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1.
Viruses ; 14(6)2022 06 17.
Article in English | MEDLINE | ID: covidwho-1964105

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has resulted in over 6 million deaths and significant morbidity across the globe. Alongside common respiratory symptoms, COVID-19 is associated with a variety of cardiovascular complications in the acute and post-acute phases of infection. The suggested pathophysiological mechanisms that underlie these complications include direct viral infection of the myocardium via the angiotensin-converting enzyme 2 (ACE2) protein and a cytokine release syndrome that results in indirect inflammatory damage to the heart. Patients with pre-existing cardiovascular disease and co-morbidities are generally more susceptible to the cardiac manifestations of COVID-19. However, studies have identified a variety of complications in low-risk individuals, including young adults and children. Myocarditis and paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS) are among the adverse events reported in the acute phase of infection. Furthermore, patients have reported cardiac symptoms persisting beyond the acute phase in post-COVID syndrome. This review summarises the acute and chronic cardiac consequences of COVID-19 in low-risk patients, explores the pathophysiology behind them, and discusses new predictive factors for poor outcomes.


Subject(s)
COVID-19 , Heart Diseases , COVID-19/complications , Child , Heart Diseases/etiology , Humans , Pandemics , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
2.
Viruses ; 14(6):1322, 2022.
Article in English | MDPI | ID: covidwho-1894249

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has resulted in over 6 million deaths and significant morbidity across the globe. Alongside common respiratory symptoms, COVID-19 is associated with a variety of cardiovascular complications in the acute and post-acute phases of infection. The suggested pathophysiological mechanisms that underlie these complications include direct viral infection of the myocardium via the angiotensin-converting enzyme 2 (ACE2) protein and a cytokine release syndrome that results in indirect inflammatory damage to the heart. Patients with pre-existing cardiovascular disease and co-morbidities are generally more susceptible to the cardiac manifestations of COVID-19. However, studies have identified a variety of complications in low-risk individuals, including young adults and children. Myocarditis and paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS) are among the adverse events reported in the acute phase of infection. Furthermore, patients have reported cardiac symptoms persisting beyond the acute phase in post-COVID syndrome. This review summarises the acute and chronic cardiac consequences of COVID-19 in low-risk patients, explores the pathophysiology behind them, and discusses new predictive factors for poor outcomes.

3.
Pacific-Basin Finance Journal ; : 101736, 2022.
Article in English | ScienceDirect | ID: covidwho-1699320

ABSTRACT

To fill the gaps between managerial distraction and disclosure quality of management earnings forecasts (MEFs), we examine the effects of managerial selective attention resulting from the COVID-19 pandemic. Using this pandemic in 2020 as an adverse shock potentially causing managerial distraction, results based on a difference-in-differences estimation suggest that managerial distraction had a negative effect on MEFs and affected forecast quality by increasing work burden and perceptual narrowing among managers, while cash reserves demonstrated a preventive function and alleviated such adverse effects. Our findings are robust, as supported by tests that address potential measurement errors.

4.
Med Sci Educ ; 31(4): 1537-1538, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1233307

ABSTRACT

Due to recent technological innovations, digital health is quickly transforming the means of healthcare delivery. Technologies such as artificial intelligence, wearables and virtual consultations are increasingly being integrated into routine clinical care and with careful consideration; these promise to bring improvements to both professional workloads and patient outcomes. We highlight the need for dedicated digital health education in order to ensure appropriate use of patient data, patient safeguarding and the means by which we might incorporate this in a post-covid COVID curriculum. We comment on what can be learnt by Barts X Medicine, the first digital health programme in England to be integrated into the medical curriculum, to improve medical teaching.

5.
Open Heart ; 8(1)2021 03.
Article in English | MEDLINE | ID: covidwho-1136107

ABSTRACT

OBJECTIVES: The clinical impact of SARS-CoV-2 has varied across countries with varying cardiovascular manifestations. We review the cardiac presentations, in-hospital outcomes and development of cardiovascular complications in the initial cohort of SARS-CoV-2 positive patients at Imperial College Healthcare National Health Service Trust, UK. METHODS: We retrospectively analysed 498 COVID-19 positive adult admissions to our institute from 7 March to 7 April 2020. Patient data were collected for baseline demographics, comorbidities and in-hospital outcomes, especially relating to cardiovascular intervention. RESULTS: Mean age was 67.4±16.1 years and 62.2% (n=310) were male. 64.1% (n=319) of our cohort had underlying cardiovascular disease (CVD) with 53.4% (n=266) having hypertension. 43.2%(n=215) developed acute myocardial injury. Mortality was significantly increased in those patients with myocardial injury (47.4% vs 18.4%, p<0.001). Only four COVID-19 patients had invasive coronary angiography, two underwent percutaneous coronary intervention and one required a permanent pacemaker implantation. 7.0% (n=35) of patients had an inpatient echocardiogram. Acute myocardial injury (OR 2.39, 95% CI 1.31 to 4.40, p=0.005) and history of hypertension (OR 1.88, 95% CI 1.01 to 3.55, p=0.049) approximately doubled the odds of in-hospital mortality in patients admitted with COVID-19 after other variables had been controlled for. CONCLUSION: Hypertension, pre-existing CVD and acute myocardial injury were associated with increased in-hospital mortality in our cohort of COVID-19 patients. However, only a low number of patients required invasive cardiac intervention.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Pandemics , Aged , Comorbidity , Female , Hospital Mortality/trends , Humans , Incidence , London , Male , RNA, Viral/analysis , Retrospective Studies , SARS-CoV-2/genetics , Survival Rate/trends
6.
Journal of Applied Clinical Medical Physics ; 21(11):4-6, 2020.
Article in English | ProQuest Central | ID: covidwho-950393

ABSTRACT

Some of these challenges experienced in our field are well described in a recent article published by NPR, “Time to Ditch Those Awful Zoom Calls, CEOs Say,” as many other fields experienced many of the same challenges. https://www.npr.org/2020/10/14/923428794/from‐the‐folks‐who‐brought‐you‐boring‐meetings‐ceos‐want‐to‐ditch‐sterile‐zoom‐c Other workflow challenges that were exposed include the benefit of in‐person interactions that allow the immediate resolution of questions and complexities associated with patient care. [...]some argue that in‐person interaction is critical to the field in order to demonstrate the value imaging physics providers must reinforce to administrators. [...]given the circumstances of this transition, it was found that regular rounding and interaction with frontline healthcare workers provided important emotional support to overwhelmed essential medical staff at work. The continuation of scholarship also depends on the continued publication of science. Because scholarship related to COVID‐19 was in huge demand, JACMP publisher Wiley initially expressed concern in their ability to manage the throughput of unrelated articles.

7.
Open Heart ; 7(2)2020 10.
Article in English | MEDLINE | ID: covidwho-892315

ABSTRACT

OBJECTIVES: To understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19. METHODS: We systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomes RESULTS: There was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62-118) min in 2020 vs 75 (57-95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34-65) min in 2020 vs 48 (35-70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3-9) days vs 3 (2-4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19. CONCLUSION: These findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity.


Subject(s)
Coronavirus Infections , Critical Pathways/organization & administration , Delivery of Health Care, Integrated/organization & administration , Outcome and Process Assessment, Health Care/organization & administration , Pandemics , Percutaneous Coronary Intervention , Pneumonia, Viral , ST Elevation Myocardial Infarction/therapy , Aged , Ambulances/organization & administration , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Databases, Factual , Female , Hospital Mortality , Humans , Length of Stay , London/epidemiology , Male , Middle Aged , Patient Admission , Patient Safety , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Retrospective Studies , Risk Assessment , Risk Factors , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , Thrombosis/mortality , Thrombosis/therapy , Time Factors , Time-to-Treatment/organization & administration , Treatment Outcome
9.
Viruses ; 12(5)2020 05 11.
Article in English | MEDLINE | ID: covidwho-232537

ABSTRACT

In early December 2019, the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged in Wuhan, China. As of May 10th, 2020, a total of over 4 million COVID-19 cases and 280,000 deaths have been reported globally, reflecting the raised infectivity and severity of this virus. Amongst hospitalised COVID-19 patients, there is a high prevalence of established cardiovascular disease (CVD). There is evidence showing that COVID-19 may exacerbate cardiovascular risk factors and preexisting CVD or may lead to cardiovascular complications. With intensive care units operating at maximum capacity and such staggering mortality rates reported, it is imperative during this time-sensitive COVID-19 outbreak to identify patients with an increased risk of adverse outcomes and/or myocardial injury. Preliminary findings from COVID-19 studies have shown the association of biomarkers of acute cardiac injury and coagulation with worse prognosis. While these biomarkers are recognised for CVD, there is emerging prospect that they may aid prognosis in COVID-19, especially in patients with cardiovascular comorbidities or risk factors that predispose to worse outcomes. Consequently, the aim of this review is to identify cardiovascular prognostic factors associated with morbidity and mortality in COVID-19 and to highlight considerations for incorporating laboratory testing of biomarkers of cardiovascular performance in COVID-19 to optimise outcomes.


Subject(s)
Biomarkers/blood , Cardiovascular Diseases/blood , Coronavirus Infections/blood , Pneumonia, Viral/blood , Betacoronavirus , COVID-19 , Cardiovascular Diseases/complications , Coronavirus Infections/complications , Humans , Pandemics , Pneumonia, Viral/complications , Prognosis , SARS-CoV-2
10.
Am J Nephrol ; 51(5): 337-342, 2020.
Article in English | MEDLINE | ID: covidwho-19673

ABSTRACT

Novel coronavirus disease 2019 (COVID-19) is a highly infectious, rapidly spreading viral disease with an alarming case fatality rate up to 5%. The risk factors for severe presentations are concentrated in patients with chronic kidney disease, particularly patients with end-stage renal disease (ESRD) who are dialysis dependent. We report the first US case of a 56-year-old nondiabetic male with ESRD secondary to IgA nephropathy undergoing thrice-weekly maintenance hemodialysis for 3 years, who developed COVID-19 infection. He has hypertension controlled with angiotensin receptor blocker losartan 100 mg/day and coronary artery disease status-post stent placement. During the first 5 days of his febrile disease, he presented to an urgent care, 3 emergency rooms, 1 cardiology clinic, and 2 dialysis centers in California and Utah. During this interval, he reported nausea, vomiting, diarrhea, and low-grade fevers but was not suspected of COVID-19 infection until he developed respiratory symptoms and was admitted to the hospital. Imaging studies upon admission were consistent with bilateral interstitial pneumonia. He was placed in droplet-eye precautions while awaiting COVID-19 test results. Within the first 24 h, he deteriorated quickly and developed acute respiratory distress syndrome (ARDS), requiring intubation and increasing respiratory support. Losartan was withheld due to hypotension and septic shock. COVID-19 was reported positive on hospital day 3. He remained in critical condition being treated with hydroxychloroquine and tocilizumab in addition to the standard medical management for septic shock and ARDS. Our case is unique in its atypical initial presentation and highlights the importance of early testing.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Gastroenteritis/virology , Kidney Failure, Chronic/complications , Pneumonia, Viral/complications , COVID-19 , Coronavirus Infections/diagnostic imaging , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnostic imaging , Renal Dialysis , SARS-CoV-2 , Tomography, X-Ray Computed , Travel-Related Illness
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