ABSTRACT
Objective: Cardiovascular disease remains the leading cause of mortality among patients with type 2 diabetes mellitus (T2DM). Sodium-glucose co-transporter-2 (SGLT-2) inhibitors is a new class of antidiabetics, conferring a significant cardiovascular risk reduction. However, underlying mechanisms are not fully understood. Right ventricular (RV) function is adversely affected early in the course of diabetes. Herein we sought to determine the effect of long-term use of SGLT-2 inhibitors on RV function. Design and method: In this pilot, observational study, we enrolled 20 patients with T2DM and stable antidiabetic and antihypertensive treatment over the last 6 months. Patients were planned to undergo a thorough echocardiographic assessment of RV function twice, before and 6 months after initiation of a SGLT-2 inhibitor. We set as primary efficacy outcome the change in tricuspid annular plane systolic excursion (TAPSE). Results: Mean age of participants was 62.8 ± 7.9 years, with a mean T2DM duration of 8.7 ± 6.1 years. Thirteen subjects were administered dapagliflozin, while the rest 7 were prescribed empagliflozin. Due to special regulations imposed in the context of coronavirus disease-19 (COVID-19) pandemic, mean treatment duration and follow-up period was 9.35 ± 3.4 months. SGLT-2 inhibitors led to a significant increase in TAPSE from 2.01 ± 0.23 to 2.12 ± 0.15 cm (p = 0.022). The result was significant for dapagliflozin (p = 0.015), while administration of empagliflozin resulted in a non-significant increase in TAPSE (p = 0.28). However, no significant difference between the two SGLT-2 inhibitors was shown (p = 0.7). Change in TAPSE was significant in subjects with prior history of cardiovascular disease (p = 0.024), while it was non-significant for subjects without previous cardiovascular disease (p = 0.26). Other parameters of RV function or RV dimensions were unchanged. Conclusions: This is the first study to assess the effect of long-term treatment with SGLT-2 inhibitors on RV function in subjects with T2DM, demonstrating a significant increase in TAPSE.
ABSTRACT
Objective: Previous meta-analyses of observational studies and randomized controlled trials demonstrated a mortality benefit with colchicine in patients with COVID-19, leading to the amendment of treatment protocols against the disease worldwide. COVID-19 pandemic still remains a global nightmare, requiring a decisive treatment strategy. Design and method: We sought to determine whether colchicine compared to standard of care offers a true benefit, both in the in-hospital and out of hospital setting, for the prevention of surrogate COVID-19 outcomes. We searched PubMed and Cochrane Library databases for relevant published randomized controlled trials up to 12th November 2021. We set as primary efficacy outcome the surrogate endpoint of COVID-19 death and as secondary efficacy outcome that of mechanical ventilation. Results: We finally included 6 randomized controlled trials in at total of 15,624 subjects with documented COVID-19 infection. All trials except for one enrolled hospitalized patients. Colchicine was not superior to standard of care in terms of prevention of COVID-19 death (RR = 0.63, 95% CI;0.33 - 1.20, I2 = 28%). In addition, colchicine did not result in a significant decrease in the risk for mechanical ventilation during disease course (RR = 0.66, 95% CI;0.36 - 1.20, I2 = 48%). Conclusions: The present pooled analysis of relevant, published randomized controlled trials so far does not support the routine use of colchicine for the prevention of surrogate COVID-19 outcomes in daily clinical practice, either in the in-hospital or in the community therapeutic management of patients with COVID- 19.
ABSTRACT
Objective: Coronavirus disease-2019 (COVID-19) still represents a global nightmare, associated with significant morbidity and mortality, despite the development of effective vaccines. Cardiovascular complications are frequent among infected subjects. Arterial stiffness is an accurate prognostic marker of cardiovascular disease, with pulse wave velocity (PWV) being the gold-standard for arterial stiffness quantification. Herein we sought to determine whether there is a significant difference in PWV between COVID-19 positive subjects and healthy controls. Design and method: We searched two major databases (PubMed and Cochrane Library) from inception to 10th December 2021 for observational studies assessing the effect of SARS-CoV-2 on arterial stiffness. We set as primary efficacy outcome the mean difference in PWV between infected patients and healthy controls. Results: We finally pooled data from 4 observational studies in a total of 327 subjects. SARS-CoV-2 positive patients exhibited significantly greater PWV compared to healthy controls (mean difference = 1.32 m/s, 95 CI;0.46 - 2.18, I2 = 62%, p = 0.0003). Conclusions: COVID-19 is associated with significantly increased PWV. However, it remains unclear whether PWV could be a significant prognostic marker of cardiovascular complications among infected subjects.
ABSTRACT
Objective: A number of studies have indicated a deleterious effect of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection on endothelial function of enrolled subjects, further impairing during post-infectious stage. Endothelial function might indeed have a prognostic role in coronavirus disease-19 (COVID-19). Herein we sought to determine the effect of SARS-CoV-2 on endothelial function as quantified by flow-mediated dilation (FMD). Design and method: We searched the PubMed database from inception till 21st December, 2021, for observational studies assessing the impact of SARS-CoV-2 on endothelial function either in the in-hospital or the outpatient setting. We set as primary efficacy outcome the mean difference in FMD between infected patients and healthy controls. Results: We pooled data from 5 observational studies in a total of 541 enrolled subjects. One study enrolled children, while the rest 4 enrolled adults. Overall, COVID-19 induced a significant decrease in FMD by 3.29% (95% CI;-4.57 to -2.01, I2 = 81%) compared to healthy controls. Conclusions: Despite being preliminary, these results suggest a significant effect of SARS-CoV-2 on endothelial system, leading to significant endothelial dysfunction. Prognostic implications of that effect have to be determined in prospective studies.
ABSTRACT
Museums have been increasingly investing in their digital presence. This became more pressing during the COVID-19 pandemic since heritage institutions had, on the one hand, to temporarily close their doors to visitors while, on the other, find ways to communicate their collections to the public. Virtual tours, revamped websites, and 3D models of cultural artefacts were only a few of the means that museums devised to create alternative ways of digital engagement and counteract the physical and social distancing measures. Although 3D models and collections provide novel ways to interact, visualise, and comprehend the materiality and sensoriality of physical objects, their mediation in digital forms misses essential elements that contribute to (virtual) visitor/user experience. This article explores three-dimensional digitisations of museum artefacts, particularly problematising their aura and authenticity in comparison to their physical counterparts. Building on several studies that have problematised these two concepts, this article establishes an exploratory framework aimed at evaluating the experience of aura and authenticity in 3D digitisations. This exploration allowed us to conclude that even though some aspects of aura and authenticity are intrinsically related to the physicality and materiality of the original, 3D models can still manifest aura and authenticity, as long as a series of parameters, including multimodal contextualisation, interactivity, and affective experiences are facilitated.
ABSTRACT
Patients with type 2 diabetes mellitus (T2DM) are at increased risk for severe coronavirus disease 2019 (COVID-19) and related mortality. Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) have significant cardiovascular and renal benefits for patients with T2DM and related comorbidities. Their anti-inflammatory properties could be beneficial in these patients. This work provides less-biased estimates regarding the risk for respiratory tract infections and acute respiratory distress syndrome by performing the first significant meta-analysis of cardiovascular outcome trials in the literature. Notably, GLP-1-RAs do not seem to increase the risk for respiratory tract infection, pneumonia, or acute respiratory distress syndrome in patients with T2DM and cardiovascular comorbidities.