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After the waves of acute COVID-19 that swept mankind in 2020 and 2021, now we are confronted with the challenge of post COVID-19 conditions. According to the definition, post COVID-19 conditions comprise all signs and symptoms of COVID-19 that persist after the acute phase (3-4 weeks), without an upper limit of duration (as for the present state of knowledge). The symptoms of post COVID-19 conditions are highly variable, could affect every system, often overlap, and typically fluctuate and change over time. In regard to this disease and its long-term burden, the Bulgarian Cardiac Institute initiated a campaign "Life after COVID-19" and the data we gathered showed that a substantial proportion of patients having suffered from COVID-19 continue to have persistent symptoms that require special medical attention. Our biggest concern was the acute vascular manifestations of post COVID-19 conditions, such as acute coronary syndromes and acute pulmonary embolism, and for these we shared our personal experience. Post COVID-19 conditions have and will have a major significance for the healthcare and economic systems in the upcoming years. This derives from the simple facts that it is highly prevalent, affects people regardless of age (including young and active people) or severity of the acute illness (even asymptomatic cases), and that we still must learn a lot about its pathogenesis, natural history, treatment, and prognosis. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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Introduction: Melatonin is a hormone synthesized by the pineal gland with proven antioxidant, anti-inflammatory and immunomodulatory effects that may be helpful in reducing the severity of COVID-19 infection.
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Introduction. Since the end of 2019, the pandemic caused by SARS-CoV2 has affected hundreds of millions of people, and the number of indirectly affected is many times higher. In addition to directly affecting lung tissue, the coronavirus infection predisposes patients to thrombotic events responsible for the occurrence of cardiovascular complications. The aim of our study was to observe patients with COVID-19 and acute coronary syndrome (ACS) and to evaluate the efficacy of anti-ischemic therapy with beta-blockers, molsidomine and trimetazidine.
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Four out of five patients who survived COVID-19 reported persistent signs and symptoms months later. The disease has a lasting effect on the working capacity, social life and mental state of the patients. The Bulgarian Cardiac Institute launched in September 2020 the first national campaign in Bulgaria "Life after COVID", thanks to which leading cardiologists in the country followed-up patients after experiencing COVID-19. More than 1,500 citizens took part in a survey with questions related to their health. Initial results showed that 80% of all participants had persistent signs and symptoms months or even a year later. The most common were: fatigue (67%), palpitations (41%), shortness of breath (31%), chest pain (30%), joint pain (27%), headache (22%) and others. We performed a medical examination and processed the data of 808 patients. The most common pathological deviations were destabilization of blood pressure (51%) - hypertension (92%);hypotension (5%) or varying blood pressure (3%);heart rhythm disorders (29%) - tachycardia (97%) or bradycardia (3%);manifestations of heart failure (15%). In more than half of the cases, additional tests and changes in therapy were required. In 10% of those examined, another specialist had to be consulted. The initial results of our study showed that a significant proportion of patients had persistent and varied symptoms - the result of multi-organ viral involvement. This would require a multidisciplinary approach and long-term medical care.
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Background: Infection caused by SARS-CoV-2 can lead to significant procoagulant events, sometimes involving life-threatening pulmonary thromboembolism (PE). Additional conditions complicating the diagnosis are the presence of risk factors for PE in almost all patients with COVID-19 and the overlap of clinical presentation between PE and COVID-19. Objectives: We conducted a single-center study at the Heart and Brain Hospital, Pleven, from December 2020 to February 2021. It included 27 consecutively hospitalized patients with recent pneumonia caused by COVID-19 and clinical presentations corresponding to PE. Methods: The cohort was divided into two groups with and without a definitive diagnosis of PE, proven by CT pulmoangiography. The aim was to find the indicators predicting the presence of PE in patients with acute or post-acute COVID-19 conditions. Results: Our results showed that some ECG criteria, including S-wave over 1.5 mm in leads I and aVL (P = 0.007), Q-wave in leads III and aVF (P = 0.020), and D-dimer as a quantitative variable (P = 0.025), were independent predictors of PE. The RV/LV diameter ratios ≥ 1.0 and right ventricular dysfunction showed a sensitivity (Se) of 62.5%, specificity (Sp) of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 86.4% to verify the PE diagnosis. Besides, the D-dimer cutoff value of 1,032 ng/mL had an optimal Se of 87.5%, Sp of 57.9%, PPV of 46.7%, and NPV of 91.7% for PE diagnosis (P = 0.021). Conclusions: Against the background of acute and post-acute COVID-19 conditions, ECG and EchoCG criteria remain the PE predictors. We suggest that a higher D-dimer cutoff value be applied in COVID-19 and post-COVID-19 patients to confirm/dismiss PE diagnosis. © 2021, Author(s).
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Introduction: Hospital medical care (HMC) is the central unit in any health care system with a complex structure and numerous points of contact with other subsystems, such as outpatient and emergency medical care.
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This article examines the impact of the Covid pandemic on the hospital and medical services market. Based on a comparative analysis of data on the activities and financing of hospital and other medical institutions, as well as mortality in the country, conclusions are drawn about the existence of moral hazard and induced demand in the hospital and medical care. The introduction of a state of epidemic emergency in Bulgaria, the suspension of the planned admission to hospitals and the absence of change in the mortality rate for the period March - October 2020 compared to the same period for 2019 provide an opportunity to make a reasonable assumption that the reduced with 320,000 number of hospitalizations in 2020 corresponds to the volume of induced demand for health products - a phenomenon based on asymmetric information and moral hazard inherent in all health systems in the world, regardless of their structure and funding.