ABSTRACT
Acute coronary syndromes (ACS) may complicate the clinical course of patients with Coronavirus Disease 2019 (COVID-19). It is still unclear whether this condition is a direct consequence of the primary disease. However, several mechanisms including direct cellular damage, endothelial dysfunction, in-situ thrombosis, systemic inflammatory response, and oxygen supply-demand imbalance have been described in patients with COVID-19. The onset of a pro-thrombotic state may also be facilitated by the endothelial dysfunction secondary to the systemic inflammatory response and to the direct viral cell damage. Moreover, dysfunctional endothelial cells may enhance vasospasm and platelet aggregation.The combination of these factors promotes atherosclerotic plaque instability, thrombosis and, consequently, type 1 myocardial infarction.Furthermore, severe hypoxia due to extensive pulmonary involvement, in association with other conditions described in COVID-19 such as sepsis, tachyarrhythmias, anemia, hypotension, and shock, may lead to mismatch between oxygen supply and demand, and cause type 2 myocardial infarction.A deeper understanding of the potential pathophysiological mechanisms underlying ACS in patients with COVID-19 could help the therapeutic management of these very high-risk patients.
ABSTRACT
Background: Since the identification of a cluster of pneumonia cases in China (Wuhan) in December 2019, the COronaVIrus Disease-19 (COVID-19) outbreak rapidly spread across different countries. Italy was the first European Country to face COVID-19 Emergency and one of the most affected. The COVID-19 Emergency has forced people to change everyday life habits in response to restrictions, stimulating people's feelings of fear and physical health threat, increasing the risk of psychological adverse outcomes, such as anxiety, depression and Post-Traumatic Stress Symptoms (PTSS) [1]. A severe illness in one's child is acknowledged to be a destabilizing event, having a negative impact on parent psychological wellbeing with an increased risk of negative mental health consequences, among which PTSS throughout the development of Post-Traumatic Stress Disorder (PTSD) [2,3]. Consistently with this evidence, parents who interfaced with suspected COVID-19 infection in their children, particularly in the early acute phase of the pandemic, may have resulted a challenging population at risk for negative psychological consequences [4]. However, scant data explored this issue. Objective: The aim of the present study was to investigate psychological outcomes on parents who accessed Pediatric Emergency Departments of three University Hospitals in Italy (Azienda Ospedaliero-Universitaria Pisana, Pisa;Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi, Bologna;Fondazione IRCSS Policlinico San Matteo, Pavia) for symptoms of suspicious COVID-19 in their children during the acute phase of the COVID-19 outbreak (April, 2020), with particular attention to the onset of PTSS. Methods: 110 parents of children with suspected COVID-19 were recruited within one month from diagnostic assessment for COVID-19 and were assessed through the Impact of Event Scale-Revised (IES-R), to evaluate PTSS. Comparison of socio-demographic and clinical features between subjects with and without PTSS was performed. A logistic regression model was used to identify the factors associated with the development of PTSS. Results: 39 (35.4%) parents reported moderate to severe PTSS (IES-R score≥24). Results showed parents of children tested positive for COVID-19 being more prone to develop PTSS as compared to those whose children were negative (p<0.001). Similarly, PTSS rates were significantly higher among mothers with respect to fathers (p=0.012), among those tested positive themselves for COVID-19 compared to those negative (p=0.026) and among those who received indication to quarantine with respect to ones who had not (p<0.001). Mean age of participants was significantly lower among subjects with PTSS than those without (p=0.025). Finally, having a child tested positive for COVID-19 showed a positive association with the onset of PTSS (p=0.007). Conclusions: These results highlight the traumatic burden of children's illness on parents, particularly on the mothers that, besides representing the most vulnerable gender to post-traumatic stress reactions, often represent the principal caregiver and suggest the need of further studies to address tailored prevention and intervention strategies, also in the framework of the ongoing COVID-19 pandemic. No conflict of interest
ABSTRACT
Covid-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On 30 January 2020 the World Health Organization (WHO) declared that the outbreak of Covid-19 realizes a public health emergency of international concern. Because of the primary involvement of the respiratory system, chest CT is strongly recommended in suspected Covid-19 cases, for both initial and follow-up. We present the case of a Covid-19 patient, a 57-year-old man, with a typical HRCT course of OP reaction.