The association between the elevated serum levels of cardiac Trop I and mortality in patients with and without pre-existing CAD in COVID-19 patients: A retrospective observational study

Background: COVID-19 has appeared as a pandemic and public health issue at a universal level. First documented as a respiratory disease, COVID-19 has been found to interrelate with and disturb the cardiovascular system causing myocardial injury and also cardiac dysfunction. Initial documentation of cardiac pathology can play a substantial role in dropping the death rate. This study emphasizes on the relationship between the serum levels of cardiac Trop I and prognosis in patients with and without pre-existing CAD in COVID-19 patients. Aims and Objectives: The first objective was to explore the association among the serum levels of cardiac Trop I and bad prognosis in patients with antiquity of CAD and without CAD. The secondary objective was to explore and understand whether increased Trop I is an appreciated prognostic indicator for COVID-19 patient antagonistic prognosis. Material(s) and Method(s): This was conducted as a retrospective observational study in which a whole of 45 patients admitted in COVID Hospital of Malabar Medical College and Research Center category C were studied. The medical record of the patients whose COVID-19 confirmation done by combined conclusions of reverse transcription PCR, symptoms, and chest X-ray was studies by the team. Result(s): Mean age of the study participants was 59.3 +/- 13.7. Every study participants had elevated Trop I levels with a median Trop I in study subjects being 397.9. There was a statistically significant elevation in Trop I levels in patients with CAD linked with non-CAD patients with a median IQR of 641.6 and P = 0.003 and there was a significant increase in Trop I levels in patients who expired related to patients who got discharged with a median IQR of 587.3 and P = 0.003. Conclusion(s): From this study, we accomplish that rise in cardiac troponin-I level is connected with elevated mortality in patients with COVID-19. Hence, it can be used as significant biomarker of disease evolution, hospitalization, and worse prognosis in COVID-19 patients.Copyright © 2023, Mr Bhawani Singh. All rights reserved.

Identifying Clinical Subtypes of Long COVID: An Unsupervised Machine Learning Approach

Objectives: The symptoms of patients with post-acute COVID-19 syndrome are heterogenous, impact multiple systems, and are often non-specific. To better understand the symptomatic profile of this population, this study used real-world data and unsupervised machine learning techniques to identify distinct groupings of long COVID patients. Method(s): Children/adolescents (age 0-17) and adults (age 18-64 and >=65) with >=2 primary diagnoses for U09.9 "Post COVID-19 condition" from 10/01/2021 (ICD-10 code introduction) until 03/31/2022 were selected from Optum's de-identified Clinformatics Data Mart Database, with the first diagnosis deemed index. Included patients had >=1 diagnosis for COVID-19 at least 4 weeks before index and continuous enrollment during the 12 months prior to index. Diagnoses recorded +/-2 weeks from index that were not present prior to the initial COVID-19 diagnosis were captured and used as patient features for k-means clustering. Final cluster assignments were selected based on silhouette coefficient and clinical relevancy of groupings. Result(s): 3,587 patients met eligibility criteria, yielding three clusters. Concurrent symptom domains surrounding index included breathing, fatigue, pain, cognitive, and cardiovascular diagnoses. The first cluster (N=2,578, 71.8%) was characterized by patients with only a single symptom domain (33% breathing, 33% cardiovascular, 20% fatigue, 11% cognitive). The second cluster (N=651, 18.1%) all presented with breathing symptoms accompanied by one additional domain (cardiovascular 40%, fatigue 28%, pain 18%). The final cluster (N=358, 9.9%) experienced breathing symptoms accompanied by two additional domains (fatigue and cardiovascular 34%, cardiovascular and cognitive 34%). Cluster 3 was slightly older than clusters 1 or 2 (mean age 66 vs. 58 years, respectively). Conclusion(s): Unsupervised machine learning identified distinct groups of long COVID patients, which may help inform multidisciplinary care needs. Our analysis suggests that many patients with long COVID may experience symptoms from only a single domain, and multi-system illness may generally include breathing complications accompanied by fatigue and/or cardiovascular complications.Copyright © 2023

Classic endocrine disorders: implications for cardiovascular disease

Chronic underproduction or autonomous oversecretion of hormone by endocrine glands has implications for the development and progression of cardiovascular disease. Hormonal effects on the vasculature may be direct, for example, tachycardia and atrial arrhythmias in hyperthyroidism, or mediated indirectly via adverse profiles of one or more major cardiovascular risk factors, for example, arterial hypertension in Conn's syndrome. The timescale of vascular effects may be relatively rapid, for example, resting tachycardia or atrial fibrillation precipitated by hyperthyroidism, or long-term, for example, atherosclerosis associated with acromegaly or hypopituitarism of long duration. The COVID-19 pandemic has highlighted clinically important interactions between the endocrine, metabolic, and cardiovascular systems. Endocrinologists and cardiologists will often need to collaborate closely in the management of patients with endocrine-associated vascular disease. © 2023 Elsevier Inc. All rights reserved.

Identification of Patients Diagnosed with Rare and Emerging Diseases Utilizing the Trinetx Network: A Case Study of African and American Trypanosomiasis

Objectives: Due to large sample sizes, electronic medical records (EMR) databases have the potential to provide pivotal insights into patients diagnosed with rare, orphan, or emerging diseases. This study aimed to explore the patient profile of African and American trypanosomiasis, both vector-borne parasitic diseases, pre-and post the COVID-19 pandemic using the TriNetX Network. Method(s): From Jan 1, 2018 - Nov 30, 2019 (pre-COVID) and Jan 1, 2020 - Nov 30, 2021 (post-COVID) patients were queried from the TriNetX Global health research network, inclusive of 88 million patients from the United States (US), Europe, the Middle East, Africa, Latin America, and Asia Pacific. Eligible patients with an ICD-10 diagnosis code of African trypanosomiasis or American trypanosomiasis were identified (2280 patients on 22-Dec-2022) and analyzed separately, pre- and post-COVID. Result(s): We identified 340 patients pre- and 960 patients post-COVID with African trypanosomiasis and 960 patients pre- and 190 patients post-COVID with American trypanosomiasis. Most patients resided in the US. Pre-COVID African trypanosomiasis patients had a mean age of 38 and were 59% female while post-COVID patients had a mean age of 34 and were 57% female. Pre-COVID American trypanosomiasis patients had a mean age of 49 and were 57% female while post-COVID patients had a mean age of 49 and were 53% female. Top co-diagnoses included diseases of the respiratory (85%, 84%) and nervous systems (82%, 79%) for patients with African trypanosomiasis and diseases of the digestive (69%, 54%) and circulatory systems (68%, 61%) for patients with American trypanosomiasis in both the pre- and post-COVID cohorts, respectively. Conclusion(s): Using real-world EMR data we were able to obtain patient profiles for a rare disease (African trypanosomiasis) and a common, emerging disease (American trypanosomiasis). This informationsupportsutilizing EMR data for describing patient populations in rare, orphan, or emerging diseases, which may aid drug development for these indications.Copyright © 2023

The long-term effects of the Covid-19 infection on cardiac symptoms.

BACKGROUND: Besides the lungs, coronavirus disease 2019 (COVID-19) can affect the cardiovascular, digestive, urinary, hepatic, and central nervous systems. Other than its short-term effects, COVID-19 may also cause long-term complications. In this study, we assessed long-term COVID-19 cardiovascular symptoms among patients in a cardiovascular clinic. METHOD: A retrospective cohort was conducted between October 2020 to May 2021 on patients at an outpatient cardiovascular clinic in Shiraz, Iran. Patients with a history of COVID-19 at least one year before their referral were included. Baseline information was extracted from the clinic's database. Data were collected regarding symptoms like dyspnea, chest pain, fatigue, and palpitations after a year of COVID-19. We also noted any major adverse cardiac events (MACE). RESULTS: Most common symptoms after a year of COVID-19 were exertional dyspnea (51.2%), dyspnea at rest (41.6%), fatigue (39%), and chest pain (27.1%). The symptoms were more prevalent in hospitalized patients than in non-hospitalized patients. The prevalence of MACE was about 6.1% during the 12-month follow-up, with this rate being higher in those with a history of hospitalization or comorbid diseases. CONCLUSION: The prevalence of cardiovascular symptoms was fairly high in patients at our clinic a year after COVID-19, and the most common symptom was dyspnea. Hospitalized patients had more MACE. (Clinicaltrial.gov number: NCT05715879)(04/02/2023).

Rehabilitation Characteristics and Outcomes for Lung Transplantation for COVID-19: A Case Series.

OBJECTIVE: Severe coronavirus disease 2019 (COVID-19) can result in irreversible lung damage, with some individuals requiring lung transplantation. The purpose of this case series is to describe the initial experience with the rehabilitation and functional outcomes of 9 patients receiving a lung transplant for COVID-19. METHODS: Nine individuals, ranging in age from 37 to 68 years, received bilateral orthotopic lung transplantation (BOLT) for COVID-19 between December 2020 and July 2021. Rehabilitation was provided before and after the transplant, including in-hospital rehabilitation, postacute care inpatient rehabilitation, and outpatient rehabilitation. RESULTS: Progress with mobility was limited in the pretransplant phase despite rehabilitation efforts. Following transplantation, 2 individuals expired before resuming rehabilitation, and 2 others had complications that delayed their progress. The remaining 5 experienced clinically important improvements in mobility and walking capacities. CONCLUSION: Considerable rehabilitation resources are required to care for individuals both before and after BOLT for COVID-19. Rehabilitation can have a profound impact on both functional and clinical outcomes for this unique patient population. IMPACT: There is limited literature on the rehabilitation efforts and outcomes for patients who received BOLT for COVID-19. Occupational therapists and physical therapists play an important role during the pretransplant and posttransplant recovery process for this novel patient population. LAY SUMMARY: Patients with a bilateral orthotopic lung transplant due to COVID-19 require a unique rehabilitation process. They have significant difficulties with activities of daily living and functional mobility across the pretransplant and posttransplant continuum of care, but progressive gains in functional performance may be possible with a comprehensive multidisciplinary rehabilitation program.

Co-exposure to urban particulate matter and aircraft noise adversely impacts the cerebro-pulmonary-cardiovascular axis in mice

Worldwide, up to 8.8 million excess deaths/year have been attributed to air pollution, mainly due to the exposure to fine particulate matter (PM). Traffic-related noise is an additional contributor to global mortality and morbidity. Both health risk factors substantially contribute to cardiovascular, metabolic and neuropsychiatric sequelae. Studies on the combined exposure are rare and urgently needed because of frequent co-occurrence of both risk factors in urban and industrial settings. To study the synergistic effects of PM and noise, we used an exposure system equipped with aerosol generator and loud-speakers, where C57BL/6 mice were acutely exposed for 3d to either ambient PM (NIST particles) and/or noise (aircraft landing and take-off events). The combination of both stressors caused endothelial dysfunction, increased blood pressure, oxidative stress and inflammation. An additive impairment of endothelial function was observed in isolated aortic rings and even more pronounced in cerebral and retinal arterioles. The increase in oxidative stress and inflammation markers together with RNA sequencing data indicate that noise particularly affects the brain and PM particularly affects the lungs. Noise also increased levels of circulating stress hormones adrenaline and noradrenaline, while PM increased levels of circulating cytokines CD68 and MCP-1. The combination of both stressors has additive adverse effects on the cardiovascular system that are based on PM-induced systemic inflammation and noise-triggered stress hormone signaling. We demonstrate an additive upregulation of ACE-2 in the lung, suggesting that there may be an increased vulnerability to COVID-19 infection. The data warrant further mechanistic studies to characterize the propagation of primary target tissue damage (lung, brain) to remote organs such as aorta and heart by combined noise and PM exposure.Copyright © 2023

The role of physical activity in modulating COVID-19 neuropsychological complications: a narrative review

Since 2020, the COVID-19 pandemic, triggered by SARS-CoV-2, represents the major global issue affecting the lifestyle of people around the world. Wuhan, China was the first city to detect the SARS-CoV-2 virus, but the virus soon spread around the world, forcing the World Health Organization to declare a global epidemic on March 11, 2020 (1). Previous pathological conditions or comorbidities such as old age are one of the main causes of premature death and increased morbidity and mortality due to COVID-19 (4). Inactivity due to hospitalization and bed rest and reduced physical activity due to constant quarantine and social distancing can reduce the ability of organ systems to resist viral infection and the risk of damage to the immune, respiratory, and Increase cardiovascular systems, musculoskeletal and nervous system (4). On the other hand, the health benefits of physical activity, from cardiovascular health to mental health, have been well established (5). Decreased physical activity and increased sedentary behaviors were reported during quarantine in several populations, including children and patients with a variety of medical conditions (6). In general, COVID-19 lifestyle changes have led to a decrease in physical activity and consequently more inactivity in different parts of the community, which can pose a risk to general or mental health, especially for certain populations. In this study, we have tried to review the neurological and psychological effects of COVID-19 and the resulting lifestyle changes, and specifically the role of exercise in relation to these effects. Central nervous system (CNS) and peripheral nervous system (PNS) manifestations can occur during and after COVID-19, but the underlying mechanisms, symptomatology, and frequency of these complications are not well understood (7). Limited postmortem studies have shown signs of hypoxic brain damage and inflammatory neurological changes in the brainstem, while neuropathological data from the PNS are almost non-existent. Due to the cause, direct invasion of acute respiratory syndrome of COVID-19 virus to nerve tissue has been suggested in several cases, but autoimmune damage and neurological complications related to intensive care management can also be effective. The contribution of these mechanisms to the overall burden of CNS and PNS complications of COVID-19 is unknown (7). Follow-ups in Germany and the United Kingdom have shown that neuropsychological symptoms after COVID-19 in 20 to 70% of patients, even in young adults, last for months after the onset of respiratory symptoms, suggesting brain involvement persists (9). COVID-19, which enters through angiotensin-converting enzyme receptors, can damage endothelial cells, leading to inflammation, thrombosis, and brain damage. In addition, systemic inflammation leads to a decrease in monoamines and neurotrophic factors and activation of microglia, which leads to an increase in glutamate and N-methyl-d-aspartate-3 and excitatory toxicity, and these factors cause the onset or exacerbation of existing neuropsychiatric symptoms. They are already (9). However, the extent of damage caused by the COVID-19 pandemic strain is still speculated;it has recently been suggested that irregular neuro-endocrine-immune interactions may be behind psychiatric manifestations observed in quarantined individuals (12, 13). Persistent and increased stressful events can direct immune, endocrine, and nervous system responses primarily through hypothalamic-pituitary-adrenal (HPA) mediated dysfunction (12), and changes in the levels of systemic inflammatory mediators or the brain predispose individuals to pathological psychological conditions. It acts like anxiety and depression. In addition, stress can be a potential trigger for neuroinflammation, a term used to indicate an imbalance or intensification of immune signals in the brain that can lead to several disorders such as aggression, psychosis, depression, and anxiety disorders (12). Covid 19 has also been shown to alter nerve growth factors that may affect the neurop

Insights Regarding Outcomes for Covid-19 Hospitalizations with Adult Congenital Heart Disease (Achd)

Background: As of December 2022, SARS-CoV-2 coronavirus resulted in over 6 million deaths worldwide.[1] It was realized early into the pandemic, that COVID-19 significantly impacts the Cardiovascular system. [2] Patients with pre-existing cardiovascular comorbidities were particularly at higher risk of adverse outcomes during their hospitalizations. [3] Similarly, it can be safe to assume patients with adult congenital heart disease (ACHD) should considered a high-risk population for the development of severe COVID infection with increased rates of significant cardiovascular complications. Objective(s): Based on this reasoning and the paucity of data available on this topic using a large database, we sought to investigate the outcomes of patients with ACHD who were admitted to the hospital with COVID-19. Method(s): The National Inpatient Sample database for 2020 was queried to identify adult hospitalizations with a primary diagnosis of COVID-19 and a secondary diagnosis of ACHD using International Classification of Diseases - 10 Clinical Modification (ICD-10-CM) codes. The primary outcome studied was inpatient mortality, while secondary outcomes included inpatient complications, mean length of stay (LOS), and total hospital charge (THC). Multivariate logistic and linear regression analyses were used to adjust for possible confounders and analyze the variables. Result(s): Out of 1,050,045 COVID-19 hospitalizations registered, 2,425 (0.23%) had ACHD as a secondary diagnosis. Encounters with ACHD who were hospitalized with COVID-19 had significantly higher adjusted odds of inpatient mortality (Adjusted Odds Ratio [aOR]: 1.4, [95% CI: 1.05-1.88], p=0.022), Longer LOS (Mean 2.4 days, [95% CI: 1.35-3.40], p <0.001), and higher Total Hospital Charges (Mean $53,000, [95% CI: 20811-85190], p <0.001). A Forrest plot (Figure 1) demonstrates a graphical representation of the multivariate analysis of the significant in-hospital complications when adjusted for patient demographics, comorbidities, and hospital characteristics. Conclusion(s): Among COVID-19 hospitalizations, those with a history of congenital heart diseases had significantly worse outcomes in terms of in-hospital mortality, sepsis;the need for endotracheal intubation, mechanical ventilation, and vasopressors;developing acute kidney injury and pulmonary embolism, in addition to the longer length of stay, and higher total hospital charges. [Formula presented]Copyright © 2023

Functional features of the cardiovascular system in COVID-19 children

The functional state of the cardiovascular system of children aged 8-12 years who underwent COVID-19 was studied. It has been shown that one of the mechanisms of functional disorders in the cardiovascular system in the period from 3 to 6 months after suffering COVID-19 is considered a syndrome of autonomic dysfunction. The manifestations of autonomic dysfunction in children are hypertensive changes in the cardiovascular system in the absence of pronounced clinical manifestations, the presence of functional tension of regulatory systems, unsatisfactory functional status, decreased rates of increase in heart rate power in response to load, low values of sympathetic regulation mechanisms and centralization of the cardiovascular system regulation circuit, a large proportion of the influence of the peripheral regulation circuit. Conclusion. One of the pathogenetic mechanisms for reducing the functional parameters of the cardiovascular system in children who have had a coronavirus infection is endothelial dysfunction syndrome.

Radiium systemic radiotherapy - 223 patients with mCRPC. Experience of the Republic of Bashkortostan

Introduction & Objectives: The incidence of prostate cancer, both in the world and in the Russian Federation, tends to increase. In the Republic of Bashkortostan in 2021, 699 patients with this diagnosis were registered. 19.6% of patients had stage IV disease at the time of diagnosis. 5818 patients were registered, of which 361 died within a year. The effectiveness of hormonal treatment of common prostate cancer has time limitations, after which there is a development of resistance to castration and progression of the disease. To date, drugs such as kabazitaxel, sipuleucel-T vaccine, abiraterone, enzalutamide and radium-223 have been approved for use in metastatic CRPC. The purpose of the work: analysis of the experience of systemic radiotherapyand Radium - 223 patients with mCRPC in the Republic of Bashkortostan in 2021. Material(s) and Method(s): Analysis of patients who received systemic radiotherapy Radium - 223 in the Republic of Bashkortostan according to medical documentation and research data. In 2021, Radiy-223 radiotherapy was performed on 7 patients diagnosed with mCRPC. Median age 63.14 years. All patients met the criteria for treatment, i.e. had castration-resistant prostate cancer with bone metastases, without visceral metastases. All patients had concomitant pathology from the cardiovascular system, respiratory tract, endocrine system. According to the previous surgical treatment, patients were distributed as follows: orchidectomy - 4, prostatectomy - 1 and 2 patients underwent tumor biopsy. By morphology: Glisson 6 - 2 patients, Glisson 7 - 1, Glisson 8 - 3, Glisson 10 - 1. 4 patients were referred to Xofigo for radiologically confirmed progression, 3 patients were progressingin height at PSA levels. Result(s): 1 patient previously received 1 line of systemic therapy, 5 patients received 2 lines, 1 patient received 3 lines of therapy. 6 patients received all 6 courses of radiotherapy, 1 patient did not complete treatment due to COVID 19. He is expected to complete therapy. All patients are currently alive with no signs of disease progression. Serious side effects were not registered. Conclusion(s): The "therapeutic window" for the prescription of radium-223 is the period before the appearance of visceral metastases and decline of the somatic status. To achieve the maximum benefit from the appointment of radium-223, it is necessary to conduct >=5 cycles of therapy, which is possible in 1-2 treatment lines. It is necessary to select patients carefully for radiotherapy - Radium 223.Copyright © 2022 European Association of Urology. Published by Elsevier B.V.

Manifestaciones extrapulmonares de COVID-19.

Coronaviruses are a large family of single-stranded ARN viruses that infect a wide variety of animals, including humans. The SARS-CoV-2 virus, which is responsible for the disease called COVID-19, has infected 27,249,308 people and caused 890,971 deaths worldwide until September 7, 2020. Considering the genetic similarities between SARS-CoV-2 and the epidemic coronaviruses SARS-CoV and MERS, presumably they share tropisms for specific cell lines and systemic conditions. The clinical and paraclinical characteristics of this new virus have been described in detail at the pulmonary level, although there is increasing evidence that it is a multisystemic agent. In the present work, we describe the extrapulmonary manifestations of COVID-19 reported to date, including hematological, cardiovascular, neurological, renal, muscular, ophthalmological, endocrine-metabolic, gastrointestinal, hepatobiliary, cutaneous and in special populations: pediatric (including multisystemic inflammatory syndrome) and pregnant women. It is essential to know the systemic complications of SARS-CoV-2 infection when managing these patients, given the potential risk to life of the most serious manifestations. Therefore, it is advisable to consider them in a targeted manner and provide timely treatment as far as possible.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Critical illness in patients with omicron variant COVID-19: different but crucial

Introduction: During the COVID-19 pandemic, various virus variants evolved worldwide. COVID-19 omicron (CO) was associated with a decrease in length of hospital stay, ICU admission and death [1] as compared to COVID-19 delta (CD). To estimate impact of CO on ICUs worldwide, we investigated characteristics, disease course and outcome of critically ill CO patients. Method(s): Of 8562 critically ill COVID-19 patients included in the prospective international multicenter RISC-19-ICU registry [2,3], characteristics and outcome were compared for 1890 CD and 272 CO patients admitted to ICU between 1-2021 and 9-2022. Mixed model analysis corrected for individual center effects and adjusted for age, sex, vaccination status, use of steroids and anticoagulants was used. Result(s): There was no difference in age, sex and BMI between groups. CO patients had more comorbidities [mean difference (MD) 0.7, 95% CI (0.5-1.0), p = 0.02], especially arterial hypertension, and higher SAPS II score [MD 0.0 (0-0.1), p < 0.001], SOFA score [MD 0.1 (0.1-0.3), p < 0.0001]. CO patients presented with higher cardiovascular system SOFA subscore, but better PF-ratio at ICU admission and smaller risk for intubation and mechanical ventilation throughout their ICU stay [OR 0.5 (0.3-0.8)]. There was no difference in ECMO treatments, ICU length of stay [MD 0.6 (0-11.4), p = 0.72] or ICU survival [HR 1 (0.7-1.5), p = 0.88] between the two groups. Conclusion(s): We show that critically ill CO patients present with more comorbidities, less severe respiratory disease but more severe hemodynamic instability at ICU admission as compared to CD patients, although the ICU length of stay and mortality was similar. These differences could be explained by differences in disease characteristics caused by CO, or by the increasing prevalence of CO as co-factor to preexisting disease. Continued monitoring of critically ill CO patients in ICUs worldwide is warranted.

The effect of comorbidities on the prognosis of COVID-19 is more than thought: a summary of our region

Objective: Nowadays community immunity is trying to be achieved through vaccination. If the threshold value can be exceeded, COVID-19 may also be one of the seasonal infections with annual epidemics like influenza. The current study intends to understand how the most common underlying comorbidities affect the intensive care unit (ICU) and mechanical ventilation (MV) requirements and mortality of COVID-19. Materials and Methods: Main demographic data, laboratory, and radiological findings were obtained retrospectively from medical records of 152 patients diagnosed with COVID-19. Comorbidities were ensured from the prescription information system. Effect of all data on ICU and MV requirements and mortality were analyzed with Student's t-test, Mann-Whitney-U, or Chi-square tests. Length of hospital stay was evaluated according to univariate analyzes. Results: Out of 152 patients, 72 were men. The median age was 56.5 years. The median length of hospital stay was 7 days. The case fatality rate was 5.9%. Elderly ages, clinical symptoms during admission, and laboratory values increased the risk of ICU, MV and mortality significantly (p < 0.05). At least one or more comorbidities were present in nearly half of the patients. The most prevalent comorbidities were hypertension, diabetes, and cardiovascular diseases, respectively. Especially diabetes was significantly associated with poor prognosis (p < 0.05). Conclusion: COVID-19 patients with any comorbidity yielded poorer clinical outcomes. Awareness of comorbidities, trying to cure them, and striving for maintaining a high personal health status seems to prevent the bad prognosis of the COVID-19.

Pain in Covid-19 and Features of Pathogenetic Molecular Mechanisms

Although it has been almost three years since the World Health Organization (WHO) declared a pandemic, COVID-19 is still an unsolved problem, thereby attracting great scientific interest. The disease has a heterogeneous clinical picture with multiple manifestations from different organs and systems. Currently, COVID-19 is perceived as a polysyndromic inflammatory disease involving not only the respiratory system, but also the musculoskeletal system, the cardiovascular system, the skin, the excretory and the nervous system, and is accompanied by a number of hematological, gastrohepatoenterological and endocrine disorders. Various pain phenomena also appear in the clinical presentation of the disease, often as a single manifestation or in combination with symptoms from different organs and systems. The pathogenesis of pain is complex and there is still no consensus on the exact driving mechanisms. Several different signaling pathways play an important role in the generation of pain impulses and perception. They are different for different types of pain. At this stage, the role of angiotensin-converting enzyme 2 (ACE), the renin-angiotensin system (RAC), angiotensin 2 receptors (AT2R), direct neuronal invasion of the virus, the involvement of pro-inflammatory cytokines, hypoxia, the involvement of macrophages, is discussed. as well as the role of overactivity of the immune system, causing the so-called "cytokine storm". Pain is the result of complex biochemical processes influenced to varying degrees by biological, physiological and social factors. Our knowledge at this stage remains scarce and is the subject of many studies on the key pathogenic mechanisms. Therefore, the purpose of this review is to describe the known mechanisms for the occurrence and persistence of pain in patients with COVID-19, as well as to classify the pain phenomena and present its most common localizations. The diagnosis and treatment of COVID-19 and associated pain should be carried out by a multidisciplinary team of specialists, given the heterogeneous clinical presentation of the disease.Copyright © 2023 Medical Information Center. All rights reserved.

Cardiovascular implications and physical activity in middle-aged and older adults with a history of COVID-19 (CV COVID): a protocol for a randomised controlled trial.

BACKGROUND: The clinical manifestation of COVID-19 is associated with infection and inflammation of the lungs, but there is evidence to suggest that COVID-19 may also affect the structure and function of the cardiovascular system. At present, it is not fully understood to what extent COVID-19 impacts cardiovascular function in the short- and long-term following infection. The aim of the present study is twofold: (i) to define the effect of COVID-19 on cardiovascular function (i.e. arterial stiffness, cardiac systolic and diastolic function) in otherwise healthy individuals and (ii) to evaluate the effect of a home-based physical activity intervention on cardiovascular function in people with a history of COVID-19. METHODS: This prospective, single-centre, observational study will recruit 120 COVID-19-vaccinated adult participants aged between 50 and 85 years, i.e. 80 with a history of COVID-19 and 40 healthy controls without a history of COVID-19. All participants will undergo baseline assessments including 12-lead electrocardiography, heart rate variability, arterial stiffness, rest and stress echocardiography with speckle tracking imaging, spirometry, maximal cardiopulmonary exercise testing, 7-day physical activity and sleep measures and quality of life questionnaires. Blood samples will be collected to assess the microRNA expression profiles, cardiac and inflammatory biomarkers, i.e. cardiac troponin T; N-terminal pro B-type natriuretic peptide; tumour necrosis factor alpha; interleukins 1, 6 and 10; C-reactive protein; D-dimer; and vascular endothelial growth factors. Following baseline assessments, COVID-19 participants will be randomised 1:1 into a 12-week home-based physical activity intervention aiming to increase their daily number of steps by 2000 from baseline. The primary outcome is change in left ventricular global longitudinal strain. Secondary outcomes are arterial stiffness, systolic and diastolic function of the heart, functional capacity, lung function, sleep measures, quality of life and well-being (depression, anxiety, stress and sleep efficiency). DISCUSSION: The study will provide insights into the cardiovascular implications of COVID-19 and their malleability with a home-based physical activity intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT05492552. Registered on 7 April 2022.

Long-term effects of coronavirus disease 2019 on the cardiovascular system: The CV COVID-19 registry

Background: Patients with COVID-19 have an increased risk of cardiovascular adverse events during the acute phase. However, the long-term cardiovascular outcomes are unknown. Objective(s): We aimed to determine the long-term effects of COVID-19 in the cardiovascular system. Method(s): This is a multicenter, observational, retrospective registry conducted at 17 centers in Spain and Italy. Consecutive patients older than 18 years who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV2 in the participating institutions were included. Patients were classified into two groups, according to the results of the RT-PCR: COVID-19 positive or negative. The primary outcome was cardiovascular (CV) death at 1-year. The secondary outcomes included acute myocardial infarction, stroke, heart failure hospitalization, pulmonary embolism, and serious cardiac arrhythmias at 1-year. Outcomes were compared between the two groups. An independent clinical event committee adjudicated events. Result(s): A total of 4427 patients were included, 3578 (80.8%) patients with COVID-19 and 849 (19.2%) without COVID-19. COVID-19 patients were older, had a higher rate of classical cardiovascular risk factors, except for active smoking, and had fewer comorbidities. At a median time of 13.5 (IQR 11.8-15.8) months, after an adjustment by baseline characteristics, there was no difference in CV death (1.4% vs. 1.1%;HR 1.03 [0.49-2.18];p=0.941) between patients with COVID-19 and without. However, COVID- 19 patients experienced higher rate of venous thromboembolism (VTE) (3.9% vs. 0.6%, HR 6.11 [2.46-15.16];p=0.001), major bleeding (2.9% vs. 0.5%, HR 5.38 [1.95-14.84];p=0.001), and serious cardiac arrhythmias (2.6% vs. 0.9%, HR 2.25 [1.07-4.73];p=0.033). During follow-up, between discharge and end of follow-up, COVID-19 patients did not experience a higher risk of adverse cardiovascular outcomes (composite of CV death, any MI, ischemic stroke, systemic arterial thrombosis, VTE, heart failure hospitalization, or any serious arrhythmia) compared to patients without (HR 0.80;[0.53-1.21];p=0.298). Conclusion(s): At 1-year follow-up, COVID-19 was not associated with an increased risk of cardiovascular death but with a higher risk of VTE events, major bleeding, and serious cardiac arrhythmias. COVID-19 was not associated with a higher risk of adverse cardiovascular events during follow-up.

Coronary Artery Calcium Score: Current Efficacy of Cardiac CT in Patients at Hail Region, Saudi Arabia

Calcium levels in the Coronary Artery are an indicative marker of the presence and extent of atherosclerosis. This serves as an additional prognostic indicator in addition to traditional risk factors. Moreover, the coronary calcium test is associated with a descriptor known as the calcium score or calcium score (Cs), which is primarily useful for stratifying the risk of asymptomatic patients, while for patients with acute or chronic chest pain, coronary axial computed tomography is generally required. A retrospective analysis of data was conducted in the radiology department of King Salman Specialist Hospital in Hail City, the kingdom of Saudi Arabia, between January and May 2022. A total of 40 patients were randomly selected, 25 males and 15 females. The study included all patients with or suspected of having a calcium deposit who underwent a CT scan using the Siemens SOMATOM definition MDC scan. Patients underwent a scan with the preparations and laboratory tests required for their coronary artery calcium scores. In this study, males were more likely to be affected by calcium deposits (64%), whereas females were 36%. Approximately 50 percent of the study populations were found to be normal (no identifiable calcium deposits) and 37.5% to have moderate calcium deposits. There is a significant association between CACS and moderate CVD risks based on age and gender in this study. Better control of cardiovascular system (CVS) risks is recommended in all primary care centers in the Kingdom of Saudi Arabia (KSA).Copyright © 2022 International Journal of Pharmaceutical Research and Allied Sciences. All rights reserved.

Post-COVID-19 and reproductive health (data from the survey and analysis of the results)

The article presents the data of a survey and analysis of the results of the studies «Post-covid syndrome in obstetrics and reproductive medicine» and «COVID-19 and reproductive health outside and during pregnancy» of 1000 patients of the obstetric department of the Filatov City Clinical Hospital No.15 of the Moscow Departament of Health for the period of the COVID-19 pandemic from March 27, 2020 to March 26, 2022. The state of the cardiovascular system of a group of patients after COVID-19 was separately assessed, a number of important parameters of myocardial function were identified to identify groups at high risk of cardiac complications and their long-term individual rehabilitation after infection. The importance of vaccination at the preconception stage in women and men, during pregnancy and lactation was noted. © 2023, Media Sphera Publishing Group. All rights reserved.