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The experience of managing patients with COVID-19 around the world has shown that, although respiratory symptoms predominate during the manifestation of infection, then many patients can develop serious damage to the cardiovascular system. However, coronary artery disease (CHD) remains the leading cause of death worldwide. The purpose of the review is to clarify the possible pathogenetic links between COVID-19 and acute coronary syndrome (ACS), taking into account which will help to optimize the management of patients with comorbid pathology. Among the body's responses to SARS-CoV-2 infection, which increase the likelihood of developing ACS, the role of systemic inflammation, the quintessence of which is a "cytokine storm" that can destabilize an atherosclerotic plaque is discussed. Coagulopathy, typical for patients with Covid-19, is based on immunothrombosis, caused by a complex interaction between neutrophilic extracellular traps and von Willebrandt factor in conditions of systemic inflammation. The implementation of a modern strategy for managing patients with ACS, focused on the priority of percutaneous interventions (PCI), during a pandemic is experiencing great difficulties due to the formation of time delays before the start of invasive procedures due to the epidemiological situation. Despite this, the current European, American and Russian recommendations for the management of infected patients with ACS confirm the inviolability of the position of PCI as the first choice for treating patients with ACS and the undesirability of replacing invasive treatment with thrombolysis.Copyright © 2023 Stolichnaya Izdatelskaya Kompaniya. All rights reserved.
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Introduction: COVID-19 pandemic has been associated with increased rates of de-pression, anxiety, and suicidal ideation. Individuals with mental illnesses are disproportionately affected by additional complex health issues. This study aims to examine the knowledge and impact of COVID-19 among patients with mental disorders at the Harris County Psychiatric Center (HCPC). Method(s): A retrospective review of surveys was conducted for patients with mental illness at HCPC. Participants were surveyed on demographics, COVID-19 knowledge, and COVID-19 healthcare impact. The data were analyzed with SPSS 20 for Windows at a 0.05 significance level. Result(s): A total of 46 patients were included in the study. We found that the patient population with mental disorders has different methods of obtaining information regarding COVID-19 and practices varying safety measures. To be precise, more women (52.2%) than men (21.7%) learned about COVID-19 through family and friends (p=0.032). More Hispanic (21.4%) compared to non-Hispanic (0%) patients learned about COVID-19 through resources from the World Health Organization (WHO) (p=0.032). Fewer African American (AA) patients avoided contact with people who were sick (39% vs. 81%) Caucasian (p=0.01) and (100%) Asian/Native American/Pacific Islander [ANAPI] patients (p=0.04). We found more non-Hispanic (50.0%) vs. Hispanic (7.1%) patients reported that their personal time (time outside of work) was unchanged by COVID-19 (p=0.007). More Hispanic (57.1%) vs. non-Hispanic (17.9%) patients reported increased time with family members (p=0.009). Compared to Hispanic patients, more non-Hispanic patients reported unchanged difficulty scheduling appoint-ments (46.4% vs. 7.1%) (p=0.015), obtaining prescription (71.4% vs. 35.7%) (p=0.045), and finding housing placement (53.6% vs. 21.4%) (p=0.047). Furthermore, more Caucasian compared to AA patients reported more changes in how they feel (35.7% vs. 76.2%) (p=0.033), anxiety (52.6% vs. 0%) (p=0.002), stress (47.4% vs. 7.7%) (p=0.024), and sadness (30% vs. 0%) (p=0.031). Finally, more ANAPI (67%) compared to AA patients (0%) reported increased anxiety (p=0.025). Conclusion(s): Our findings suggest that African American patients report less knowledge of COVID-19 prevention and less impact on their mental health by the pandemic compared to other racial groups. Our findings suggest that African American patients may have limited knowledge of COVID-19 prevention compared to other races, Caucasian and Asian/Native American/Pacific Islander patients may have increased mood changes, and Hispanic patients may be experiencing more healthcare inequality amidst the pandemic. However, further inves-tigation of the impending ramifications of the pandemic is warranted.Copyright © 2023 Bentham Science Publishers.
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The heroin epidemic has existed for decades, but a sharp rise in opioid overdose deaths (OODs) jolted the nation in the mid-twenty-teens and continues as a major health crisis to this day. Although the new wave of OODs was initially approached as a rural problem impacting a White/Caucasian demographic, surveillance records suggest severe impacts on African Americans and urban-dwelling individuals, which have been largely underreported. The focus of this report is on specific trends in OOD rates in Black and White residents in states with a significant Black urban population and declared as hotspots for OOD: (Maryland (MD), Illinois (IL), Michigan (MI), and Pennsylvania (PA)), and Washington District of Columbia (DC). We compare OODs by type of opioid, across ethnicities, across city/rural demographics, and to homicide rates using 2013-2020 data acquired from official Chief Medical Examiners' or Departments of Health (DOH) reports. With 2013 or 2014 as baseline, the OOD rate in major cities (Baltimore, Chicago, Detroit, Philadelphia) were elevated two-fold over all other regions of their respective state. In DC, Wards 7 and 8 OODs were consistently greater than other jurisdictions, until 2020 when the rate of change of OODs increased for the entire city. Ethnicity-wise, Black OOD rates exceeded White rates by four- to six-fold, with fentanyl and heroin having a disproportionate impact on Black opioid deaths. This disparity was aggravated by its intersection with the COVID-19 pandemic in 2020. African Americans and America's urban dwellers are vulnerable populations in need of social and political resources to address the ongoing opioid epidemic in under-resourced communities.
ABSTRACT
Marginalized ethnic groups commonly experience discrimination, and these experiences are increasingly linked to adverse health outcomes. Research indicates that the psychosocial stress of discrimination is negatively associated with cardiovascular health. We report a study of the role of U.S. acculturation in this link via an examination of the relation of discrimination with cardiovascular responses to a psychosocial evaluative stressor in a sample of Latino, East Asian, and European American young adults and explored the role of U.S. acculturation and ethnicity in that association. Participants (n = 158, Mage = 20.49, 58% Females, 53.8% Latinos, 14.6% European Americans, 12.7% East Asians) from a larger study on stress reactivity self-reported on experiences of discrimination, U.S. acculturation (rating scale, nativity) and ethnicity. We obtained measures of heart rate variability (HRV), as indexed by root mean-squared successive differences (RMSSD) and high-frequency HRV (HFHRV). Relevant to this study, participants engaged in a 3-minute standing baseline, and then took part in the 5-minute speech task of the Trier Social Stress Test (TSST). Results indicated that discrimination, parental nativity, and quadratic time interacted to influence the RMSSD trajectory during the TSST. Specifically, those reporting higher levels of discrimination and had at least one U.S. born parent exhibited a decrease in RMSSD (? = 0.18, RSE = 0.08, z = 2.30, p = .021, 95%CI [0.03, 0.33]). We also found that during the TSST, East Asians surprisingly exhibited significantly lower HFHRV, as compared with European Americans (? = -233.78, RSE = 86.93, z = -2.69, p = 0.007, 95%CI [-404.17, -63.40]), while Latinos were not significantly different from European Americans in HFHRV (? = -15.00, RSE = 92.99, z = -0.16, p = .872, 95%CI [-197.26, 167.26]). Furthermore, higher discrimination was associated with lower HFHRV (? = -12.68, RSE = 4.20, z = -3.02, p = 0.003, 95%CI [-20.92, -4.45]). Taken together, these findings suggest that perceiving higher levels of discrimination can play a role in the ability to physiologically regulate during stress, and that U.S. acculturation may also contribute. It also suggests the importance of considering ethnicity, as the cardiovascular health of those of various marginalized ethnic groups may be differentially affected. Paper Session 34 - Current state of the art of COVID-19 research Saturday 15:45-16:45.
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Background and Aims: Initial reports on US COVID-19 showed different outcomes in different races. In this study, we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality. Methods: We analyzed data from hospitalized COVID- 19 patients (n=5,852) from 8 hospitals. Demographics, comorbidities, symptoms and laboratory data were collected. Results: The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and dead patients' mean ages were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, and EA were 14.8%, 7.3%, and 16.3%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation, respiratory failure, shortness of breath (SOB) (p<0.01), fatigue (p=0.04), diarrhea (p=0.02), and increased AST (p<0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had a higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables were age (over 45 years old), male sex, EA, patients hospitalized in Indiana, Michigan, Georgia, and District of Columbia. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP, and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID- 19 death in our cohort. Conclusion: Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, predictors of mortality include male gender, diarrhea, elevated AST, comorbidities, respiratory symptoms and failure, and elevation of inflammatory- related biomarkers. These findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to a high frequency of comorbidities and older age among AA.
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Introduction: Recent studies indicate Obstructive Sleep Apnea (OSA) patients have higher severity of respiratory compromise after COVID19 infection due to their sleep related hypoxemic burden. The pro-inflammatory state associated with OSA, sympathetic excitation, and recurrent hypoxemia may predispose to poorer post-COVID19 outcomes. We compared COVID19 infection outcomes in a cohort of hospitalized Veterans with and without OSA. Methods: We used Jesse Brown Veteran Affairs Medical Center (JBVAMC) Registry for Research on Risk Factors and Outcomes of Veterans Evaluated for COVID19. The registry includes all patients who received a test for COVID19 at JBVAMC through November 8th,2021. Data are from the VA COVID19 Shared Data Resource and chart review, and include demographic data, pharmacological and non-pharmacological interventions, clinical outcomes, and preexisting conditions. The study was approved by the Institutional review board (IRB). STATA v16 was used for data analysis. Results: Of the 13,385 patients included in the registry, 1890 patients were found to have a positive COVID19 test, of which 625 were hospitalized and included in our study. The sample was older (mean age of 66.8 years), predominantly men (583, 93.3%) and African Americans (461, 73.8%). 18.7% (117, 18.7%) were European American, and (47, 7.5%) were of other race categories. The group with OSA was 37.8% (n=236) and without OSA was 62.2% (n=389) of the total sample. Elixhauser comorbidity index was higher in OSA group compared to those without OSA (p:0.00001, mean (SD): 16.73(14.6) vs. 12.03 (13.1)). Univariate analysis demonstrated a higher rate of readmission at 60 days (p=0.02, Odds ratio (95% CI): 1.69 (1.1-2.6)) and use of mechanical ventilation (p=0.05, Odds ratio (95% CI): 1.65 (0.99-2.75) in OSA vs. without OSA. These associations were attenuated in multivariate logistic regression models including age, gender, race, Elixhauser index and body mass index. OSA did not affect the length of stay or inpatient mortality. Conclusion: In hospitalized COVID19 patients, OSA increases the probability of readmission and risk of mechanical ventilation, but this effect is likely due to higher comorbidity and obesity rates in OSA. In the future, we plan to examine larger samples of Veterans hospitalized with COVID19 and assess the effect of positive airway pressure treatment to understand the impact of OSA on COVID19 outcomes.
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BACKGROUND AND AIM: The symptoms of coronavirus and myocarditis are similar to each other, such as chest pain. It is very important to distinguish between these two diseases to prevent or treat the disease. In this study, we aimed to describe connection of CXADR gene and ACE2 in COVID-19. METHODS: We were found similar genes with CXADR gene and ACE2 using STRING and GENEMANIA databases. Then, we attained pathway of viral myocarditis using KEGG Pathway Databases. After that, we got probably damaging SNPs on CXADR gene using Exome Variant Server and Polyphen2 databases. RESULTS: First of all, we showed the viral myocarditis pathway in our study. We found the expression level of the CXADR gene using bioinformatics methods and our results showed that the CXADR gene is overexpressed in skin, bladder, brain, stomach, prostate and testis. Then, we found 78 variations in the CDXADR gene in European American and African American populations, 11 of them were damaging polymorphisms in the CXADR gene. CONCLUSIONS: Our results may be support to explain the pathogenesis of high-risk group diseases in COVID-19. In the future, this study may contribution to solve physiopathology of COVID-19 linked with myocarditis.
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Study Objectives: Due to their ubiquity, smartphone applications are becoming increasingly important for emergency response, including providing a means of mobilizing volunteer responders. Data from these applications may be useful for identifying potential disparities in emergency response by revealing geographic gaps and racial and income-based inequity in the availability of volunteers. This could in turn be used to create targeted interventions to increase equitable emergency response coverage. The purpose of our study was to examine associations between race, SES factors, and access to emergency resources using data from PulsePoint (PP), a smartphone-based emergency response application for public cardiac arrest. We sought to contextualize this investigation to the COVID-19 pandemic, to further understand how pandemic conditions may intersect with existing inequities. Methods: The PP responder position data from the Allegheny County PP deployment was aggregated into zip code-level totals from data samplings taken from August 2019 to May 2020 using geospatial informatics software (QGIS). These totals were stratified into pre- and intra-pandemic periods, as well as by racial and demographic characteristics obtained from the US Census Bureau. The change in available responders at the zip-code level, as well as the association between number of available responders and racial and demographic characteristics, were examined using Mann-Whitney U Tests due to non-normal distribution of responder counts. Results: The median (IQR) of available PP responders before and after the stay at home order were 67.4125 (116.9375) and 73.05 (127.95), respectively. Fifteen percent of zip codes in the Pittsburgh area have > 30% of African Americans with a median (IQR) of 280 (1488). This compared to 95.6% of zip codes in the Pittsburgh area that have > 30% of Caucasian-Americans with a median (IQR) of 8582 (12538). The median (IQR) for the percent below the poverty level for all zip codes was 9% (10.8%). The p-value of available PP responders before the shutdown for high-income vs. low-income zip codes was 0.493. The p-value of available PP responders after the shutdown for high-income vs. low-income zip codes was 0.197. Lastly, the p-values of available PP after the shutdown to zip codes with > 30% vs. <30% Caucasian-Americans and > 30% vs. <30% African Americans were -0.443 and 1.095, respectively. Conclusion: In summary, SES was associated with the number of PP responders at the zip code level in Allegheny county. Interestingly, the pandemic shifted the distribution of responders to a net increase in available responders which did not entirely differ by race, but by income.
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In 2020, the AACR's U.S. Cancer Disparities Progress Report showed that the there is still a significant gap in cancer incidence and mortality between white Americans and other racial and ethnic groups. That's not because the science hasn't progressed or because people of color are biologically predisposed to cancer. It's because the systems and structures put in place decades ago continue to harm the health of racial and ethnic minorities. Red-lining in the 1930s created segregated housing, and then the creation of the national highway system decimated majority-Black neighborhoods, leaving them treeless, polluted, and lacking healthy food and medical facilities. As a result, people living in these neighborhoods are more likely to get cancer and also more likely to die from it. So, when COVID-19 hit, many of us were not surprised that communities of color were disproportionately affected. And the current situation with COVID-19 vaccines is a great demonstration that while science is necessary for improving health, it's not sufficient. Those amazingly effective vaccines can't keep hospitals from being overwhelmed if a large chunk of the population won't get the shot, just as advances in cancer screening and treatment can't end disparities if they're predominantly going to wealthy white people. This realization has been one of our blind spots as scientists and physicians. Not only must work toward equitable access to care, but we must also work on building trust in medicine, which we do by demonstrating that we're trustworthy. There's a science to it, though we're going to have to allow for greater flexibility and messiness than we're accustomed to.
ABSTRACT
African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer's disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D3 supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.