IT IS SOMETHING MAKING THE DIFFERENCE BETWEEN HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME VERSUS HYPERTENSIVE PATIENTS WITHOUT METABOLIC SYNDROME IN SARS-COV-2 INFECTION?

Objective: The aim of the study was to compare the clinical particularities and the lab tests in hypertensive patients with metabolic syndrome, versus hypertensive patients without metabolic syndrome, admitted for SARS-COV2 infection. Design and method: We performed a retrospective study on 217 patients admitted to a Clinical Emergency Hospital between January 2021 and October 2021. Results: We had 217 patients admitted in internal medicine clinic for infection with SARS-COV2 virus. Patients with hypertension and metabolic syndrome (subgroup 1, 93 patients) were aged between 37 and 91 years (average age of 69 years). Patients with hypertension without metabolic syndrome (subgroup 2, 55 patients) were aged between 47 and 97 (average age of 72 years). Gender distribution in subgroup 1: 50% male, 50% female. In the subgroup 2, the gender distribution was: 51.52% male, 48.48% female. At admission, the stages of SARS-COV2 infection in subgroup 1, according to CT examination, were severe in 54.41%, moderate in 27.94%, and mild in 17.64%, and in subgroup 2 were severe in 47.16%, moderate in 24.52%, and mild in 28.30%. As comorbidities in subgroup 1: cancer in 5.88%, chronic heart failure in 26.47% of cases, atherosclerosis in 55.88%, COPD in 7.35%, depression in 7.35% and dementia in 5.88% of cases. In subgroup 2 the comorbidities were: cancer in 4.55% of patients, chronic heart failure in 36.36% of patients, atherosclerosis in 62.12%, COPD in 4.55%, depression in 3.03%, dementia in 10.61% of patients. High levels of the inflammatory markers in subgroup 1: CRP in 98.53% of cases, D-dimers in 85.29%, NT-proBNP in 76.34%, IL6 in 83.87%. In subgroup 2: high levels of CRP in 93.94% of cases, D-dimers in 84.85%, NT-proBNP in 69.09%, IL6 in 83.63%. Permanent atrial fibrillation was more prevalent in subgroup 2 (18.18% of cases) compared to subgroup 1 (9.67% of cases) while the prevalence of paroxysmal atrial fibrillation was higher in subgroup 1 (5.45% versus 8.60% of cases). Conclusions: Increased NT-proBNP and paroxysmal atrial fibrillation had a higher prevalence in patients with hypertension and metabolic syndrome for the same age group and degree of SARS-COV2 pulmonary infection.

PARTICULARITIES OF HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME, ADMITTED FOR SARS-COV-2 INFECTION TO A CLINICAL EMERGENCY HOSPITAL

Objective: The aim of the study was to assess the clinical particularities and the lab tests in hypertensive patients with metabolic syndrome, admitted for SARSCOV2 infection. Design and method: We performed a retrospective study on 217 patients admitted to a Clinical Emergency Hospital between January 2021 and October 2021. Results: We had 217 patients admitted in internal medicine clinic for infection with SARS-COV2 virus, most of them with moderate and severe form of disease. From them, 148 patients (68.20%) had hypertension on admission and 114 patients (52.53%) had metabolic syndrome. Patients were aged between 23 and 99 (average age of 65 years). In comparison, the patients in the hypertensive subgroup were aged between 37 and 97 (average age of 70). The gender distribution was similar in the large group and hypertensive subgroup: 52.07% male, 47.92% female in the large group, and 52.03% male, 47.97% female in the hypertensive subgroup. At admission, the stages of SARS-COV2 infection in patients with metabolic syndrome, according CT examination, were severe in 54.41% of cases, moderate in 27.94%, and mild in 17.64%. According the IDF definition of the metabolic syndrome, 8.33% of the patients had 5 criteria, 35.29% patients had 4 criteria, and 58.82% patients had 3 criteria of disease. Hypertension was encountered in 80.95% of patients with metabolic syndrome, obesity in 56.75% and diabetes mellitus in 52.70% of cases. As comorbidities: cancer in 5.88% of patients, chronic heart failure in 26.47% of cases (72.22% NYHA II class and 27.78% NYHA III class), atherosclerosis in 55.88%, COPD in 7.35%, depression in 7.35% and dementia in 5.88% of cases. High levels of the inflammatory markers or specific lab tests were encountered: CRP in 98.53% of cases, pro-calcitonin in 86.76%, ferritin 80.88%, IL-6 in 83.33%, D-dimers in 85.29%, NT-proBNP 71.92%, troponin 70.59%, LDH in 91.17%, uric acid in 11.76%. Conclusions: The most reliable comorbidity factor who predict evolution/prognosis of SARS-COV2 infection in patients with metabolic syndrome was diabetes mellitus (the levels of glycaemia and the need of high units of insulin), despite the fact that hypertension and obesity were more prevalent.

NEW ONSET OF HYPERTENSION IN PATIENTS ADMITTED FOR INFECTION WITH SARS-COV-2 VIRUS

Objective: The aim of the study was to assess the clinical particularities and the lab tests in patients hospitalized for SARS-COV2 infection, with new onset of hypertension on admission. Design and method: We performed a retrospective study on 217 patients admitted to a Clinical Emergency Hospital between January 2021 and October 2021. Results: We had 217 patients admitted in internal medicine clinic for infection with SARS-COV2 virus, most of them with moderate and severe form of disease. From them, 148 patients had hypertension, 83.78% with medical history of hypertension and 16.22% with new onset of high blood pressure on admission. Patients were aged between 23 and 99 years, with an average age of 65 years. In comparison, the patients with new onset of hypertension (subgroup 1) were aged between 37 and 90 years, with an average age of 66 years. The most affected group of age was 60-69 years. In subgroup 1, the gender distribution was: 58.33% male, 41.66% female. At admission, the stages of SARS-COV2 infection in subgroup 1, according to CT examination, were severe in 52.38%, moderate 19.04%, and mild 28.57% of patients. As comorbidities in subgroup 1: cancer in 8.33%, metabolic syndrome 54.16%, dyslipidemia 4.16%, obesity 50%, type II diabetes mellitus 45.83%, chronic heart failure in 12.5% of cases (37.5% NYHA I class, 54.16% NYHA II class and 8.3% NYHA III class), atrial fibrillation in 12.5%, atherosclerosis in 16.66%, anxiety disorders in 4.16% and dementia in 8.33% of cases. High levels of inflammatory markers in Subgroup 1: CRP in 95.83%, procalcitonin in 87.5%, ferritin 79.16%, D-dimers in 83.33%, troponin 4.16%, NT-proBNP in 50% of cases. Decreased GFR was found in 65.21% of patients. Microalbuminuria was present in 29.16% of patients. The antihypertensive medication during hospitalization was: diuretics in 45.83%% of cases, betablockers in 33.34%, calcium blockers in 8.33%, angiotensin converting enzyme inhibitors in 16.67%. Conclusions: Hypertension with new onset during SARS-COV2 infection and its persistence in post-covid syndrome may have complex pathogenic mechanisms and require personalized therapeutic decision.

Cardiac Implication in Pediatric Multisystemic Inflammatory Syndrome – Three Case Reports and Review of the Literature

Pediatric multisystem inflammatory syndrome (PMIS) appears to be a relatively rare complication of COVID-19 in children, occurring in less than 1% of children with confirmed SARS-CoV-2 infection. This condition can appear several weeks after the acute SARS-CoV-2 infection and is assumed to be a delayed immune response to coronavirus disease 2019 which can lead to a severe cardiovascular involvement. In this retrospective study, our main purpose was to summarize the clinical data from three types of onsets in patients diagnosed with PMIS and report the experience to the known data in the literature. We put the emphasis on the course of management considering the three different presenting faces of the PMIS in children. All patients received IV immunoglobulin and antiplatelet treatment, 66% (2 of 3) necessitated inotropic support, corticosteroid therapy (metilprednisolon), anticoagulation, 33% (1 of 3) received Anakinra (antagonist of the interleukin 1 receptor). All of them received cardiac remodeling treatment with Lisinopril and Bisoprolol (associated or not with Spironolactone and Furosemide). Evolution was good with discharge in approximately 2 weeks from admission, without symptoms, and with cardiac improvement at echocardiography. PMIS is an alarming situation that necessitate multidisciplinary approach and a complex management. The cardiac evaluation is crucial in risk evaluation and guidance for a correct approach of the disease. © 2021, MediaMed Publicis. All rights reserved.

Overlaping syndromes: Kawasaki-like disease in pediatric multisystem inflammatory syndrome vs atypical kawasaki disease. british or american? one case, many possibilities

Kawasaki disease is a challenging diagnosis even in typical forms of presentation. The features are represented by long lasting fever, specific mucocutaneous signs and coronary artery dilations as expression of medium artery vasculitis of unknown origin. Kawasaki-like disease emerged as a variant of pediatric multisystem inflammatory syndrome (PMIS) associated with COVID-19 infection. A 1 year 9-month-old boy who presented with fever, semi-consistent stools, vomiting, facial edema and hepatomegaly was transferred in our hospital with suspicion of myocarditis due to the clinical presentation, inflammatory markers and systolic dysfunction. In a few days after presentation, also, dilation of the coronary artery appeared while the child had persistent constant symptomatology. Gradually, a pediatric multisystem inflammatory syndrome (PMIS) developed, but without positive markers of COVID-19 infection, which remained negative (both antigen and antibodies). So, in front of all elements of PMIS except exposure to SARS-CoV-2, we concluded for an atypical Kawasaki disease with elements of PMIS. But the debate between the elaborated criteria British and American for PMIS are circling around the demonstration of the infection, past or present, making some cases difficult to diagnose. In this high affluence of Kawasaki-like disease, with intricated elements of myocarditis and multisystem inflammatory syndrome it is more and more difficult to establish a clear diagnosis. While the diagnosis looks complex, the curative treatment goes in the same direction – immunoglobulin, immunosuppressive treatment, inotropic and antiaggregant or anticoagulant treatment. © 2021, MediaMed Publicis. All rights reserved.