular hypertrophy, volume overload, conduction system abnormalities, and myocardial ischemia. Objectives The aim of this study is to investigate the relationship between COVID-19 mortality and RWPT in superficial ECG. METHODS This study retrospectively examined 640 patients diagnosed with COVID-19 and treated in an intensive care unit at a single center between January 2021 and June 2022. All patients included in the study had clinical and radiological characteristics and signs of COVID-19 pneumonia. RESULTS 640 patients included in the study were divided into 2 groups: surviving and deceased. There were 510 patients in the surviving group and 130 patients in the deceased group. The deceased group was found to be significantly older. The number of patients with COPD was higher in the deceased group. Troponin, lactate dehydrogenase (LDH), C-reactive protein (CRP), D-dimer and T-peak to T-end interval(Tpe) and RWPT were found to be significantly increased in the deceased group. In binary logistic regression analysis; age, COPD, LDH, CRP, troponin, D-dimer, Tpe interval, RWPT were determined as independent risk factors for mortality. CONCLUSIONS Prolonged RWPT is useful in risk stratification for COVID-19 pneumonia mortality.
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Affiliation(s)
- Fatih Sivri
- Hatay Dörtyol State Hospital, 31000, Hatay, Turkey.
| | | | | | - Yahya Kemal Içen
- Specialistin Department of Cardiology, Adana Health Practices and Research Center, Health Sciences University, 01000 Adana, Turkey
| | - Mukremin Coskun
- Specialistin Department of Cardiology, Adana Health Practices and Research Center, Health Sciences University, 01000 Adana, Turkey
| | - Fatih Aksoy
- Süleyman Demirel Universty, 3200, Isparta, Turkey
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Ishisaka Y, Aikawa T, Malik A, Kampaktsis PN, Briasoulis A, Kuno T. Association of Remdesivir use with bradycardia: A systematic review and meta-analysis. J Med Virol 2023; 95:e29018. [PMID: 37539782 DOI: 10.1002/jmv.29018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
Remdesivir has been used for coronavirus disease 2019 (COVID-19) pneumonia with oxygen requirements that do not require mechanical intubation, and several studies showed a reduction in disease duration. However, there is a concern about bradycardia as its side effect. We aimed to investigate the association between Remdesivir and bradycardia by integrating findings from prior studies. We queried PubMed and EMBASE in February 2023 and performed a meta-analysis of studies investigating bradycardia in patients who did or did not receive Remdesivir. The outcome of interest was the rate of bradycardia and in-hospital mortality. We identified eight studies involving 8993 patients, of which seven studies investigated bradycardia. Six studies were observational, one was a case-control, and one was a randomized trial. Incidence of bradycardia was 400/3480 patients (22.3%, 95% confidence interval, CI: [6.5-54.4], I2 = 99%) in the Remdesivir group and 294/5005 (9.8%, 95% CI: [2.8-29], I2 = 98.61) in the non-Remdesivir group. The odds ratio of bradycardia was 2.11 (95% CI: [1.65-2.71], I2 = 22%, p < 0.001) for the Remdesivir group. There was no difference in mortality between the two groups. Patients who received Remdesivir for COVID-19 were more likely to develop bradycardia. The effect of confounding factors should be considered to further clarify the possible association.
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Affiliation(s)
- Yoshiko Ishisaka
- Department of Medicine, Mount Sinai Beth Israel, New York City, New York, USA
| | - Tadao Aikawa
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Polydoros N Kampaktsis
- Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, Iowa, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, USA
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Nageeb Louz RE, Salah Eddin MA, Macky TA, Tolba DAA. Post COVID-19 Retinal Evaluation Using Optical Coherence Tomography Angiography: A Case Control Study. Ocul Immunol Inflamm 2023; 31:1175-1183. [PMID: 36413337 DOI: 10.1080/09273948.2022.2141651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To study the effect of coronavirus disease of 2019 (COVID-19) on retinal vasculature by Optical Coherence Tomography Angiography (OCTA). METHODS Macular OCTA images of patients recovered from COVID-19 infections were studied including foveal avascular zone (FAZ), capillary vascular densities (CVD) of the superficial and deep capillary network (SCP, DCP), and central foveal thickness (CFT). RESULTS The FAZ area was significantly larger in post COVID-19 cases compared to the healthy controls (p=0.032). Post COVID-19 cases had significant lower CVDs in perifoveal quadrants of the SCP. They also had lower CVD in the whole area, parafoveal, temporal and inferior perifoveal areas in the DCP. The parafoveal DCP area showed a positive correlation with disease duration (r=0.249, p-value=0.018). The whole SCP was significantly larger in cases with lymphopenia (p-value=0.004). CONCLUSION This study found asymptomatic retinal vascular affection in post COVID-19 eyes showing a relation with disease clinical and laboratory features.
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Affiliation(s)
- Ramy Emad Nageeb Louz
- The Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, El-Manial, Egypt
| | | | - Tamer A Macky
- The Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, El-Manial, Egypt
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Khan MA, Alsulami M, Yaqoob MM, Alsadie D, Saudagar AKJ, AlKhathami M, Farooq Khattak U. Asynchronous Federated Learning for Improved Cardiovascular Disease Prediction Using Artificial Intelligence. Diagnostics (Basel) 2023; 13:2340. [PMID: 37510084 PMCID: PMC10377760 DOI: 10.3390/diagnostics13142340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Healthcare professionals consider predicting heart disease an essential task and deep learning has proven to be a promising approach for achieving this goal. This research paper introduces a novel method called the asynchronous federated deep learning approach for cardiac prediction (AFLCP), which combines a heart disease dataset and deep neural networks (DNNs) with an asynchronous learning technique. The proposed approach employs a method for asynchronously updating the parameters of DNNs and incorporates a temporally weighted aggregation technique to enhance the accuracy and convergence of the central model. To evaluate the effectiveness of the proposed AFLCP method, two datasets with various DNN architectures are tested, and the results demonstrate that the AFLCP approach outperforms the baseline method in terms of both communication cost and model accuracy.
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Affiliation(s)
- Muhammad Amir Khan
- Department of Computer Science, COMSATS University Islamabad Abbottabad Campus, Abbottabad 22060, Pakistan
| | - Musleh Alsulami
- Information Systems Department, Umm Al-Qura University, Makkah 21961, Saudi Arabia
| | - Muhammad Mateen Yaqoob
- Department of Computer Science, COMSATS University Islamabad Abbottabad Campus, Abbottabad 22060, Pakistan
| | - Deafallah Alsadie
- Information Systems Department, Umm Al-Qura University, Makkah 21961, Saudi Arabia
| | - Abdul Khader Jilani Saudagar
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia
| | - Mohammed AlKhathami
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia
| | - Umar Farooq Khattak
- School of Information Technology, UNITAR International University, Kelana Jaya, Petaling Jaya 47301, Selangor, Malaysia
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Oragui CC. Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated With COVID-19. Cureus 2023; 15:e41950. [PMID: 37588330 PMCID: PMC10426319 DOI: 10.7759/cureus.41950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/18/2023] Open
Abstract
Since 2019, the global pandemic caused by the SARS-CoV-2 virus, also known as COVID-19, has dramatically affected every aspect of health and society. With wide-ranging socio-economic ramifications and the morbidity/mortality associated with the disease, a lot of research has been done on this disease. With recent surges and new variants of the COVID-19 virus, we must have regularly updated information on this disease to effectively manage this disease and to maximize outcomes for patients. Worldwide data, so far, has suggested that children have milder or asymptomatic acute infectious phase, most often presenting with mild upper respiratory infection (URI) symptoms compared to the adult population. However, in the post-acute phase, it was observed that children presented with a syndrome that strongly resembled Kawasaki's disease (KD), and like in KD, they could potentially develop severe life-threatening complications. The significant difference between KD and this syndrome is the association with COVID-19 infection. This syndrome was observed to affect almost all organ systems including cardiovascular, gastrointestinal, and integumentary and was later named multisystem inflammatory syndrome in children (MIS-C) by the Pediatric Intensive Care Society in April 2020. The cardiovascular manifestations of this clinical entity have been associated with significant morbidity and mortality. This review is an attempt to give consolidated information from the studies done so far about the cardiac changes that occur from SARS-CoV-2 infection/MIS-C.
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Wang C, Hao W. Cardiac arrhythmia and immune response in COVID-19 patients. Allergol Immunopathol (Madr) 2023; 51:63-70. [PMID: 37422781 DOI: 10.15586/aei.v51i4.883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/15/2023] [Indexed: 07/11/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has presented substantial challenges for providing health care due to the numerous complications on the respiratory and cardiovascular systems of people. Cardiac arrhythmia is one of the cardiac complications, and it was observed in COVID-19 patients. Moreover, arrhythmia and cardiac arrest are common in COVID-19 patients in the intensive care unit. The occurrence of cardiac arrhythmia in COVID-19 patients is associated with hypoxia, cytokine storm, myocardial ischemia and inflammatory disease such as congestive heart failure. It is necessary to know the occurrence and mechanisms of tachyarrhythmia and bradyarrhythmia in patients with COVID-19 infection for their proper management. This review provides an overview of the association between COVID-19 and arrhythmias by detailing possible pathophysiological mechanisms.
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Affiliation(s)
- Chunlian Wang
- Institute for Prevention and Control of Chronic Non-communicable Diseases, Harbin Center for Disease Control and Prevention, Harbin, China
| | - Wenqiang Hao
- The Second Ward of Internal Medicine, The Second Hospital of Heilongjiang Province, Harbin, China; ;
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Zhang W, Ling L, Li J, Li Y, Liu Y. Coronavirus disease 2019 and acute cerebrovascular events: a comprehensive overview. Front Neurol 2023; 14:1216978. [PMID: 37448747 PMCID: PMC10337831 DOI: 10.3389/fneur.2023.1216978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Since the Corona Virus Disease 2019 (COVID-19) pandemic, there has been increasing evidence that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with acute cerebrovascular events such as cerebral infarction, cerebral hemorrhage, and cerebral venous thrombosis. Although the mechanism of cerebrovascular complications among COVID-19 patients has not been adequately elucidated, the hypercoagulable state, excessive inflammation and ACE-2-associated alterations in the renin-angiotensin-aldosterone system after SARS-CoV-2 infection probably play an essential role. In this overview, we discuss the possible mechanisms underlying the SARS-CoV-2 infection leading to acute cerebrovascular events and review the characteristics of COVID-19-related acute cerebrovascular events cases and treatment options available worldwide.
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Affiliation(s)
- Wanzhou Zhang
- Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Li Ling
- Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Jie Li
- Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Yudi Li
- Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Yajie Liu
- Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
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Sisconetto AT, Sucupira KSMB, De Souza LAPS, Luvizutto GJ. Physiotherapeutic Approaches in the Rehabilitation of Patients After Severe Acute Respiratory Syndrome Coronavirus 2: A Scoping Review of In-Hospital Until Outpatient Phase. J Manipulative Physiol Ther 2023; 46:357-365. [PMID: 39412454 DOI: 10.1016/j.jmpt.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 09/05/2024] [Accepted: 09/05/2024] [Indexed: 11/30/2024]
Abstract
OBJECTIVES This scoping review aimed to identify studies that address the use of physical therapy in the rehabilitation of adult and elderly patients after SARS-CoV-2 infection. METHODS This scoping review was based on Joanna Briggs Institute methodology: participant (P), represented by adult and elderly patients after SARS-CoV-2; concept (C), main physical therapy interventions; and context (C), recovery period after SARS-CoV-2 (in-hospital or outpatient phase). The following information sources were used: MEDLINE/PubMed, Cochrane Library, PEDro, Scopus, CINAHL, Web of Science, Science Direct, and Springer. The search was conducted between December 2019 and November 2021. Rayyan (Qatar Computing Research Institute, QCRI) was used for study selection process and analysis. RESULTS A total of 7,568 studies were identified; 11 were included in this review. The most frequent physical therapy interventions were those associated with pulmonary, cardiac, musculoskeletal, neurological, and digestive rehabilitation in adult and elderly patients after SARS-CoV-2. Physiotherapy interventions included aerobic exercises, respiratory muscle training, muscle strength training, breathing exercises, early mobilization, balance training, bronchial hygiene maneuvers, body positioning management, flexibility training, cognitive training, neuromuscular electrical stimulation, and trunk exercises. CONCLUSION Our study demonstrated the growing utility of therapeutic interventions, mainly in improving quality of life, as well as body functions after pulmonary, cardiac, neurological, digestive, and musculoskeletal rehabilitation in patients after SARS-CoV-2.
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Astley C, Leal GN, Gil S, Suguita P, Fink T, Bain V, Pereira MFB, Marques HH, Sieczkowska S, Prado D, Lima MS, Carneiro CG, Buchpiguel CA, Silva CA, Gualano B. Home-Based Exercise Training in the Recovery of Multisystem Inflammatory Syndrome in Children: A Case Series Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050889. [PMID: 37238437 DOI: 10.3390/children10050889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the potential therapeutic role of exercise on health-related quality of life, assessed by the Pediatric Outcomes Data Collection Instrument (PODCI), coronary flow reserve (CFR), cardiac function, cardiorespiratory fitness, and inflammatory and cardiac blood markers in multisystemic inflammatory syndrome in children (MIS-C) patients. METHODS This is a case series study of a 12-wk, home-based exercise intervention in children and adolescents after MIS-C diagnosis. From 16 MIS-C patients followed at our clinic, 6 were included (age: 7-16 years; 3 females). Three of them withdrew before the intervention and served as controls. The primary outcome was health-related quality of life, assessed PODCI. Secondary outcomes were CFR assessed by 13N-ammonia PET-CT imaging, cardiac function by echocardiography, cardiorespiratory fitness, and inflammatory and cardiac blood markers. RESULTS In general, patients showed poor health-related quality of life, which seemed to be improved with exercise. Additionally, exercised patients showed improvements in coronary flow reserve, cardiac function, and aerobic conditioning. Non-exercised patients exhibited a slower pattern of recovery, particularly in relation to health-related quality of life and aerobic conditioning. CONCLUSIONS Our results suggest that exercise may play a therapeutic role in the treatment of post-discharge MIS-C patients. As our design does not allow inferring causality, randomized controlled trials are necessary to confirm these preliminary findings.
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Affiliation(s)
- Camilla Astley
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo 01246-903, Brazil
- Rheumatology Division, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 01246-903, Brazil
| | - Gabriela Nunes Leal
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Saulo Gil
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo 01246-903, Brazil
| | - Priscila Suguita
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Thais Fink
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Vera Bain
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Maria Fernanda Badue Pereira
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Heloisa Helena Marques
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Sofia Sieczkowska
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo 01246-903, Brazil
| | - Danilo Prado
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo 01246-903, Brazil
| | - Marcos Santos Lima
- Department of Radiology and Oncology, Nuclear Medicine Division, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 05403-911, Brazil
| | - Camila G Carneiro
- Department of Radiology and Oncology, Nuclear Medicine Division, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 05403-911, Brazil
| | - Carlos Alberto Buchpiguel
- Department of Radiology and Oncology, Nuclear Medicine Division, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 05403-911, Brazil
| | - Clovis Artur Silva
- Children and Adolescent Institute, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo 01246-903, Brazil
- Rheumatology Division, Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo 01246-903, Brazil
- Food Research Center, University of Sao Paulo, Sao Paulo 05508-080, Brazil
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Nayfeh M, Ahmed AI, Saad JM, Alahdab F, Al-Mallah M. The Role of Cardiac PET in Diagnosis and Prognosis of Ischemic Heart Disease: Optimal Modality Across Different Patient Populations. Curr Atheroscler Rep 2023:10.1007/s11883-023-01107-0. [PMID: 37162723 PMCID: PMC10170052 DOI: 10.1007/s11883-023-01107-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE OF REVIEW Despite single-photon emission computerized tomography (SPECT) being the most used nuclear imaging technique for diagnosis of coronary artery disease (CAD), many now consider positron emission tomography (PET) as a superior modality. This review will focus on the advances of cardiac PET in recent years and its advantages compared to SPECT in diagnosis and prognosis of CAD. RECENT FINDINGS PET's higher resolution and enhanced diagnostic accuracy, as well as lower radiation exposure, all help explain the rationale for its wider spread and use. PET also allows for measurement of myocardial blood flow (MBF) and myocardial flow reserve (MFR), which aids in several different clinical scenarios, such as diagnosing multivessel disease or identifying non-responders. PET has also been shown to be useful in diagnosing CAD in various specific populations, such as patients with prior COVID-19 infection, cardiac transplant, and other comorbidities.
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Affiliation(s)
- Malek Nayfeh
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ahmed Ibrahim Ahmed
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Jean Michel Saad
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Fares Alahdab
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Mouaz Al-Mallah
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.
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47
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Cheng A, Ren H, Ma Z, Alam N, Jia L, Liu E. Trends and characteristics of COVID-19 and cardiovascular disease related studies. Front Pharmacol 2023; 14:1105459. [PMID: 37180704 PMCID: PMC10166808 DOI: 10.3389/fphar.2023.1105459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction: The new coronavirus has caused a pandemic that has infected hundreds of millions of people around the world since its outbreak. But the cardiovascular damage caused by the new coronavirus is unknown. We have analyzed the current global scenario and the general pattern of growth. After summarizing the known relationship between cardiovascular diseases and new coronary pneumonia, relevant articles are analyzed through bibliometrics and visualization. Methods: Following our pre-designed search strategy, we selected publications on COVID-19 and cardiovascular disease in the Web of Science database. In our relevant bibliometric visualization analysis, a total of 7,028 related articles in the WOS core database up to 20th October 2022 were summarized, and the most prolific authors, the most prolific countries, and the journals and institutions that published the most articles were summarized and quantitatively analyzed. Results: SARS-CoV-2 is more infectious than SARS-CoV-1 and has significant involvement in the cardiovascular system in addition to pulmonary manifestations, with a difference of 10.16% (20.26%/10.10%) in the incidence of cardiovascular diseases. The number of cases increases in winter and decreases slightly in summer with temperature changes, but the increase in cases tends to break out of seasonality across the region as mutant strains emerge. The co-occurrence analysis found that with the progress of the epidemic, the research keywords gradually shifted from ACE2 and inflammation to the treatment of myocarditis and complications, indicating that the research on the new crown epidemic has entered the stage of prevention and treatment of complications. Conclusion: When combined with the current global pandemic trend, how to improve prognosis and reduce human body damage could become a research focus. At the same time, timely detection, prevention, and discovery of new mutant strains have also become key tasks in the fight against the epidemic, and full preparations have been made to prevent the spread of the next wave of mutant strains, and still need to continue to pay attention to the differential performance of the variant "omicron."
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Affiliation(s)
| | | | | | | | - Linying Jia
- Laboratory Animal Centre, Xi’an Jiaotong University Health Science Centre, Xi’an, Shaanxi, China
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48
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Mojón-Álvarez D, Izquierdo A, Cubero-Gallego H, Calvo-Fernández A, Marrugat J, Pérez-Fernández S, Cabero P, Solà-Richarte C, Soler C, Farré N, Vaquerizo B. The natural history of QTc interval and its clinical impact in coronavirus disease 2019 survivors after 1 year. Front Cardiovasc Med 2023; 10:1140276. [PMID: 37089886 PMCID: PMC10117953 DOI: 10.3389/fcvm.2023.1140276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
Background and objectiveProlonged QTc interval on admission and a higher risk of death in SARS-CoV-2 patients have been reported. The long-term clinical impact of prolonged QTc interval is unknown. This study examined the relationship in COVID-19 survivors of a prolonged QTc on admission with long-term adverse events, changes in QTc duration and its impact on 1-year prognosis, and factors associated with a prolonged QTc at follow-up.MethodsWe conducted a single-center prospective cohort study of 523 SARS-CoV-2-positive patients who were alive on discharge. An electrocardiogram was taken on these patients within the first 48 h after diagnosis and before the administration of any medication with a known effect on QT interval and repeated in 421 patients 7 months after discharge. Mortality, hospital readmission, and new arrhythmia rates 1 year after discharge were reviewed.ResultsThirty-one (6.3%) survivors had a baseline prolonged QTc. They were older, had more cardiovascular risk factors, cardiac disease, and comorbidities, and higher levels of terminal pro-brain natriuretic peptide. There was no relationship between prolonged QTc on admission and the 1-year endpoint (9.8% vs. 5.5%, p = 0.212). In 84% of survivors with prolonged baseline QTc, it normalized at 7.9 ± 2.2 months. Of the survivors, 2.4% had prolonged QTc at follow-up, and this was independently associated with obesity, ischemic cardiomyopathy, chronic obstructive pulmonary disease, and cancer. Prolonged baseline QTc was not independently associated with the composite adverse event at 1 year.ConclusionsProlonged QTc in the acute phase normalized in most COVID-19 survivors and had no clinical long-term impact. Prolonged QTc at follow-up was related to the presence of obesity and previously acquired chronic diseases and was not related to 1-year prognosis.
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Affiliation(s)
- Diana Mojón-Álvarez
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Andrea Izquierdo
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Héctor Cubero-Gallego
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- IMIM, Heart Disease Biomedical Research Group, Barcelona, Spain
| | - Alicia Calvo-Fernández
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, Spain
| | - Jaume Marrugat
- CIBER Group in Epidemiology and Public Heath (CIBERCV), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- REGICOR (Registre Gironí del Cor) Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Silvia Pérez-Fernández
- Scientific Coordination Facility, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Paula Cabero
- Cardiology Department, Hospital del Mar, Barcelona, Spain
| | | | - Cristina Soler
- Cardiology Department, Hospital del Mar, Barcelona, Spain
| | - Núria Farré
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
- IMIM, Heart Disease Biomedical Research Group, Barcelona, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, Spain
| | - Beatriz Vaquerizo
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
- IMIM, Heart Disease Biomedical Research Group, Barcelona, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, Spain
- CIBER Group in Epidemiology and Public Heath (CIBERCV), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Correspondence: Beatriz Vaquerizo
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Mao S, Cai X, Niu S, Wei J, Jiang N, Deng H, Wang W, Zhang J, Shen S, Ma Y, Wu X, Peng Q, Huang A, Wang D. TRIM21 promotes ubiquitination of SARS-CoV-2 nucleocapsid protein to regulate innate immunity. J Med Virol 2023; 95:e28719. [PMID: 37185839 DOI: 10.1002/jmv.28719] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Abstract
The innate immune response is the first line of host defense against viral infections, but its role in immunity against SARS-CoV-2 remains unclear. By using immunoprecipitation coupled with mass spectroscopy, we observed that the E3 ubiquitin ligase TRIM21 interacted with the SARS-CoV-2 nucleocapsid (N) protein and ubiquitinated it at Lys375 . Upon determining the topology of the TRIM21-mediated polyubiquitination chain on N protein, we then found that polyubiquitination led to tagging of the N protein for degradation by the host cell proteasome. Furthermore, TRIM21 also ubiquitinated the N proteins of SARS-CoV-2 variants of concern, including Alpha, Beta, Gamma, Delta, and Omicron together with SARS-CoV and MERS-CoV variants. Herein, we propose that ubiquitylation and degradation of the SARS-CoV-2 N protein inhibited SARS-CoV-2 viral particle assembly, by which it probably involved in preventing cytokine storm. Eventually, our study has fully revealed the association between the host innate immune system and SARS-CoV-2 N protein, which may aid in developing novel SARS-CoV-2 treatment strategies.
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Affiliation(s)
- Shenglan Mao
- Department of Laboratory Medicine, Chongqing Medical University, Chongqing, China
- The Key Laboratory of Molecular Biology of Infectious Diseases designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Xuefei Cai
- The Key Laboratory of Molecular Biology of Infectious Diseases designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Siqiang Niu
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Wei
- Department of Clinical Laboratory, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong, China
| | - Ning Jiang
- School of Basic Medical Science, Chongqing Medical University, Chongqing, China
| | - Haijun Deng
- The Key Laboratory of Molecular Biology of Infectious Diseases designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Wen Wang
- Department of Laboratory Medicine, Chongqing Medical University, Chongqing, China
- The Key Laboratory of Molecular Biology of Infectious Diseases designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Jing Zhang
- Department of Laboratory Medicine, Chongqing Medical University, Chongqing, China
- The Key Laboratory of Molecular Biology of Infectious Diseases designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Shimei Shen
- Department of Laboratory Medicine, Chongqing Medical University, Chongqing, China
- The Key Laboratory of Molecular Biology of Infectious Diseases designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Yuanyan Ma
- Department of Laboratory Medicine, Chongqing Medical University, Chongqing, China
- The Key Laboratory of Molecular Biology of Infectious Diseases designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Xiaoli Wu
- Department of Laboratory Medicine, Chongqing Medical University, Chongqing, China
- The Key Laboratory of Molecular Biology of Infectious Diseases designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Qiling Peng
- School of Basic Medical Science, Chongqing Medical University, Chongqing, China
| | - Ailong Huang
- The Key Laboratory of Molecular Biology of Infectious Diseases designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Deqiang Wang
- Department of Laboratory Medicine, Chongqing Medical University, Chongqing, China
- The Key Laboratory of Molecular Biology of Infectious Diseases designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
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50
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Matino E, Tavella E, Rizzi M, Avanzi GC, Azzolina D, Battaglia A, Becco P, Bellan M, Bertinieri G, Bertoletti M, Casciaro GF, Castello LM, Colageo U, Colangelo D, Comolli D, Costanzo M, Croce A, D’Onghia D, Della Corte F, De Mitri L, Dodaro V, Givone F, Gravina A, Grillenzoni L, Gusmaroli G, Landi R, Lingua A, Manzoni R, Marinoni V, Masturzo B, Minisini R, Morello M, Nelva A, Ortone E, Paolella R, Patti G, Pedrinelli A, Pirisi M, Ravizzi L, Rizzi E, Sola D, Sola M, Tonello N, Tonello S, Topazzo G, Tua A, Valenti P, Vaschetto R, Vassia V, Zecca E, Zublena N, Manzoni P, Sainaghi PP. Effect of Lactoferrin on Clinical Outcomes of Hospitalized Patients with COVID-19: The LAC Randomized Clinical Trial. Nutrients 2023; 15:1285. [PMID: 36904283 PMCID: PMC10005739 DOI: 10.3390/nu15051285] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
As lactoferrin is a nutritional supplement with proven antiviral and immunomodulatory abilities, it may be used to improve the clinical course of COVID-19. The clinical efficacy and safety of bovine lactoferrin were evaluated in the LAC randomized double-blind placebo-controlled trial. A total of 218 hospitalized adult patients with moderate-to-severe COVID-19 were randomized to receive 800 mg/die oral bovine lactoferrin (n = 113) or placebo (n = 105), both given in combination with standard COVID-19 therapy. No differences in lactoferrin vs. placebo were observed in the primary outcomes: the proportion of death or intensive care unit admission (risk ratio of 1.06 (95% CI 0.63-1.79)) or proportion of discharge or National Early Warning Score 2 (NEWS2) ≤ 2 within 14 days from enrollment (RR of 0.85 (95% CI 0.70-1.04)). Lactoferrin showed an excellent safety and tolerability profile. Even though bovine lactoferrin is safe and tolerable, our results do not support its use in hospitalized patients with moderate-to-severe COVID-19.
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Affiliation(s)
- Erica Matino
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Elena Tavella
- Department of Maternal-Infant Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
- Internal Medicine, Department of Medical Sciences, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza, University of Turin School of Medicine, 10126 Turin, Italy
| | - Manuela Rizzi
- Department of Health Sciences, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Danila Azzolina
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Antonio Battaglia
- Division of Dermatology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Paolo Becco
- Division of Oncology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Giovanni Bertinieri
- Division of Internal Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | | | - Giuseppe Francesco Casciaro
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Division of Internal Medicine, Azienda Ospedaliera “SS. Antonio e Biagio e Cesare Arrigo”, 15121 Alessandria, Italy
| | - Umberto Colageo
- Intensive Care Unit, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Donato Colangelo
- Department of Health Sciences, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Davide Comolli
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Martina Costanzo
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Alessandro Croce
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Davide D’Onghia
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Francesco Della Corte
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Anesthesia and Intensive Care Medicine, AOU “Maggiore della Carità”, 28100 Novara, Italy
| | - Luigi De Mitri
- Division of Diabetology and Endocrinology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Valentina Dodaro
- Internal Medicine, Department of Medical Sciences, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza, University of Turin School of Medicine, 10126 Turin, Italy
| | - Filippo Givone
- Division of Pneumology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Alessia Gravina
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Luca Grillenzoni
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | | | - Raffaella Landi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Anna Lingua
- Division of Infectious Disease, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Roberto Manzoni
- Division of Dermatology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Vito Marinoni
- Division of Geriatric Care, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Bianca Masturzo
- Division of Obstetrics and Gynecology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Rosalba Minisini
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Marina Morello
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Anna Nelva
- Division of Diabetology and Endocrinology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Elena Ortone
- Division of Geriatric Care, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Rita Paolella
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Medical Department, Division of Cardiology, AOU “Maggiore della Carità”, 28100 Novara, Italy
| | - Anita Pedrinelli
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Lidia Ravizzi
- Division of Pneumology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Eleonora Rizzi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Daniele Sola
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Mariolina Sola
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Nadir Tonello
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Stelvio Tonello
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Gigliola Topazzo
- Division of Diabetology and Endocrinology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Aldo Tua
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Piera Valenti
- Department of Public Health and Infectious Diseases, University of Rome, La Sapienza, 00185 Rome, Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Anesthesia and Intensive Care Medicine, AOU “Maggiore della Carità”, 28100 Novara, Italy
| | - Veronica Vassia
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Erika Zecca
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Nicoletta Zublena
- Division of Palliative Care, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Paolo Manzoni
- Department of Maternal-Infant Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
- Internal Medicine, Department of Medical Sciences, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza, University of Turin School of Medicine, 10126 Turin, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
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