ABSTRACT
Introduction: Cardiac arrhythmia is a frequent complication of COVID-19, However, there are currently only a few case reports of advanced atrioventricular block (AVB). Hypothesis: We sought to describe a case series of AVB as a complication of COVID-19. Methods: We included a series of ten (10) consecutive patients with confirmed COVID-19, who developed advanced AVB in a prospective observational multi-center study. Patients underwent clinical, laboratory evaluation, Holter, telemetry, Echocardiogram, Chest X-Ray, chest CT scan and cardiac MRI. Results: Of the ten (10) patients, 5 were female (50%) with a mean age of 62,7 +-11,5 years. Eight (8) developed complete AVB, one a 3:1 AVB and one 2:1 AVB. None of the patients had a history of cardiac arrhythmia AVB was not related to medication or intubation. Six patients developed AVB during their hospitalization for COVID-19 and 4 after the first month as a late sequela. Four patients were asymptomatic, one presented syncope, two dyspnea and two dizziness. Six patients presented reverse AVB early by a high dose of corticosteroid in six and colchicine in 3 cases, with no recurrent episodes.Four patients required a permanent pacemaker for persistent conduction defect. Conclusions: Advanced AVB could be a complication of COVID-19. The conduction disturbance was reversed by corticosteroids with or without colchicine in six of ten cases The resolution with corticosteroids of the advanced AVB in these patients could reflect the transient nature of the viral infection and the inflammatory response associated with it in some patients. Four patients required a pacemaker. Physicians should be aware of this complication.
ABSTRACT
This book considers the impact of the COVID-19 pandemic on international diplomacy, and the challenges and opportunities it presents for the future of multilateralism. Global cooperation and solidarity are central to responding to and mitigating the health and socio-economic effects of the COVID-19 pandemic, yet, to many, this was slow to mobilize and lacking in political leadership. This book takes a practical look at the lessons learned from the period spanning the World Health Organization's first declaration of a public health emergency of international concern in January 2020, to the commemoration of the 75th Anniversary of the United Nations in October 2020. This timespan covers a critical period in which to consider key areas of diplomacy, covering a range of tools of global cooperation: multilateral diplomacy, the rule of law, sustainable development, economics and financing, digital governance, and peace and security. Each chapter in this book introduces readers to the current situation in their respective areas, followed by a constructive consideration of lessons learned from the pandemic's impact on that field, and key recommendations for the future. The practical focus and future orientation is particularly important as the book injects pragmatism and guidance that will facilitate 'building back better' in COVID response plans, while creating space for continued focus on global commitments around sustainable development and the future of the UN. Written by a team of authors who have worked directly in International Public Policy and the establishment of global agendas at the United Nations, this book will be essential reading for professionals and policymakers involved in diplomatic roles, as well as students and scholars interested in the future of international relations, global governance and sustainable development. © 2021 selection and editorial matter, Hana Alhashimi, Andres Fiallo, Toni-Shae Freckleton, Mona Ali Khalil, Vahd Mulachela and Jonathan Viera. All rights reserved.