Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 14 de 14
Filter
1.
Expert Opin Investig Drugs ; 31(10): 1017-1025, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2017343

ABSTRACT

INTRODUCTION: Postural orthostatic tachycardia syndrome (POTS) is an increasingly well-recognized condition encountered in clinical practice. Diagnosis and treatment remain extremely challenging. The limited success of currently available therapies has laid the foundation for a number of experimental therapies. AREAS COVERED: In this review, we will briefly outline the pathophysiology and clinical features of this syndrome, before moving on to its management, with a specific focus on experimental pharmacological therapies. Finally, we briefly discuss POTS related to the SARS CoV-2 (COVID-19) pandemic. EXPERT OPINION: Despite tremendous advances, the diagnosis and management of POTS remains extremely challenging. The multitude of contributory mechanisms, which predominate to varying degrees in different patients further complicates management. Improved characterization of pathophysiological phenotypes is essential to individualize management. Lifestyle measures form the first line of therapy, followed by beta-blockers, ivabradine, fludrocortisone, and midodrine. Supplemental therapies such as iron, vitamin D and α lipoic acid are quite safe and a trial of their use is reasonable. The use of erythropoietin, IVIG, desmopressin, etc., are more specialized and nuanced alternatives. In recent years, interest has grown in the use of cardiac neuromodulation. Though preliminary, some of these therapies are quite promising.


Subject(s)
COVID-19 , Erythropoietin , Midodrine , Postural Orthostatic Tachycardia Syndrome , Thioctic Acid , Deamino Arginine Vasopressin/therapeutic use , Fludrocortisone/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Iron/therapeutic use , Ivabradine/therapeutic use , Midodrine/therapeutic use , Postural Orthostatic Tachycardia Syndrome/diagnosis , Postural Orthostatic Tachycardia Syndrome/drug therapy , Therapies, Investigational , Thioctic Acid/therapeutic use , Vitamin D/therapeutic use
2.
Arch Med Sci Atheroscler Dis ; 7: e5-e23, 2022.
Article in English | MEDLINE | ID: covidwho-1856061

ABSTRACT

Introduction: We performed a systematic review of comorbidities and symptoms of adult patients with coronavirus disease 2019 (COVID-19) to evaluate comorbidities, symptoms, and severity. Material and methods: We searched databases and extracted comorbidities and symptoms from the included studies. We stratified the similar signs and symptoms in groups and on the basis of severity and compared them with stratified analysis. Individual case reports and case series with < 5 patients were excluded. Results: A total of 163 studies with 43,187 patients were included. Mean age was 54.6 years. There were significantly fewer women in the study (43.9% vs. 56.1%, p < 0.0001). Prevalent cardiovascular comorbidities were hypertension (31.9%), obesity (27.9%), hyperlipidemia (26.4%), smoking (18.9%), diabetes mellitus (17.2%), atherosclerotic disease (9.2%) and arrhythmia (5.0%). The most frequently reported constitutional symptoms of COVID-19 were fever (73.9%), fatigue (33.4%), malaise (29.9%), myalgia and/or arthralgia (19.2%), generalized weakness (19.0%), and chills (11.3%). For the cardiovascular system, chest pain and/or tightness were most often reported (19.6%), followed by palpitations (5.2%). Hypertension and diabetes were common in severe disease. Obesity and congestive heart failure were not observed in any non-severe cases. Severe cases compared to non-severe cases more frequently had fever (87.8% vs. 58.5%, p < 0.001), shortness of breath (47.4% vs. 20.6%, p < 0.001), cough (66.8% vs. 62.9%, p < 0.001), sputum production (35.4% vs. 26.5%, p < 0.001) and rhinorrhea (32.2% vs. 7.3%, p < 0.001). Conclusions: Hypertension, diabetes, and atherosclerotic diseases are common comorbidities across the world, with obesity as the second most common in the US and more common in men.

3.
Curr Probl Cardiol ; : 101236, 2022 Apr 29.
Article in English | MEDLINE | ID: covidwho-1814290

ABSTRACT

Pulmonary hypertension is one of the difficult situations to treat. Complex pathophysiology, association of the multiple comorbidities make clinical scenario challenging. Recently it is being shown that patients who had recovered from coronavirus disease infection, are at risk of developing pulmonary hypertension. Studies on animals have been going on to find out newer treatment options. There are recent advancements in the treatment of pulmonary hypertension. Role of anticoagulation, recombinant fusion proteins, stem cell therapy are emerging as therapeutic options for affected patients. SGLT2 inhibitors have potential to have beneficial effects on pulmonary hypertension. Apart from the medical managements, advanced interventions are also getting popular. In this review article, the authors have discussed pathophysiology, recent advancement of treatments including coronavirus disease patients, and future aspect of managing pulmonary hypertension. We have highlighted treatment options for patients with sleep apnea, interstitial lung disease to discuss the challenges and possible options to manage those patients.

4.
Cardiol Rev ; 30(3): 123-128, 2022.
Article in English | MEDLINE | ID: covidwho-1778950

ABSTRACT

Cardiometabolic disease describes a combination of metabolic abnormalities that increases the risk of type 2 diabetes and cardiovascular diseases, including pathological changes such as insulin resistance, hyperglycemia, dyslipidemia, abdominal obesity, and hypertension, and environmental risk factors such as smoking, sedentary lifestyle, poor diet, and poverty. As the number of coronavirus disease 2019 (COVID-19) patients continues to rise, type 2 diabetes, cardiovascular disease, hypertension, and obesity, all components of, or sequelae of cardiometabolic disease, were identified among others as key risk factors associated with increased mortality in these patients. Numerous studies have been done to further elucidate this relationship between COVID-19 and cardiometabolic disease. Cardiometabolic disease is associated with both increased susceptibility to COVID-19 and worse outcomes of COVID-19, including intensive care, mechanical ventilation, and death. The proinflammatory state of cardiometabolic disease specifically obesity, has been associated with a worse prognosis in COVID-19 patients. There has been no evidence to suggest that antihypertensives and antidiabetic medications should be discontinued in COVID-19 patients but these patients should be closely monitored to ensure that their blood pressure and blood glucose levels are stable. Assessment of vaccination efficacy in cardiometabolic disease patients is also discussed.


Subject(s)
COVID-19 , Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Hypertension , COVID-19/complications , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Humans , Hypertension/complications , Hypertension/drug therapy , Hypertension/epidemiology , Obesity/complications , Obesity/epidemiology , Risk Factors
5.
Hosp Pract (1995) ; 49(5): 307-324, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1528104

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 infections are associated with greater risk of both arterial and venous thromboembolic events.Pathophysiology and Clinical implications: This has been attributed to a florid proinflammatory state resulting in microvascular dysfunction, activation of platelets and procoagulant systems as well as possible direct endothelial injury. The associated morbidity and mortality of these events has prompted much speculation and varied anticoagulation and fibrinolytic strategies based on multiple criteria including disease severity and biomarkers. No clear definitive benefit has been established with these approaches, which have frequently led to greater bleeding complications without significant mortality benefit.Overview: In this review, we outline the burden of these thromboembolic events in coronavirus disease-2019 (COVID-19) as well as the hypothesized contributory biological mechanisms. Finally, we provide a brief overview of the major clinical studies on the topic, and end with a summary of major societal guideline recommendations on anticoagulation in COVID-19.


Subject(s)
Blood Coagulation Disorders/etiology , Blood Coagulation , COVID-19/complications , Anticoagulants/therapeutic use , Blood Platelets/virology , COVID-19/drug therapy , COVID-19/virology , Humans , Risk Factors , Venous Thromboembolism/etiology , Venous Thrombosis/etiology
6.
Future Cardiol ; 18(2): 135-142, 2022 02.
Article in English | MEDLINE | ID: covidwho-1394693

ABSTRACT

There has been strong evidence of myocardial injury in COVID-19 patients with significantly elevated serum cardiac troponin (cTn). While the exact mechanism of injury is unclear, possible suggested pathological mechanisms of injury are discussed. These include increased susceptibility of the myocardium and endothelium to viral invasion, underlying hyperinflammatory state and subsequent cytokine storm, a hypercoagulable and prothrombotic state, and indirect myocardial injury due to hypoxemia. As a result of these pathological mechanisms in COVID-19 patients, cTn may be elevated largely due to myocarditis, microangiopathy or myocardial infarction. The utility of cTn as a biomarker for measuring myocardial injury in these patients and assessing its ability as a prognostic factor for clinical outcome is also discussed.


Subject(s)
COVID-19 , Cardiovascular Diseases , Myocardial Infarction , Troponin/blood , Biomarkers/blood , COVID-19/diagnosis , Cardiovascular Diseases/diagnosis , Humans , Myocardial Infarction/diagnosis
7.
Cardiol Rev ; 30(3): 129-133, 2022.
Article in English | MEDLINE | ID: covidwho-1320339

ABSTRACT

Coronavirus disease 2019 (COVID-19) is characterized by a clinical spectrum of diseases ranging from asymptomatic or mild cases to severe pneumonia with acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. Extracorporeal membrane oxygenation (ECMO) has been used as rescue therapy in appropriate patients with COVID-19 complicated by ARDS refractory to mechanical ventilation. In this study, we review the indications, challenges, complications, and clinical outcomes of ECMO utilization in critically ill patients with COVID-19-related ARDS. Most of these patients required venovenous ECMO. Although the risk of mortality and complications is very high among patients with COVID-19 requiring ECMO, it is similar to that of non-COVID-19 patients with ARDS requiring ECMO. ECMO is a resource-intensive therapy, with an inherent risk of complications, which makes its availability limited and its use challenging in the midst of a pandemic. Well-maintained data registries, with timely reporting of outcomes and evidence-based clinical guidelines, are necessary for the careful allocation of resources and for the development of standardized utilization protocols.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Respiratory Distress Syndrome , COVID-19/complications , COVID-19/therapy , Extracorporeal Membrane Oxygenation/methods , Humans , Pandemics , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , SARS-CoV-2
8.
Arch Med Sci ; 17(4): 1109-1113, 2021.
Article in English | MEDLINE | ID: covidwho-1296093

ABSTRACT

INTRODUCTION: We report our experience with cancer care delivery during the peak of COVID-19 pandemic in New York City. METHODS: Retrospective analysis of the patients treated from the 1st of March, 2020 to the 8th of May, 2020. RESULTS: Team huddles, infection screening and patient selection strategies were implemented. One hundred and seventy patients were treated in 576 visits. Six developed severe COVID-19 requiring hospitalization, two died. Their median Charlson Comorbidity Index was 9, higher than the rest of the cohort. CONCLUSIONS: Cancer care delivery is safe and feasible using an approach focused on careful patient selection, team communication and infection control.

9.
Arch Med Sci Atheroscler Dis ; 5: e306-e312, 2020.
Article in English | MEDLINE | ID: covidwho-1110606

ABSTRACT

INTRODUCTION: There is a paucity of literature surrounding the in-hospital mortality and associated risk factors among coronavirus disease 2019 (COVID-19) affected patient populations in our geographical area, northern New Jersey. MATERIAL AND METHODS: A retrospective observational cohort study was performed in a tertiary care academic medical center with two locations in Paterson and Wayne serving Passaic County in northern New Jersey. The study included all 900 patients with a positive reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swab sample for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) viral test. We determined the in-hospital 75-day mortality of patients treated in the intensive care unit (ICU) compared to the medical-surgical floor unit. RESULTS: Overall in-hospital 75-day mortality was 40.7% (n = 367). The ICU group had a 77.1% (n = 237) mortality and the floor group a 21.9% (n = 130) mortality. The ICU group of patients had a higher incidence of cardiac injury, acute renal injury, liver failure, vasopressor use and the elevation of serum markers: ferritin, lactate dehydrogenase, interleukin 6 (IL-6), D-dimer, procalcitonin, and C-reactive protein compared to the floor group. Multiple logistic regression analyses revealed that age > 65 years, elevated IL6, acute renal injury, cardiac injury, and invasive mechanical ventilation were risk factors associated with mortality. CONCLUSIONS: Age > 65 years, elevated IL6, acute renal injury, cardiac injury, and invasive mechanical ventilation were risk factors associated with mortality in our COVID-19 patients.

10.
Arch Med Sci Atheroscler Dis ; 5: e263-e270, 2020.
Article in English | MEDLINE | ID: covidwho-1110605

ABSTRACT

INTRODUCTION: Although Coronavirus Disease 2019 (COVID-19) is primarily a disease of the respiratory system in its transmission and clinical manifestations, physicians have also reported a tropism toward the nervous system. METHODS: Neurological symptoms can occur as one of many systemic manifestations of a critical form of the disease or in isolation as the predominant presenting complaint. RESULTS: We report a series of 6 patients who suffered significant cerebrovascular accidents while being treated for critical COVID-19 in the intensive care units of a quaternary care hospital in New York's Hudson valley. CONCLUSIONS: This series demonstrates how a relatively rare but catastrophic neurological complication can occur in patients with COVID-19 while they are being managed for their more common problems such as respiratory and renal failure.

12.
Am J Ther ; 2020 Oct 01.
Article in English | MEDLINE | ID: covidwho-835217
13.
Am J Case Rep ; 21: e925787, 2020 Aug 15.
Article in English | MEDLINE | ID: covidwho-717815

ABSTRACT

BACKGROUND At the end of 2019, coronavirus (SARS-CoV-2) was recognized as the cause of a cluster of pneumonia cases in Wuhan, a city in China. There are numerous complications associated with COVID-19 infection, such as acute respiratory distress syndrome, renal failure, circulatory shock, and multi-organ failure. Spontaneous pneumothorax following COVID-19 pneumonia is an extremely rare complication. CASE REPORT We report the case of a 49-year-old man with a past medical history of type 2 diabetes mellitus with an initial presentation of cough, shortness of breath, and fever. He was diagnosed with COVID-19 pneumonia and rapidly deteriorated on the day of admission, requiring initiation of mechanical ventilation. The patient recovered clinically and was discharged home. He returned 21 days after discharge with a spontaneous pneumothorax. CONCLUSIONS Spontaneous pneumothorax is a rare complication after apparent recovery from COVID-19 pneumonia. It is imperative that treating physicians are aware of this complication in order to recognize it early and treat it promptly.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Pneumothorax/virology , COVID-19 , Chest Tubes , Diabetes Mellitus, Type 2 , Dyspnea/etiology , Humans , Male , Middle Aged , Pandemics , Pneumothorax/diagnostic imaging , Pneumothorax/therapy , SARS-CoV-2 , Tomography, X-Ray Computed
14.
Drugs ; 80(15): 1553-1562, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-716437

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV­2), is now a global pandemic. This virus primarily affects the respiratory tract and causes lung injury characterized by acute respiratory distress syndrome. Although the pathophysiology of COVID-19 is not yet clear, the most widely accepted mechanism is systemic inflammation. A clinically significant effect of the inflammation is coagulopathy. As a result of this effect, patients are found to have a high risk of venous thromboembolism. Studies have reported a high incidence of thrombotic complications in critically ill patients with COVID-19. In this review, we discuss the most updated evidence on the pathophysiology, diagnosis, and treatment of the coagulopathy of COVID-19. Prophylactic anticoagulation is recommended for all in-patients with COVID-19. Those with a higher risk of developing thromboembolic events or who have already developed venous thromboembolism should be treated with therapeutic anticoagulation. We also discuss post-discharge prophylaxis for high-risk patients and some newly proposed treatments for the hypercoagulability that could improve the outcomes of the affected patients.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Thrombosis/prevention & control , Venous Thromboembolism/prevention & control , Anticoagulants/administration & dosage , Betacoronavirus/isolation & purification , COVID-19 , Critical Illness , Humans , Pandemics , SARS-CoV-2 , Thrombosis/virology , Venous Thromboembolism/virology
SELECTION OF CITATIONS
SEARCH DETAIL