Effect of COVID-19 on cardiac electrophysiology practice: a systematic review of literature.

The authors conducted a systematic review on the effect of coronavirus disease 2019 on electrophysiology (EP) practice and procedure volume in various settings. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed/MEDLINE, Scopus, Web of Science, CINAHL, and Embase were examined with combinations of medical subject headings terms for identification of the relevant studies. After excluding duplicates, irrelevant, and ineligible studies, 23 studies were included for full qualitative analysis. The overall study-level volume reduction of EP procedures ranged from 8 to 96.7%. All studies reported an overall reduction in EP physiology procedures being carried out except one in Poland, which reported an overall increase in the total EP procedures carried out in 2020. This study still reported a decrease in EP procedure volume during the first lockdown phase. Procedural volume reduction was seen most commonly for cardiovascular implantable electronic device placement (20/23 studies, 86.9%), electrophysiology studies (11/23 studies, 47.8%), and ablations (9/23, 39.1% studies). The most common reason stated for the observed decline in EP procedures was the cancellation and postponement of nonurgent elective cases in the hospitals (15/23 studies, 65.2%). There has been an overall reduction in EP procedure volume across different centers. The impact of the decline in EP procedures will be seen only after the services resume to prepandemic levels, but an increase in-patient volume and procedure waiting time is expected. This review will provide insights into improving healthcare service delivery in times of unprecedented public health emergencies.

Menstrual abnormalities after COVID-19 vaccines: A systematic review

The objective of this systematic review is to give a comprehensive interpretation of menstrual cycle changes after the COVID-19 vaccination. Additionally, it is imperative to assess reports of menstrual changes following vaccination to dispel concerns that COVID-19 vaccines hinder the likelihood of pregnancy in the long run. A literature review was conducted using digital databases to systematically identify the studies reporting any menstrual abnormalities after the COVID-19 vaccine. Detailed patient-level study characteristics including the type of study, sample size, administered vaccines, and menstrual abnormalities were ed. A total of 78 138 vaccinated females were included in this review from 14 studies. Of these, 39 759 (52.05%) had some form of a menstrual problem after vaccination. Due to the lack of published research articles, preprints were also included in this review. Menorrhagia, metrorrhagia, and polymenorrhea were the most commonly observed problems and the overall study-level rate of menstrual abnormality ranged from 0.83% to 90.9%. Age, history of pregnancy, systemic side-effects of COVID-19, smoking, and second dose of COVID-19 vaccine were predictors of menstrual problems after vaccination.

Level of Trust in Health Care Systems During COVID-19 Pandemic Among Health Care Workers of Pakistan.

This survey aimed to evaluate the levels of trust and satisfaction among healthcare workers towards the national healthcare delivery system and whether it has been affected by the global disruption created by COVID-19. This was an analytical cross-sectional study that took place from January to October 2021 at a tertiary level health care facility in Rawalpindi, Pakistan, using an online data collection tool. Our sample included 10, 133 healthcare workers of all cadres. Our study found a significant level of distrust of healthcare workers towards multiple aspects of the healthcare delivery system, particularly towards government agencies and other members of healthcare delivery. We noted a significant gender disparity between male and female respondents with males showing more trust than female healthcare workers. We conclude that significant efforts need to be made by policymakers in the government to alleviate this trust deficit before it worsens.

Menstrual abnormalities after COVID-19 vaccines: A systematic review.

The objective of this systematic review is to give a comprehensive interpretation of menstrual cycle changes after the COVID-19 vaccination. Additionally, it is imperative to assess reports of menstrual changes following vaccination to dispel concerns that COVID-19 vaccines hinder the likelihood of pregnancy in the long run. A literature review was conducted using digital databases to systematically identify the studies reporting any menstrual abnormalities after the COVID-19 vaccine. Detailed patient-level study characteristics including the type of study, sample size, administered vaccines, and menstrual abnormalities were abstracted. A total of 78 138 vaccinated females were included in this review from 14 studies. Of these, 39 759 (52.05%) had some form of a menstrual problem after vaccination. Due to the lack of published research articles, preprints were also included in this review. Menorrhagia, metrorrhagia, and polymenorrhea were the most commonly observed problems and the overall study-level rate of menstrual abnormality ranged from 0.83% to 90.9%. Age, history of pregnancy, systemic side-effects of COVID-19, smoking, and second dose of COVID-19 vaccine were predictors of menstrual problems after vaccination.

Alteraciones menstruales tras la vacunación contra la COVID-19: revisión sistemática Resumen El objetivo de esta revisión sistemática es aportar una interpretación amplia sobre los cambios de los ciclos menstruales tras la vacunación contra la COVID-19. Además, es imperativo evaluar los informes sobre los cambios menstruales tras la vacunación, para disipar preocupaciones en cuanto a que las vacunas contra la COVID-19 dificultan la probabilidad de embarazo a largo plazo. Se realizó una revisión de la literatura utilizando bases de datos digitales para identificar sistemáticamente los estudios que reportan cualquier alteración menstrual tras la vacuna contra la COVID-19. Se resumieron las características detalladas del estudio al nivel del paciente, incluyendo tipo de estudio, tamaño de la muestra, vacunas administradas, y alteraciones menstruales. Se incluyó en la revisión a un total de 78 138 mujeres vacunadas, procedentes de 14 estudios. De ellas, 39 759 (52,05%) tuvieron algún tipo de problema menstrual tras la vacunación. Debido a la falta de artículos de investigación publicados, también se incluyeron preimpresos en esta revisión. Menorragia, metrorragia, y polimenorrea fueron los problemas más comúnmente observados, oscilando la tasa global de alteraciones menstruales a nivel de estudios entre el 0,83 y el 90,9%. La edad, los antecedentes de embarazos, los efectos secundarios sistémicos de la COVID-19, el tabaquismo y la segunda dosis de la vacuna contra la COVID-19 fueron factores predictivos de problemas menstruales tras la vacunación.

Post-acute COVID-19 syndrome and its prolonged effects: An updated systematic review.

Objective: This systematic review aimed at estimating the prevalence of post-acute COVID-19 symptoms in view of published literature that studied prolonged clinical manifestations after recovery from acute COVID-19 infection. Methods: Relevant databases were searched for extraction of articles. For data synthesis, based on the distribution of quantitative variables, they were expressed as mean ± standard deviation (SD) or median and interquartile range (IQR). Qualitative variables were presented as frequency (n) and percentages (%). Results: Twenty-one articles qualified for the final analysis. The most common persistent clinical manifestations were fatigue (54.11%), dyspnea (24.38%), alopecia (23.21%), hyperhidrosis (23.6%), insomnia (25.98%), anxiety (17.29%), and arthralgia (16.35%). In addition to these symptoms, new-onset hypertension, diabetes, neuropsychiatric disorders, and bladder incontinence were also reported. Conclusion: Clinical features of post-acute COVID-19 infection can manifest even after 60 days of initial infection. Multidisciplinary care along with regular follow-up must be provided to such patients.

Effect of COVID-19 on lipid profile parameters and its correlation with acute phase reactants: A single-center retrospective analysis.

Background and objective: The development and correlation of dyslipidemia is unknown in COVID-19. This investigation was performed to assess the pathological alterations in lipid profile and their association in COVID-19. Methods: This was a retrospective study performed on real-world patients to assess serum levels of LDL-C, HDL, TG, TC on COVID-19 patients (mild: 319; moderate: 391; critical: 357). Age- and gender-matched controls who had their lipid profiles in the same period were included as the control group. Results: LDL-C, HDL, TG, and TC levels were significantly lower in COVID-19 patients when compared with the control group (P < 0.001, 0.047, 0.045, <0.001, respectively). All parameters decreased gradually with COVID-19 disease severity (LDL-C: median (IQR), mild: 98 (91,134); moderate: 97 (81,113); critical: 68 (68,83); HDL: mild: 45 (37,50); moderate: 46 (41,50); critical: 40 (37,46); TG: mild: 186 (150,245); moderate: 156 (109,198); critical: 111 (98,154); TC: mild: 224 (212,238); moderate: 212 (203,213); critical: 154 (125,187)). Logistic regression demonstrated lipid profile as predictor of severity of COVID-19 disease. Conclusion: Hypolipidemia develops in increasing frequency with severe COVID-19 disease. It inversely correlates with levels of acute-phase reactants, indicating SARS-COV-2 as the causative agent for alteration in lipid and thyroid levels.

Epidemiology, clinical ramifications, and cellular pathogenesis of COVID-19 mRNA-vaccination-induced adverse cardiovascular outcomes: A state-of-the-heart review.

The coronavirus disease 2019 (COVID-19) has overwhelming healthcare systems globally. To date, a myriad of therapeutic regimens has been employed in an attempt to curb the ramifications of a severe COVID-19 infection. Amidst the ongoing pandemic, the advent and efficacious uptake of COVID-19 vaccination has significantly reduced disease-related hospitalizations and mortality. Nevertheless, many side-effects are being reported after COVID-19 vaccinations and myocarditis is the most commonly reported sequelae post vaccination. Majority of these diseases are associated with COVID-19 mRNA vaccines. Various studies have established a temporal relationship between these complications, yet the causality and the underlying pathogenesis remain hypothetical. In this review, we aim to critically appraise the available literature regarding the cardiovascular side effects of the various mRNA vaccines and the associated pathophysiology.

Symptomatology, prognosis and clinical findings of STEMI as a ramification of COVID-19: A systematic review and proportion meta-analysis.

Background: There is an increasing COVID-19 population with concurrent STEMI. SARS-CoV-2 poses a significant risk of hypercoagulable and/or prothrombotic events due to the disturbance in hemostasis by affecting all three components of the Virchow's triad. These abnormalities in hemostasis are an increased risk factor for cardiovascular events, including acute thrombotic occlusion of coronary arteries leading to myocardial infarction. Objective: The objective of this study is to collate the prognosis, symptomatology and clinical findings of COVID-19 adverse events causing STEMI. Methods: Databases were queried with various keyword combinations to find applicable articles. Cardiovascular risk factors, symptomatology, mortality and rates of PCI were analyzed using random-effect model. Results: 15 studies with a total of 379 patients were included in the final analysis. Mean age of patients was 62.82 ± 36.01, with a male predominance (72%, n = 274). Hypertension, dyslipidemia and diabetes mellitus were the most common cardiovascular risk factors among these patients, with a pooled proportion of 72%, 59% and 40% respectively. Dyspnea (61%, n = 131) was the most frequent presenting symptom, followed by chest pain (60%, n = 101) and fever (56%, n = 104). 62% of the patients had obstructive CAD during coronary angiography. The primary reperfusion method used in the majority of cases was percutaneous coronary intervention (64%, n = 124). Mortality, which is the primary outcome in our study, was relatively high, with a rate of 34% across studies. Conclusion: Our findings show that most cases have been found in males, while the most common risk factors were Hypertension and Diabetes Mellitus. In most COVID-19 cases with ST-segment myocardial infarction, most hospitalized patients underwent primary percutaneous coronary intervention instead of fibrinolysis. The in-hospital mortality was significantly higher, making this report significant. As the sample size and reported study are considerably less, it warrants a further large-scale investigation to generalize it.

Association of ABO blood group with COVID-19 severity, acute phase reactants and mortality.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is the ongoing pandemic with multitude of manifestations and association of ABO blood group in South-East Asian population needs to be explored. METHODS: It was a retrospective study of patients with COVID-19. Blood group A, B, O, and AB were identified in every participant, irrespective of their RH type and allotted groups 1, 2,3, and 4, respectively. Correlation between blood group and lab parameters was presented as histogram distributed among the four groups. Multivariate regression and logistic regression were used for inferential statistics. RESULTS: The cohort included 1067 patients: 521 (48.8%) participants had blood group O as the prevalent blood type. Overall, 10.6% COVID-19-related mortality was observed at our center. Mortality was 13.9% in blood group A, 9.5% in group B, 10% in group C, and 10.2% in AB blood group (p = 0.412). IL-6 was elevated in blood group A (median [IQR]: 23.6 [17.5,43.8]), Procalcitonin in blood group B (median [IQR]: 0.54 [0.3,0.7]), D-dimers and CRP in group AB (median [IQR]: 21.5 [9,34]; 24 [9,49], respectively). Regarding severity of COVID-19 disease, no statistical difference was seen between the blood groups. Alteration of the acute phase reactants was not positively associated with any specific blood type. CONCLUSION: In conclusion, this investigation did not show significant association of blood groups with severity and of COVID-19 disease and COVID-19-associated mortality.

Acceptance of COVID-19 vaccine in Pakistan among health care workers.

OBJECTIVE: Acceptance of the COVID-19 vaccine will impart a pivotal role in eradicating the virus. In Pakistan, health care workers (HCWs) are the first group to receive vaccination. This survey aimed at the level of acceptance to the COVID-19 vaccine and predictors of non-acceptance in HCWs. METHOD: This was a cross-sectional study design and data were collected through 3rd December 2020 and February 14th, 2021. An English questionnaire was distributed through social media platforms and administration of affiliate hospitals along with snowball sampling for private hospitals. RESULTS: Out of 5,237 responses, 3,679 (70.2%) accepted COVID-19 vaccination and 1,284 (24.5%) wanted to delay until more data was available. Only 5.2% of HCWs rejected being vaccinated. Vaccine acceptance was more in young (76%) and female gender (63.3%) who worked in a tertiary care hospital (51.2%) and were direct patient care providers (61.3%). The reason for rejection in females was doubtful vaccine effectiveness (31.48%) while males rejected due to prior COVID-19 exposure (42.19%) and side effect profile of the vaccine (33.17%). Logistic regression analysis demonstrated age between 51-60 years, female gender, Pashtuns, those working in the specialty of medicine and allied, taking direct care of COVID-19 patients, higher education, and prior COVID-19 infection as the predictors for acceptance or rejection of COVID-19 vaccine. CONCLUSION: In conclusion, this survey suggests that early on in a vaccination drive, majority of the HCWs in Pakistan are willing to be vaccinated and only a small number of participants would actually reject being vaccinated.

Association of hypothyroidism with acute COVID-19: a systematic review.

OBJECTIVE: There is an increasing body of literature on the impact of COVID-19 on the pituitary-thyroid axis. Therefore, we conducted a systematic review to assess the prevalence of hypothyroidism in patients with COVID-19. METHODS: A literature review was conducted using LitCOVID for study selection in PubMed and MEDLINE till May 2021. All relevant original articles evaluating thyroid dysfunction were included and information regarding the prevalence of hypothyroid disease in COVID-19 was retrieved from the eligible articles. RESULTS: Out of 32 articles, six articles qualified for the final analysis which included 1160 patients. There was significant heterogeneity among the included articles. Most of the patients had lower mean triiodothyronine (T3) and normal or low thyroid-stimulating hormone (TSH). Increased TSH ranged from 5.1% to 8% while low T3 was present in up to 28% of the patients. In these studies, the prevalence of altered thyroid hormones was significantly more in COVID-19 patients as compared to control groups. A positive correlation between low mean T3 and clinical severity of COVID-19 was reported. CONCLUSION: This systematic review reveals a significant proportion of hypothyroidism associated with COVID-19. Therefore, routine assessment of thyroid function is warranted in hospitalized COVID-19 patients.

Love in the time of COVID-19: a scoping review on male sexual health.

The coronavirus disease 2019 (COVID-19) outbreak constitutes an unparalleled socioeconomic burden on the global scale. In critically ill COVID-19 patients, the disease manifests as a state of hyper inflammation causing the 'cytokine storm', which leads to various pulmonary, cardiovascular, and spurious manifestations. One such reported sequelae of COVID-19 is sexual dysfunction in males even after recovery from the disease. Various mechanisms have been proposed regarding the erectile dysfunction a patient suffers after COVID-19. Most important is the hypothesis of endothelial dysregulation, subclinical hypogonadism, psychosocial misery, and pulmonary impairment contributing to erectile dysfunction. Assessment of testicular function and hormonal axis is needed to assess the novel association of COVID-19 with sexual and reproductive health issues in males.

Thyroid function analysis in COVID-19: A retrospective study from a single center.

BACKGROUND AND OBJECTIVE: Coronavirus disease 2019 (COVID-19) is an on-going epidemic with a multitude of long-ranging effects on the physiological balance of the human body. It can cause several effects on thyroid functions as well. We aimed to assess the lasting sequelae of COVID-19 on thyroid hormone and the clinical course of the disease as a result. METHODS: Out of 76 patients, 48 patients of COVID-19 positive and 28 patients of COVID-19 negative polymerase chain reaction (PCR) were assessed for thyroid functions, IL-6, and Procalcitonin between moderate, severe, and critical pneumonia on HRCT. RESULTS: Seventy-five percent of patients with COVID-19 had thyroid abnormalities and higher IL-6 levels (76.10 ± 82.35 vs. 6.99 ± 3.99, 95% CI 52.18-100.01, P-value <0.01). Logistic regression analysis suggested TT3 (P-value 0.01), IL-6 (P-value <0.01), and Procalcitonin (P-value 0.03) as independent risk factors for COVID-19. ROC curve demonstrated IL-6 as the most sensitive marker (P-value <0.01), and TT3, and Procalcitonin as the predictor for COVID-19 disease. CONCLUSION: This pilot study from Pakistan demonstrates that changes in serum TSH and TT3 levels may be important manifestations of the courses of COVID-19 pneumonia.

COVID-19 Associated Pneumonia and Pleural Effusion Masquerading as Heart Failure in Rheumatic Heart Disease.

The ongoing outbreak of coronavirus disease 2019 (COVID-19) that began in Wuhan, China, became an international emergency when thousands of people were infected around the world. COVID-19 emerged in Pakistan in April 2020, precipitating a nationwide lockdown. While some countries are now recovering from the pandemic, its peak is not estimated to occur in Pakistan until August 2020. We present a case of rheumatic heart disease with fever, myalgia and an unusual radiological finding of the virus. LEARNING POINTS: Unusual radiological findings are being seen in COVID-19 patients.Pleural effusion in a mildly symptomatic patient is a rare presentation of the disease.Early aggressive treatment can produce dramatic improvement in COVID-19 pneumonia.

Paying in Blood: A Case of Thrombocytopenia in Covid-19.

Novel coronavirus disease 2019 (COVID-19) primarily involves the respiratory system. Consumptive coagulopathy is seen in acute respiratory distress syndrome (ARDS) and multi-organ failure (MOF). Usually, only severely sick patients develop mild thrombocytopenia. We present a case of mildly symptomatic young adult, presenting with severe thrombocytopenia. She responded well to corticosteroids.