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Journal of Hypertension ; 40:e172, 2022.
Article in English | EMBASE | ID: covidwho-1937717


Objective: Endothelial dysfunction is thought to underlie many of the complications of COVID-19 but to what degree this persists after recovery is unknown. Here we examine endothelial function in subjects previously hospitalized with COVID- 19, those with mild symptoms who were not hospitalized and negative controls (absence of SARS-CoV-2-antibodies). Endothelial function was measured as pulse wave response to the β2 adrenergic agonist salbutamol (PWRS) which is mediated through the nitric oxide - cyclic guanosine monophosphate pathway (NO-cGMP). Design and method: Echocardiography was used to exclude subjects with cardiac abnormalities. Tonometry of the radial artery (SphygmoCor, AtCor Medical, Sydney, Australia) was performed in duplicate by a single operator before and after inhalation of 200 mcg of salbutamol using a spacer device. The PWRS was taken as the change from baseline in augmentation index (Aix) as calculated by the SphygmoCor system. In a sub-sample, PWRS was assessed in the presence and absence of the phosphodiesterase type 5 inhibitor sildenafil which inhibits the breakdown of cGMP. Results: We recruited 88 subjects (49 men) aged 47.9 ± 14.3 (mean ± SD) years of whom 32 were previously hospitalized with COVID-19 (~6 months). Subjects previously hospitalized with COVID-19 were all previously assessed in a dedicated pulmonary clinic. Age, gender, BMI, smoking status, diabetes and estimated 10-year cardiovascular risk (Q-RISKâ3) were similar between the groups. Administration of salbutamol reduced AIx in controls and those with mild COVID-19 but produced an increase in AIx in previously hospitalized COVID-19 cases (mean [95% CI]): -2.85 [-5.52, -0.188] %, -2.32 [-5.17,0.54] %, and 3.03 [0.06, 6.00] % respectively, P = 0.017 between the groups. In a sub-sample (11 hospitalized and 11 non-hospitalized) the PWRS was measured again 30 minutes after oral administration of sildenafil 25 mg. This produced a greater reduction in AIx: -5.28 [-9.00, -1.54] % in non-hospitalized and a reduction: -3.90 [-7.60, -0.21] % in hospitalized patients, and an overall improvement in the PWRS (P = 0.006). Conclusions: In subjects previously hospitalized with severe COVID-19, endothelial function is impaired for many months after hospital discharge and the impaired NO-cGMP mediated vasodilation may be reversed by sildenafil.

BJS Open ; 5(SUPPL 1):i26-i27, 2021.
Article in English | EMBASE | ID: covidwho-1493727


Introduction: During the COVID-19 pandemic, mental health services have been presented with the unique challenge of providing effective and safe patient care whilst maintaining safety regulations. Telepsychiatry has emerged as a potential solution to this and is now being used across the UK to diagnose and manage mental health conditions. Evidence has shown that its effectiveness is comparable to face to face consultations, however, is much less clear regarding patient satisfaction. We therefore initiated a systematic review to establish whether patients are satisfied with tele-delivery of psychiatric care, and to identify the predictors of a positive experience with telepsychiatry. Methods: A preliminary search was performed using five databases (MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO), with a date restriction between 2010-2020 to reflect advances in technology over the past decade. Results: Preliminary data shows that patient views on telepsychiatric services are largely positive. Factors that arose in literature potentially affecting this include location, cost, privacy, digital literacy and technological issues including audio/video quality. Conclusion: Our study so far shows that patient views on telepsychiatry are generally positive. The review is still in process, however, we anticipate that it will only further support our preliminary findings. These findings will be used to improve patient-centred delivery and provision of telepsychiatric services. We intend to produce a checklist of factors affecting patient satisfaction and test this in a national multicentre study. We are hoping that the study results and the resulting checklist will encourage greater patient involvement in setting up and delivering telepsychiatric services.

Environ Pollut ; 285: 117664, 2021 Sep 15.
Article in English | MEDLINE | ID: covidwho-1293769


The impacts of COVID-19 lockdown restrictions have provided a valuable global experiment into the extent of improvements in air quality possible with reductions in vehicle movements. Mexico City, London and Delhi all share the problem of air quality failing WHO guideline limits, each with unique situations and influencing factors. We determine, discuss and compare the air quality changes across these cities during the COVID-19, to understand how the findings may support future improvements in their air quality and associated health of citizens. We analysed ground-level PM10, PM2.5, NO2, O3 and CO changes in each city for the period 1st January to August 31, 2020 under different phases of lockdown, with respect to daily average concentrations over the same period for 2017 to 2019. We found major reductions in PM10, PM2.5, NO2 and CO across the three cities for the lockdown phases and increases in O3 in London and Mexico City but not Delhi. The differences were due to the O3 production criteria across the cities, for Delhi production depends on the VOC-limited photochemical regime. Levels of reductions were commensurate with the degree of lockdown. In Mexico City, the greatest reduction in measured concentration was in CO in the initial lockdown phase (40%), in London the greatest decrease was for NO2 in the later part of the lockdown (49%), and in Delhi the greatest decrease was in PM10, and PM2.5 in the initial lockdown phase (61% and 50%, respectively). Reduction in pollutant concentrations agreed with reductions in vehicle movements. In the initial lockdown phase vehicle movements reduced by up to 59% in Mexico City and 63% in London. The cities demonstrated a range of air quality changes in their differing geographical areas and land use types. Local meteorology and pollution events, such as forest fires, also impacted the results.

Air Pollutants , Air Pollution , COVID-19 , Air Pollutants/analysis , Air Pollution/analysis , Cities , Communicable Disease Control , Environmental Monitoring , Humans , India , London , Mexico , Pandemics , Particulate Matter/analysis , SARS-CoV-2