Gender differences in genotypic distribution of endothelin-1 gene and endothelin receptor A gene in pulmonary hypertension associated with rheumatic mitral valve disease

Introduction: The female gender is a risk factor for idiopathic pulmonary arterial hypertension. However, it is unknown whether females with rheumatic mitral valve disease are more predisposed to develop pulmonary hypertension compared to males. Aim: We aimed to investigate whether there was a difference in genotypic distribution of endothelin-1 (ET-1) and endothelin receptor A (ETA) genes between female and male patients of pulmonary hypertension associated with rheumatic mitral valve disease (PH-MVD). Methods: We compared prevalence of ET-1 gene (Lys198Asn) and ETA gene (His323His) polymorphisms according to gender in 123 PH-MVD subjects and 123 healthy controls. Results: The presence of mutant Asn/Asn and either mutant Asn/Asn or heterozygous Lys/Asn genotypes of Lys198Asn polymorphism when compared to Lys/Lys in females showed significant association with higher risk (odds ratio [OR] 4.5; p ¼0.007 and OR 2.39; p ¼0.02, respectively). The presence of heterozygous C/T and either mutant T/T or heterozygous C/T genotypes of His323His polymorphism when compared to wild C/C genotype in females showed a significant association with higher risk (OR 1.96; p ¼0.047 and OR 2.26; p ¼0.01, respectively). No significant difference was seen in genotypic frequencies in males between PH-MVD subjects and controls. Logistic regression analysis showed that mutant genotype Asn/Asn (p ¼0.007) and heterozygous genotype Lys/Asn of Lys198Asn polymorphism (p ¼0.018) were independent predictors of development of PH in females.

Outcome of patients with COVID pneumonia on High Flow Nasal Oxygen Therapy

Background & Aims: The coronavirus pandemic has caused a rapid surge in patients requiring intensive care unit (ICU) admission. The mainstay of treatment is supplemental oxygen therapy by an oxygen mask, nonrebreathing mask, high flow nasal oxygen therapy (HFNOT), non-invasive and invasive mechanical ventilation. HFNOT is a relatively newer, easy-to-use technique with better patient compliance. This study aimed to assess the outcome of HFNOT in Corona Virus disease (COVID) patients in ICU. Methods: This record based; retrospective study included 43 reverse transcriptase polymerase chain reaction (RTPCR) confirmed COVID patients whose respiratory support was initiated on HFNOT as per the inclusion criteria. The primary outcome of this study was to assess the number of patients requiring mechanical ventilation (HFNOT failure). The secondary outcome was to assess the association of HFNOT failure with age, co-morbidity index, and severity of illness. Results: Out of forty-three patients, twenty-five patients (58%) required conversion to mechanical ventilation. Eighteen patients (42%) were managed with HFNOT alone. HFNOT failure was more with increasing age and higher comorbidity score (p value<0.05). Conclusion: We concluded that HFNOT can be successfully used in COVID patients in ICU without the need for mechanical ventilation. However, it should be used cautiously in patients with higher 4C mortality scores.