Continuity of Latin American crises and struggles in times of pandemic

After numerous mobilizations during 2019, the health crisis at the beginning of 2020 led to the implementation of multiple restrictive measures, limiting or prohibiting travel and gatherings in the public space in several Latin American countries. The severity of these measures and the choice of designating armed actors for their enforcement suggest that social and political struggles have come to a halt. Based on Chilean, Guatemalan and Venezuelan cases, selected for their great disparities, this paper argues that the health situation plays only a marginal role in the evolution of mobilization dynamics. More broadly, the pandemic does not seem to imply any fundamental upheaval in the evolution of social movements. © 2022 Institut des Hautes Etudes de l'Amerique Latine (IHEAL). All rights reserved.

Cardiovascular manifestations secondary to COVID-19: A narrative review.

The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly, becoming a major threat to global health. In addition to having required the adaptation of healthcare workers for almost 2 years, it has been much talked about, both in the media and among the scientific community. Beyond lung damage and respiratory symptoms, the involvement of the cardiovascular system largely explains COVID-19 morbimortality. In this review, we emphasize that cardiovascular involvement is common and is associated with a worse prognosis, and that earlier detection by physicians should lead to better management. First, direct cardiac involvement will be discussed, in the form of COVID-19 myocarditis, then secondary cardiac involvement, such as myocardial injury, myocardial infarction and arrhythmias, will be considered. Finally, worsening of previous cardiovascular disease as a result of COVID-19 will be examined, as well as long-term COVID-19 effects and cardiovascular complications of COVID-19 vaccines.

COVID-19 in young patients: Less cardiovascular risk factors but more specific cardiovascular complications

Background Main features of COVID-19 patients have been reported in the literature. While young patients under 45 years old (y/o) account for a non-negligible part of hospitalized patients, data on this population remain sparse. Purpose To describe the characteristics and outcomes of hospitalized COVID-19 young patients (< 45 y/o). Methods The Critical COVID France (CCF) study was an observational multicenter study including patients hospitalized for COVID-19. Primary composite outcome included transfer to ICU or in-hospital death. Secondary outcomes were cardiovascular complications diagnosed by the referring medical team according to available clinical, biological and radiological findings. Results Among 2,878 patients hospitalized for COVID-19 in 24 centers, 321 (11.2%) patients were under the age of 45 y/o. They had a higher body mass index (BMI) (28.9 ± 6.6 vs 27.7 ± 6.0, P = 0.004) but less other cardiovascular risk factors including hypertension (29 (9.2%) vs. 1422 (56.1%), P < 0.001), diabetes (20 (6.3%) vs. 656 (25.9%), P < 0.001) and dyslipidemia (15 (4.7%) vs. 783 (30.7%), P < 0.001). The primary outcome occurred in 54 (16.8%) patients under 45 y/o vs. 783 (30.7%) in patients aged > 45 y/o (P < 0.001), with a strong impact on the death rate (3 (0.9%) vs. 358 (14.0%), P < 0.001). The group under 45 y/o experienced more frequently related COVID-19 cardiovascular complications such as pericarditis (12 (0.5%) vs. 7 (2.2%), P = 0.003) and myocarditis (14 (0.6%) vs 8 (2.5%), P = 0.002). Conversely, acute heart failure occurred more frequently in patients aged > 45 y/o (183 (7.2%) vs. 3 (0.9%), P < 0.001). Acute coronary syndrome and stroke were similar between the two groups (Fig. 1). Conclusion In this nationwide multicenter observational study of hospitalized COVID-19 patients, patients under the age of 45 y/o had less cardiovascular risk factors but more specific related COVID-19 cardiovascular complications such as pericarditis and myocarditis.

Prognostic value of right ventricular dilatation in patients with COVID-19: A multicentre study

Introduction: Although cardiac involvement has prognostic significance in COVID-19 and is associated with severe presentations, few studies have explored the prognostic role of transthoracic echocardiography (TTE). We investigated the link between TTE parameters and prognosis in COVID-19. Method: Consecutive patients with COVID-19 admitted in 24 French hospitals were retrospectively included. Comprehensive data, including clinical and biological parameters, were recorded at admission. Focused TTE was performed during hospitalization, according to clinical indication. Patients were followed-up for a primary composite outcome of death or transfer to intensive care unit (ICU) during hospitalization. Results: Among 2878 patients, 445 (15%) underwent TTE. Most had cardiovascular risk factors, a history of cardiovascular disease, and were under cardiovascular medications. Dilatation and dysfunction were observed in12% (48/412) and 23% (102/442) of patients for the left ventricle, and in 12% (47/407) and 16% (65/402) for the right ventricle (RV), respectively. Primary composite outcome occurred in 44% (n = 196) of patients (9% [n = 42] for death without ICU transfer and 35% [n = 154] for admission to ICU). RV dilatation was the only TTE parameter associated with the primary outcome. After adjustment, male sex (hazard ratio [HR] 1.56, 95% CI 1.09 − 2.25;P = 0.02), higher body mass index (HR 1.10, 95% CI 1.02 − 1.18;P = 0.01), anticoagulation (HR 0.53, 95% CI 0.33 − 0.86;P = 0.01), and RV dilatation (HR 1.66, 95% CI 1.05 − 2.64;P = 0.03) remained independently associated with the primary outcome (Fig. 1). Conclusion: Echocardiographic evaluation of RV dilatation could be useful for assessing the risk of inhospital death or transfer to ICU in severe hospitalized COVID-19 patients.

Cardiovascular Comorbidities and Covid-19 in Women

Background: While women account for 40-50 % of patients hospitalized for coronavirus disease 2019 (Covid-19), no specific data have been reported in this population. Purpose: Assess the burden of cardiovascular comorbidities on outcomes in women hospitalized for Covid-19. Methods: We conducted a retrospective observational multicenter study from February 26 to April 20, 2020 in 24 French hospitals including all adults admitted for Covid-19. Primary composite outcome included transfer to intensive care unit (ICU) or in-hospital death. Results: Among 2878 patients hospitalized for Covid-19, 1212 (42.1 %) were women. Women were significantly older (68.3 ± 18.0 vs. 65.4 ± 16.0 years, P < 0.001) but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8 %) experienced the primary outcome, including 161 (13.3 %) transfer to ICU and 115 (9.5 %) deaths without transfer to ICU. The survival free from death or transfer to ICU was higher in women (HR 0.63, 95 %CI 0.53-0.73, P < 0.001), whereas the observed difference in in-hospital deaths did not reach statistical significance (P = 0.18). The proportion of women that experienced the primary outcome were 37.8 % in women with heart failure (n = 112), 30.9 % in women with coronary artery disease (n = 81), 29.1 % in women with diabetes (n = 254), 26.1 % in women with dyslipidemia (n = 315), and 26.0 % in women with hypertension (n = 632). Age (HR 1.05, 5 years increments, 95 %CI 1.01-1.10), body mass index (HR 1.06, 2 units increments, 95 %CI 1.02-1.10), chronic kidney disease (HR 1.57, 95 %CI 1.11-2.22), and heart failure (HR 1.52, 95 %CI 1.04-2.22) were independently associated with the primary outcome (Fig. 1). Conclusions: Women hospitalized for Covid-19 were older and had less prevalent cardiovascular comorbidities than men. While female sex was associated with a lower risk of transfer to ICU or in-hospital death, Covid-19 remains associated with considerable morbi-mortality in women, especially in those with cardiovascular diseases.

Pulmonary Embolism in Covid-19 patients: A French Multicentre Cohort Study

Background: While pulmonary embolism (PE) appears to be a major issue in Covid-19, data remain sparse. Purpose: We aimed to describe the risk factors and baseline characteristics of patients with PE in a large cohort of Covid-19 patients. Methods: In a retrospective multicentric observational study, we included consecutive hospitalised patients for Covid-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis, those who were directly admitted to an intensive care unit (ICU), and those still hospitalised without PE experience were excluded. Results: Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer requirement and mechanical ventilation requirement were significantly higher in the PE group (P < 0.001 and P < 0.001, respectively). In an univariable analysis, traditional venous thromboembolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic-dose anticoagulation before hospitalisation or prophylaxis-dose anticoagulation introduced during hospitalisation had lower PE occurrence (OR 0.40, 95%CI(0.14-0.91);P = 0.04 and OR 0.11, 95%CI(0.06-0.18);P < 0.001, respectively). In a multivariable analysis, the following variables (also statistically significant in univariable analysis) were associated with PE: male gender (OR 1.03, 95%CI(1.003-1.069);P = 0.04), anticoagulation with prophylaxis-dose (OR 0.83, 95%CI(0.79-0.85), P < 0.001) or therapeutic-dose (OR 0.87, 95%CI(0.82-0.92), P < 0.001), C-reactive protein (OR 1.03, 95%CI(1.01-1.04), P = 0.001) and time from symptom onset to hospitalisation (OR 1.02, 95%CI(1.006-1.038), P = 0.002) (Table 1). Conclusion: Pulmonary embolism risk factors in Covid-19 context do not include traditional thromboembolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.