OUTCOMES IN PATIENTS WITH COVID-19 COMPLICATED BY HIGH GRADE ATRIOVENTRICULAR BLOCK

Background: There is growing evidence showing that arrhythmias are one of the major complications of COVID-19.However, there are currently only a few case reports of high-grade atrioventricular block (AVB). We sought to describe a large case series of AVB as a complication of COVID-19. Objective: The purpose of the current study is to describe a large case series of AVB as a complication of COVID-19. Methods: We included a series of twenty-five (25)consecutive patients with confirmed COVID-19, who developed advanced AVB in a prospective observational multi-center study. Patients underwent clinical, laboratory evaluation, Holter, telemetry, Echocardiogram, Chest X-Ray, chest CT scan and cardiac MRI Results: Of the 25 patients 13 were male with a mean age of 62+-13 years. 19 developed complete AVB, one a 3:1 AVB and five 2:1 AVB. None of the patients had a history of cardiac arrhythmia. AVB was not related to medication or intubation. Eighteen patients developed AVB during their hospitalization for COVID-19 and 7 after the first month as a late sequela. Five patients were asymptomatic, 6 presented syncope, seven dyspnea and seven dizziness. Eleven patients presented reverse AVB early by a high dose of corticosteroid in all of them, and combined with colchicine in 4 cases, with no recurrent episodes. 13 patients required a permanent pacemaker for persistent conduction defect (52%) and one died of ventricular fibrillation without pacemaker Conclusion: Advanced AVB could be a complication of COVID-19. The conduction disturbance was reversed by corticosteroids with or without colchicine in eleven of twenty five cases (44%)The resolution with corticosteroids of the advanced AVB in these patients could reflect the transient nature of the viral infection and the inflammatory response associated with it in some patients. 13 patients required a pacemaker(52%). Physicians should be aware of this complication.

[COVID suspected patients in Primary Care in Madrid at the beginning of first wave: Clinical characteristics and healthcare assistance.]

OBJECTIVE: Primary Care (PC) must attend and follow COVID-19 patients with mild and moderate symptoms, and identify severe cases. The aim of this study was to describe the characteristics of patients attended in PC with suspicious COVID-19 and health care provision by PC. METHODS: Retrospective longitudinal observational study of electronic health records (EHR) and agendas. Probabilistic sampling of suspicious COVID-19 patients' pathway in 5 health centers in Madrid between March 16 and 20, 2020. The variables used were sociodemographic, symptoms, examination, radiography, characteristics of schedules and professional sick leaves. Descriptive analysis and time to event (pneumonia). RESULTS: 240 EHR were reviewed. Average age 48 years, 60% women. Most frequent symptoms: cough (80%) and elevation of temperature (63%). Pneumonia appeared in 23%. 73% were bilateral. Age and male gender were related to pneumonia. 20% required admission. 7 patients died (2.9%). 19,027 COVID-19 appointments were scheduled in PC. 60% of patients were attended in PC without performing chest X-ray or assistance by other care level. 22.4% of GPs working days were absent because of sick leaves. Differences were found amongst facilities in chest X-ray requesting (max. 62%, min. 2%). The PC center with the fewest X-rays requested was the one with the major number of sick leaves. CONCLUSIONS: Age and male gender were related to pneumonia onset in PC. Health care activity was intense, and variability was found amongst facilities. Professional sick leaves could affect the quality of care.

Al2O3referenced microring resonators for the detection of interleukin-6

Concentrations down to 300 pM of the interleukin-6 biomarker, identified as an inflammatory marker for severe COVID-19 infection, have been detected in buffer using referenced microring resonators in the emerging Al2O3 integrated photonic platform. Antifouling was achieved by applying an Xantec HC1000M hydrogel. © 2021 IEEE.

Advanced atrio-ventricular block in patients with active covid-19 infection

Introduction: Cardiac arrhythmia is a frequent complication of COVID-19, However, there are currently only a few case reports of advanced atrioventricular block (AVB). Hypothesis: We sought to describe a case series of AVB as a complication of COVID-19. Methods: We included a series of ten (10) consecutive patients with confirmed COVID-19, who developed advanced AVB in a prospective observational multi-center study. Patients underwent clinical, laboratory evaluation, Holter, telemetry, Echocardiogram, Chest X-Ray, chest CT scan and cardiac MRI. Results: Of the ten (10) patients, 5 were female (50%) with a mean age of 62,7 +-11,5 years. Eight (8) developed complete AVB, one a 3:1 AVB and one 2:1 AVB. None of the patients had a history of cardiac arrhythmia AVB was not related to medication or intubation. Six patients developed AVB during their hospitalization for COVID-19 and 4 after the first month as a late sequela. Four patients were asymptomatic, one presented syncope, two dyspnea and two dizziness. Six patients presented reverse AVB early by a high dose of corticosteroid in six and colchicine in 3 cases, with no recurrent episodes.Four patients required a permanent pacemaker for persistent conduction defect. Conclusions: Advanced AVB could be a complication of COVID-19. The conduction disturbance was reversed by corticosteroids with or without colchicine in six of ten cases The resolution with corticosteroids of the advanced AVB in these patients could reflect the transient nature of the viral infection and the inflammatory response associated with it in some patients. Four patients required a pacemaker. Physicians should be aware of this complication.

Finding answers in lipid profile in COVID-19 patients.

INTRODUCTION: A small percentage of patients will develop a severe form of COVID-19 caused by SARS-CoV-2 infection. Thus, it is important to predict the potential outcomes identifying early markers of poor prognosis. In this context, we evaluated the association of SARS-CoV-2 infection with lipid abnormalities and their role in prognosis. METHODS: Single-center, retrospective, observational study of COVID-19 patients admitted from March to October 2020. Clinical and laboratory data, comorbidities, and treatments for COVID-19 were evaluated. Main outcomes including intensive care unit (ICU) admission and mortality were analyzed with a multivariable Cox proportional hazards regression model. RESULTS: We selected 1489 from a total of 2038 consecutive patients with confirmed COVID-19, who had a complete lipid profile before ICU admission. During the follow-up performed in 1109 patients, we observed a decrease in T-c, HDL-c, and LDL-c in 28.6%, 42.9%, and 30.4% of patients, respectively, and an increase in TG in 76.8%. The decrease of both T-c and HDL- c was correlated with a decrease in albumin levels (r = 0.39 and r = 0.37, respectively). Kaplan-Meier survival curves found an increased ICU admission in patients with lower T-c (HR 0.55, CI 0.36-0.86), HDL-c (HR 0.61, CI 0.45-0.84), and LDL-c (HR 0.85, CI 0.74-0.97). Higher values of T-c (HR 0.45, CI 0.36-0.57), HDL-c (HR 0.66, CI 0.54-0.81), and LDL-c (HR 0.86, CI 0.78-0.94) showed a protective effect on mortality. CONCLUSIONS: Abnormalities in lipid profile are a frequent complication of SARS-CoV-2 infection and might be related to morbidity and mortality. FUNDING: Proyectos de Investigación en Salud (FIS) and cofinanced by FEDER.

Clinical characteristics of SARS-CoV-2 pneumonia diagnosed in a primary care practice in Madrid (Spain)

BACKGROUND: Possible cases of SARS-CoV-2 infection were diagnosed in primary care in Madrid, some of these cases had pneumonia. Most of the SARS-CoV-2 pneumonia published data came from hospitalised patients. This study set out to describe clinical characteristics of patients with SARS-CoV-2 pneumonia diagnosed in primary care across age groups and type of pneumonia. METHODS: Observational retrospective study obtaining clinical data from the electronic health records of patients who were followed-up by SARS-CoV-2 possible infection in a primary care practice in Madrid. All the cases were collected by in-person or remote consultation during the 10th March to the 7th of April. EXPOSURE: Diagnosis of SARS-CoV-2 pneumonia by chest X-ray ordered by the GP. Main outcomes and measures: Symptoms of SARS-CoV-2 pneumonia, physical examination and diagnostic tests as a blood test, nasopharyngeal swab results for RT-PCR (Reverse transcriptase-polymerase chain reaction) and chest X-ray results. RESULTS: The overall SARS-CoV-2 pneumonias collected were 172 (female 87 [50.6%], mean age 60.5 years standard deviation [SD] 17.0). Comorbidities were body mass index >= 25 kg/m² (90 [52.3%]), hypertension (83 [48.3%]), dyslipidaemia (68 [39.5%]) and diabetes (33 [19.2%]). The sample was stratified by age groups (< 50 years, 50-75 years and >= 75 years). Clinical manifestations at onset were fever (144 [83.7%]), cough (140 [81.4%]), dyspnoea (103 [59.9%]) and gastrointestinal disturbances (72 [41.9%]). Day 7.8 (SD:4.1) from clinical onset was the mean day of pneumonia diagnosis. Bilateral pneumonia was more prevalent than unilateral (126 [73.3%] and 46 [26.7%]). Patients with unilateral pneumonia were prone to higher pulse oximetry (96% vs 94%, p < 0.001). We found differences between unilateral and bilateral cases in C-reactive protein (29.6 vs 81.5 mg/L, p < 0.001), and lymphocytes (1400.0 vs 1000.0E3/ml, p < 0.001). Complications were registered: 42 (100%) of patients >= 75 years were admitted into hospital;pulmonary embolism was only present at bilateral pneumonia (7 patients [5.6%]) and death occurred in 1 patient with unilateral pneumonia (2.2%) vs 10 patients (7.9%) with bilateral pneumonia ( p 0.170). CONCLUSION: Clinical manifestations of SARS-CoV-2 pneumonia were fever, cough and dyspnoea;this was especially clear in the elderly. We described different characteristics between unilateral and bilateral pneumonia.

Proposal of adaptation of the performance protocols in interventional cardiology during COVID-19

The current epidemiological situation forces the health services to be restructured to stop the pandemic of the new coronavirus. In Cuba, cardiovascular diseases are the leading cause of death and there is evidence that increases the risk of mortality during SARS-CoV-2 infection. Some countries show delayed attendance of cardiovascular emergency services, with fear of seeking attention during the pandemic. To raise the quality of medical care and decrease the risk of contagion in the population and health personnel in this complex epidemiological scenario, this article proposes an adaptation of the protocols of intervention in interventional cardiology. Flow charts are developed for decision-making in the diagnosis of acute coronary syndrome and their invasive behavior and structural pathology. © 2020, Cuban Society of Cardiology, Cuban Institute of Cardiology and Cardiovascular Surgery. All rights reserved.

Neutrophil lymphocyte index, heart and covid-19

Infection with the new SARS-CoV2 coronavirus, which causes COVID-19 disease, causes myocardial damage in a significant subgroup of patients. This has been related to the presence of systemic and myocardial inflammation where various inflammatory markers are involved, one of them being the lymphocyte neutrophil ratio. The objective of this article is to describe the relationship of the lymphocytic neutrophil ratio, as a cardiac biomarker, with the myocardial damage that can appear during infection by the disease. A non-systematic review of the evidence published in different databases was carried out and 37 bibliographies on the subject were selected. © 2020, Cuban Society of Cardiology, Cuban Institute of Cardiology and Cardiovascular Surgery. All rights reserved.