The effect of covid-19 vaccine on the endothelial function

Background: Covid-19 vaccine was associated with several complications such as thromboembolic complications. The exact mechanism is not well established. Since covid 19 virus caused severe endothelial dysfunction, we suspect that the vaccine with a similar immunological response may cause this dysfunction. Aim(s): To study the effect of covid-19 vaccine on endothelial function. Method(s): We conducted a prospective study. The endothelial function was clinically assessed using a post-occlusive reactive hyperemia protocol with finger thermal monitoring device. Endothelial quality index (EQI) was assessed at inclusion before the first dose of coronavirus vaccine and 30 days later. Result(s): 20 patients were included in our study. Their mean age was 41 years old [23-65]. The sex ratio was 3/2. They were all healthy individuals. The Majority, 75% of our patients, have impaired their endothelial function 30 days after the first dose of covid-19 vaccine. Conclusion(s): The Covid-19 vaccine effect on endothelial function may be responsible for its complications. Key words: Covid-19 vaccine, endothelial dysfunction.

Profil épidémiologique et aspects cliniques du COVID long

Introduction Depuis l'évolution de la pandémie COVID-19, plusieurs études documentaient la persistance de séquelles et de symptômes à distance de la phase aiguë de la maladie baptisé COVID long. Cette entité émergente cliniquement peu spécifique, restait sans définition consensuelle jusqu'à peu du temps. Notre étude visait à déterminer la prévalence du COVID long, ses caractéristiques cliniques et ses facteurs prédictifs. Matériels et méthodes Il s'agissait d'une étude transversale observationnelle par méthode d'entretien téléphonique durant le mois de Janvier 2021. Les patients de la liste régionale exhaustive des patients testés positifs pour SARS-Cov-2 durant le mois d'Octobre 2020 étaient inclus dans notre étude. Les mineurs et les patients décédés étaient exclus. Un délai minimal de 8 semaine définissait le COVID long. Un questionnaire était utilisé pour évaluer les caractéristiques sociodémographiques et cliniques du patient. Résultats Au total, 2070 patients participaient à l'étude. Il y avait 1230 femmes (59,4 %) soit un ratio hommes/femmes de 0,68. L'âge médian était de 40 ans [intervalle semi-interquartile (ISI) : 12,5 ans]. L'obésité était la maladie chronique la plus fréquente chez 402 patients (19,4 %). Il y avait 258 patients hypertendus (12,5 %), 190 patients diabétiques (9,2 %), 108 patients dyslipidémiques (5,2 %) et 247 fumeurs actifs (12 %). La prévalence du COVID long était de 41,6 % (N=861). Parmi eux, 229 patients (26,5 %) ont consulté un médecin au sujet de leur COVID long et 122 patients (14,13 %) ont complété par une exploration paraclinique. Selon les manifestations cliniques, les symptômes décrits du long COVID étaient l'agueusie (68,9 %), les problèmes de concentration et de mémoire (24,9 %), la fatigue (17,4 %), les céphalées (10,4 %), l'anosmie (6,5 %), la dyspnée résiduelle (5,9), les douleurs thoraciques (4,4 %) et les palpitations (4,2 %). Les facteurs indépendants associés au COVID long étaient l'âge inférieur à 60 ans (Odds Ratio ajusté (ORA)=1,8 ; IC=[1,5-2,66] ; p<0,001), le sexe féminin (ORA=1,6 ; IC=[1,35-1,96] ; p<0,001), l'antécédent de maladie respiratoire (ORA=1,8 ; IC= [1,2-2,8] ; p=0,002), l'antécédant de cancer (ORA=3,5 ; IC=[1,03-12,2] ; p=0,048), le traitement anticoagulant (ORA=1,45 ; IC =[1,1-1,8] ; p=0,002),le traitement par l'acide salicylique (ORA = 1,4 ; IC =[1,1-1,9] ; p = 0,026) et la forme clinique de l'épisode aigue : légère (ORA=5,5 ; IC=[3,5-8,5] ; p<0,001) et modéré (ORA=7,1 ; IC=[4,2-11,9] ; p<0,001). Conclusion La compréhension multidisciplinaire de tous les aspects de la pandémie de COVID-19, y compris ces manifestations à long terme, doit être repensée surtout à la phase post-vaccinale. Le COVID long pose de plus en plus un problème de santé publique vu sa fréquence et sa gravité. Par conséquent, des consensus de suivi systémique des patients COVID-19 à long court s'avèrent alors nécessaires pour une meilleure évaluation diagnostique, pronostique et thérapeutique de cette nouvelle entité. Aucun lien d'intérêt

Sulodexide in the treatment of patients with long COVID 19 symptoms and endothelial dysfunction: The results of TUN-EndCOV study

Background: Endothelial dysfunction is probably one of the mechanisms of long COVID-19 symptoms. Sulodexide has pleiotropic properties within the vascular endothelium that can prove beneficial in the long COVID-19 symptoms. Purpose: We aimed to evaluate the effect of sulodexide when used in patients with endothelial dysfunction and long COVID-19 symptoms. Methods: We conducted a prospective multicenter longitudinal case-control study. Endothelial function was evaluated with DTM “E4-Diagnose” Polymath based on the Endothelium Quality Index (EQI). A group of patients with endothelial dysfunction (EQI < 2.0) received sulodexide. All the patients were followed-up 21 days after inclusion. Primary outcomes were defined as endothelial function amelioration (delta EQI) and long COVID-19 symptoms evolution during the follow-up. Results: A total of 410 patients were included in this study. Patients were included at an average time of 1.89 ± 1.2 month after COVID-19 infection. At inclusion, 210 (51.2%) patients had an EQI < 2. The median age was 49 ± 13.8 (18–80) years. Among the patients with endothelial dysfunction, only 79 patients received sulodexide. Patients in sulodexide group had lower EQI than the non-medical intervention group (0.94 ± 0.6 vs. 1.52 ± 0.4;P < 10−3). They were more diabetic, hypertensive, had more coronary artery disease and received more long-term medications (aspirin, Bblockers and statins) than the others (P = 0.01, 0.002, 0.01, 0.009, 0.001 and 0.01, respectively). At the 21-days follow-up, patients in sulodexide group presented lower long COVID symptoms especially chest pain, palpitations, fatigue and neuro-cognitive difficulties associated to a significant amelioration of endothelial function (delta EQI 1.26 ± 1.07 vs. 0.22 ± 0.7;P < 10−3). Conclusion: Sulodexide in patients with long COVID-19 may be a good intervention to ameliorate chest pain, palpitations, fatigue and neuro-cognitive difficulties associated to endothelial dysfunction.

Predictors of thromboembolic events in COVID-19 ambulatory patients

Introduction: Unlikely COVID-19 hospitalized patients, there are not clear data about the incidence and the predictors of arterial and venous thromboembolic events in COVID-19 outpatients patients. Objectives: To determine the incidence of TE in COVID-19 ambulatory setting. Patients and methods: We conducted an observational study in our study including COVID-19 ambulatory patients and we analysed the predictors of TE events at 30 days. Results: We included 2089 patients with a mean age of 43 ± 16 years. The incidence of primary outcomes was 1.6% and the incidence of venous and arterial TE complications was 0.9%. The predictors of arterial and venous TE complications were hormonal contraception (OR = 23), moderate clinical presentation (OR = 3.5), recent surgery or miscarriage during the last month before COVID-19 infection (OR = 9.2) and COVID-19 signs on CT scan (OR = 4.9). While physical activity proved to be a protective factor. Conclusions: The incidence of TE events is low in COVID-19 patients. Thromboprophylaxis should be prescribed in selected people.

Endothelial dysfunction is the key of long COVID-19 symptoms: The results of TUN-EndCOV study

Background: The COVID-19 disease is a multisystem disease due to in part to the vascular endothelium injury. Lasting effects and long-term sequalae could persist after the infection and may be due to persistent endothelial dysfunction. Purpose: Our study focused on the study of endothelial function measurement by digital thermal monitoring (DTM) of endothelial quality index with E4 diagnosis Polymath in a large cohort of long COVID-19 patients to determine whether long COVID-19 symptoms are due to endothelial dysfunction. Methods: This is a prospective multicenter longitudinal observational cohort study. Endothelial function was evaluated with “E4-Diagnose” Polymath Tunisia based on the Endothelium Quality Index (EQI). A complete echocardiographic evaluation analysis was performed. Primary outcomes were defined as the occurrence of long COVID-19 symptoms in patients with endothelial dysfunction measured by EQI. Results: A total of 798 patients were included in this study. Patients were included at an average time of 68.93 ± 43.1 days. The mean EQI was 2.02 ± 0.99 [0–5]. A total of 397 (49.7%) patients had poor or very poor EQI and 211 (26.4%) patients had very poor EQI. The median age was 49.94 ± 14.2 (18–80) years. A total of 618 patients (77.4%) had long COVID-19 symptoms. Patients with long COVID-19 symptoms had a reduced EQI (1.99 ± 0.97 vs. 2.09 ± 1.05, P = 0.24). Among long COVID-19 symptoms, fatigue was the most common symptom reported in 42.2%. Fatigue and chest pain were significantly associated to the endothelial dysfunction (P = 0.04 and 0.001 respectively). Patients with chest pain had significantly lower EQI (1.74 ± 1.0 vs. 2.09 ± 0.9, P ≤ 10−3) and LVGLS (−16.35 ± 3.0 vs. −17.16 ± 2.5, P = 0.04). Conclusion: Long COVID-19 symptoms specifically chest pain and fatigue are due to persistent poor endothelial quality index. These findings allow a better care of patients with long COVID-19 symptoms.

The long COVID: Findings of 24 rhythmic Holter in patients suffering from palpitations

Introduction: Many patients showed long COVID syndrome after recovery from the CORONAVIRUS – SARS infection (40–50%). Many patients showed palpitations and we do not know the cause of these palpitations. Patients and methods: This is an observational study including patients showing palpitations after recovery from the COVID-19. We analyzed the results of 24 hours recording as well as echocardiographic findings and we analysed the correlation between myocardial strain and rhythms disorders. Results: Among 2338 COVID-19 patients, 45% showed long COVID symptoms at 30 days, 7% patients suffered from palpitations. We noted an inappropriate sinusal tachycardia in 60% of cases, 3 cases of ventricle disorders arrhythmia disorders. Longitudinal strain was significantly lower in patients who showed arrhythmia in the 24 recordings than in patients with normal 24 hours rhythm recordings. Conclusion: There is correlation between rhythmic disorders and myocardial damages in patients who showed COVID-19.

Planning the supply of emergency medical products to cope with pandemics

The COVID-19 pandemic exposed inadequate planning in the supply of emergency medical products (EMP) worldwide. In what followed, an exponential growth in EMP demand during the first months of the pandemic proved extremely challenging for manufacturers to adapt to. This put healthcare workers, our first line of defense, in jeopardy and stretched healthcare systems beyond their capacities. Many governments realized the deficiency of their emergency stockpile policies, and as global demand outstripped supply, they struggled to meet their population's basic EMP needs using offshore suppliers. In this work, we present a game theoretical approach for the planning of EMP supplies using a game that models the interaction between governments and private manufacturers to secure such critical supplies in the case of pandemics, while reducing the overall cost to taxpayers, and taking into consideration manufacturers profit objectives. On one hand, a policymaker can decide the strategic stockpile size for EMPs and use subsidies to encourage manufacturers to onshore some or all of their EMP manufacturing capacity to improve their domestic crisis management capabilities in case of a pandemic. On the other hand, private manufactures can evaluate offshoring cost savings compared to subsidies offered by the government on the condition of onshoring production of subsidized products and offering such items to the public at contracted pricing in pandemics. We detail the two models, present a solution to balance the competing objectives, and discuss insights from the model's analysis. © 2021 IISE Annual Conference and Expo 2021. All rights reserved.

Perceived stress among suspected patients during the COVID-19 outbreak in Tunisia

IntroductionWidespread outbreaks of infectious disease, such as COVID-19, are associated with psychological distress and symptoms of mental illness especially for patients with suggestive symptoms.ObjectivesPredict the prevalence of perceived stress and study associated factors among patients with suspected COVID-19 infection.MethodsA cross sectional study was conducted between April and May 2020. Patients consulting the sorting box at the Hedi Chaker Hospital of Sfax and declared suspect to be infected by COVID-19 were invited to participate in our study after given their cosent. Perceived Stress Scale-10 was used to evaluate prevalence of perceived stress.ResultsIn total, 149 participants participated. The mean age was 38.8±15.39 years. Medical or surgical history and psychiatric history were identified respectively in 30,2% and 12.1% of participants. Among all respondents, 74.5% took a nasopharyngeal swab to look for COVID-19 and only 6.4% had a positive test. Close contact with someone with a positive COVID-19 infection was found in 8.05%. Several participants (79,2%) expressed fear of transmitting the disease to their family members. The mean of the PSS-10 score was 11.97±9.83. Moderate to severe perceived stress was found in 44.3% of patients. Significantly higher scores were observed among participants with a positive pharyngeal swab for COVID-19 as well as those who perceived worry of transmetting the disease. No significant differences in perceived stress’ scores according to socio-demographic data.ConclusionsPerceived stress was high among patients with suspected COVID-19 infection. Perceiving worry of transmetting the disease and having a positive pharyngeal swab for COVID-19 were the principal risk factors.DisclosureNo significant relationships.

Depression in quarantined patients during the COVID-19 pandemic

IntroductionQuarantine for suspected patients of being infected by the COVID-19 can lead to negative consequences for mental health and the appearance of depressive symptoms.ObjectivesTo assess the prevalence of depression in quarantined patients, and to analyze the associated factors.MethodsThis was a descriptive and analytical survey, carried out from April 4 to May 30, 2020, with 149 patients consulting the COVID-19 sorting box at the Hedi Chaker CHU in Sfax. Suspected COVID-19 patients were contacted by phone during their quarantine and invited to participate in our study. The Patient Health Questionnaire (PHQ-9) scale was used to assess the severity of depression. Cutoffs of 5, 10, 15, and 20 represent minimal, mild, moderate, moderately severe, and severe levels of depression based on PHQ-9 scores. A cutoff score of 10 determines major depression.ResultsThe results showed a prevalence of major depression of 10.7%. Of all patients, 89.3% had minimal to mild depression;10% had moderate to moderately severe depression and 0.7% had severe depression. The PHQ-9 score was statistically correlated with travel to a suspect area during the 14 days preceding the consultation (p = 0.008), contact with a subject confirmed COVID-19 (p = 0.01), previous follow-up in psychiatry (p = 0.047), the change of residence during quarantine (p = 0.045), the fear of transmitting the disease to relatives (p = 0.00) and the positive result of the nasopharyngeal swab (p = 0.00).ConclusionsPsychological distress was felt in our patients. We recommend that necessary measures should be taken to combat depression.