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A problem of the novel coronavirus infection pandemic is the absence of specific biomarkers, the determination of which would make it possible to assess the likelihood of a severe disease course, development of complications, immediate and long-term consequences, and effective etiotropic (antiviral) therapy. The severity of the novel coronavirus infection depends on various factors such as the initial state of health, immune status, age, smoking status, concomitant cardiovascular diseases, and diabetes mellitus. However, a severe disease course is also observed in patients without the aforementioned risk factors. The development of the disease and its complications depends on sex and geographical identity. Angiotensin-converting enzyme 2 (ACE2), associated by gene-gene interaction with ACE, plays a main role in the pathogenesis of the penetration of severe acute respiratory syndrome-2 coronavirus into the cell. The main body of information on this problem is represented by systematic meta-analyses and results of single-center cohort studies, which offer insufficient information to unequivocally assert the associations of ACE and ACE2 gene polymorphisms with pathological changes in the circulatory system during and after a new coronavirus infection. Differences in the incidence of ACE and ACE2 alleles may explain the differences between susceptible populations and/or response to the severe coronavirus infection. The above studies were carried out on the effect of the coronavirus in the initial period of the pandemic. For a more complete molecular genetic picture of the influence of polymorphism, persons with different strains of the coronavirus must be considered. In addition, no data are available regarding the expressions of ACE and ACE2 genes in response to a coronavirus infection. Moreover, the identification of the polymorphic variants of the genes of the renin–angiotensin–aldosterone system and ACE2 associated with a high risk of developing and worsening cardiovascular diseases may be one of the promising areas for the early diagnosis and prevention of post-COVID-19 changes. Therefore, all scientific interest research is aimed at studying genetic factors, such as single nucleotide polymorphisms that affect susceptibility to infection, severity of the disease course, and development of circulatory system consequences. In general, polymorphic variants of ACE and ACE2 and their interaction will help us understand this problem and systematize knowledge for further research in this area. All rights reserved © Eco-Vector, 2022.
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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
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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.
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Introduction: post-COVID-19 syndrome is the set of signs and symptoms that develop during or after an infection compatible with COVID-19, that persist for more than 12 weeks and are not explained by an alternative diagnosis. Background: to characterize the clinical-epidemiological behavior of the post-COVID-19 syndrome in patients at the Andres Ortiz Polyclinic. Method: a descriptive and cross-sectional observational study was carried out from October to December 2021, in a population of 51 subjects that was studied in its entirety. The analysis was descriptive. Results: patients with 50-59 years (n = 20;39.2%), female (n = 32;62.7%) predominated. The most frequently affected organ system was the respiratory (n = 19;37.2%), while the symptoms were: chronic fatigue (n = 15;29.4%), shortness of breath (n = 11;21.5%) and cough (n = 8, 15.6%). Among the patients with respiratory (n = 30), cardiovascular (n = 24) and neurological (n = 10) diseases, the most frequent were, respectively: pulmonary fibrosis (n = 17;56.7%), cardiac arrhythmias (n = 11;45.8%) and peripheral neuropathies (n = 5;50%). Conclusions: post-COVID-19 syndrome occurred mainly between the ages of 50 and 59, in female patients, with symptoms of chronic fatigue, shortness of breath and cough, as well as pulmonary fibrosis, cardiac arrhythmias and peripheral neuropathies as main comorbidities.
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The data of the modern literature describing the long-term consequences of infection of the body with SARS-CoV-2 on the cardiovascular system in the framework of postcovid syndrome are analyzed. To date, postcovid syndrome refers to a condition in which symptoms continue to persist for more than 12 weeks from the moment of diagnosis of COVID-19. Various complaints of patients after undergoing a new coronavirus infection are described, the distinguishing feature of which is their versatility, where cardiovascular manifestations are assigned one of the leading roles. Postural orthostatic tachycardia syndrome, cardiac arrhythmia and conduction disorders are considered. The role of SARS-CoV-2 in the formation of de novo and decompensation of pre-existing cardiovascular diseases has been demonstrated. The possibility of developing heart failure in patients with COVID-19 as an outcome of inflammation of the heart muscle is shown. Particular attention is paid to the analysis of the incidence of myocarditis after 3 months or more from the diagnosis of COVID-19, as well as thrombotic complications, in the genesis of which the main role belongs to the formation of endothelial dysfunction resulting from the interaction of SARS-CoV-2 with vascular endothelial cells. The autoimmune component of the pathogenesis of damage to the cardiovascular system as a result of the formation of endothelial dysfunction in COVID-19 is also considered. The authors present a laboratory-instrumental algorithm for determining cardiovascular complications in people who have undergone COVID-19, including the determination of the N-terminal fragment of the brain natriuretic peptide B-type prohormone, the level of anticardial antibodies, electrocardiography, echocardiography, as well as magnetic resonance imaging of the heart with contrast.
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The coronavirus disease 2019 (COVID-19) pandemic in Iran is part of the worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The present study aimed to demonstrate the clinical characteristics of patients affected by COVID-19, in our tertiary teaching hospital. Medical records and compiled data of 668 patients with suspected COVID-19 were obtained retrospectively between January to April 2020. The present study outcomes included demographic features of infected patients, underlying diseases and conditions, the relationship between the results of reverse transcription-polymerase chain reaction (RT-PCR) or CT-scan with the manifestations of the disease, mortality rate, and age distribution of fatalities among men and women. The median age of hospitalized patients was 63 years old (from 18 to 94). The patients' chief complaints in the admission time were cough, dyspnea, fever, and gastrointestinal problems, respectively. Hospitalized patients' common comorbidities were hypertension (HTN), and cardiovascular disease (CVD) (24%), diabetes mellitus (DM) (21.5%), asthma, or chronic obstructive pulmonary disease (COPD) (6%), or other underlying diseases (15.5%). One-third of patients had no comorbidity according to the data of medical records. In hospitalized patients, 169 (84.5%) had positive RT-PCR, and 156 (78%) had positive chest CT findings. The mortality rate of males was higher than females (66.3% vs. 33.3%) and in patients with positive RT-PCR compared to patients with positive chest CT-scan findings. The majority of deaths had a history of DM or HTN/CVD in their medical records. The chief complaint of patients was cough. DM and HTN or CVD were the common underlying disease related to death in hospitalized cases. Besides, the hospitalization and mortality rate in males was higher than in females. About 87% of dead hospitalized cases had positive RT-PCR results, and this rate was 82% for chest CT results.
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Background: The study is devoted to the impact of a new coronavirus infection in combination with other diseases on the hospitalization outcomes. Features of mortality in the population during COVID-19 pandemic, including from blood circulatory system diseases, have been studied. However, there are few studies based on the large amount of data on the cases and outcomes of providing specialized high-tech medical care to patients with cardiovascular diseases (CVD) and concomitant diagnosis of COVID-19. Objective: The analysis of impact of a new coronavirus infection on the outcomes of hospitalization for circulatory system diseases. Material and methods: Information about more than 350 thousand cases of hospitalization of patients with blood circulatory system diseases in the context of the COVID-19 pandemic has been analyzed, of which in 1875 cases a concomitant diagnosis of COVID-19 was established. The sources of information are the depersonalized registers of compulsory health insurance accounts. For assessment of the obtained data methods of descriptive statistics, simple (unweighted) arithmetic mean values, mean values, specific weights of indicator values, a mean square (standard) deviation from mean values were used. The analysis and descriptive part of the work were carried out by means of the Microsoft Excel spreadsheet software package. Results: The outcomes of hospitalization of patients with suspected or confirmed diagnosis of COVID-19 were significantly worse than in other patients. Moreover, the frequency of lethal outcomes increases significantly in correlation with the age of patients and does not depend on the choice of treatment method – surgical or therapeutic. Conclusion: COVID-19 significantly complicates provision of medical care in conditions of the round-the-clock hospital for blood circulatory system diseases. The risks of surgical interventions for circulatory system diseases in combination with COVID-19 are as high as with the use of therapeutic technologies. It is necessary to unify the indications and contraindications to surgical treatment of conditions related to acute coronary syndrome in cases of the presence of such concomitant pathology as COVID-19. © 2022 Authors. All rights reserved.
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Background: The study is devoted to the impact of a new coronavirus infection in combination with other diseases on the hospitalization outcomes. Features of mortality in the population during COVID-19 pandemic, including from blood circulatory system diseases, have been studied. However, there are few studies based on the large amount of data on the cases and outcomes of providing specialized high-tech medical care to patients with cardiovascular diseases (CVD) and concomitant diagnosis of COVID-19. Objective: The analysis of impact of a new coronavirus infection on the outcomes of hospitalization for circulatory system diseases. Material and methods: Information about more than 350 thousand cases of hospitalization of patients with blood circulatory system diseases in the context of the COVID-19 pandemic has been analyzed, of which in 1875 cases a concomitant diagnosis of COVID-19 was established. The sources of information are the depersonalized registers of compulsory health insurance accounts. For assessment of the obtained data methods of descriptive statistics, simple (unweighted) arithmetic mean values, mean values, specific weights of indicator values, a mean square (standard) deviation from mean values were used. The analysis and descriptive part of the work were carried out by means of the Microsoft Excel spreadsheet software package. Results: The outcomes of hospitalization of patients with suspected or confirmed diagnosis of COVID-19 were significantly worse than in other patients. Moreover, the frequency of lethal outcomes increases significantly in correlation with the age of patients and does not depend on the choice of treatment method – surgical or therapeutic. Conclusion: COVID-19 significantly complicates provision of medical care in conditions of the round-the-clock hospital for blood circulatory system diseases. The risks of surgical interventions for circulatory system diseases in combination with COVID-19 are as high as with the use of therapeutic technologies. It is necessary to unify the indications and contraindications to surgical treatment of conditions related to acute coronary syndrome in cases of the presence of such concomitant pathology as COVID-19. © 2022 Authors. All rights reserved.
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Introduction. Diseases of cardiovascular system are the leading causes of morbidity and mortality among the able-bodied population. There have been no studies of the impact of the COVID-19 epidemic on cardiovascular mortality in Russian Railways. The study aims to analyze the mortality of Russian Railways employees from diseases of the circulatory system during the COVID-19 pandemic with the working-age population of the Russian Federation. Materials and methods. The study was carried out on the basis of data obtained during the COVID-19 pandemic (2019-2021). Information on the mortality of employees of JSC "Russian Railways" is formed on the basis of the data of the CHUZ of JSC "Russian Railways". Information about the natural movement of the working-age population was formed on the basis of data from the Unified State Register of Civil Status Records. Results. During the pandemic, the mortality rate in JSC "Russian Railways" was 2.2 times lower compared to the working-age population of the country. Excess mortality by road polygons was different. The maximum mortality rate (3.4 per 1000 employees) was among employees of enterprises of central subordination, the minimum (2.1) was on the Northern Railway. 82.5% of deaths occurred in men, while the mortality rate among men is 2 times higher compared to women. The main cause of death of workers were diseases of the circulatory system (BSC) — 28.7%. The mortality rate from BSK in JSC "Russian Railways" was 0.656, which is 2.9 times lower than for the working-age population of Russia. Conclusion. The study showed that under the conditions of a new coronavirus infection, the mortality rate from circulatory system diseases in Russian Railways employees is lower than in working-age population of Russia. Ethics. We have carried out this study in accordance with the rules of good clinical practice and the Helsinki Declaration. The study did not require the conclusion of the Ethics committee. © 2023, Izmerov Research Institute of Occupational Medicine. All rights reserved.
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Introduction. Diseases of cardiovascular system are the leading causes of morbidity and mortality among the able-bodied population. There have been no studies of the impact of the COVID-19 epidemic on cardiovascular mortality in Russian Railways. The study aims to analyze the mortality of Russian Railways employees from diseases of the circulatory system during the COVID-19 pandemic with the working-age population of the Russian Federation. Materials and methods. The study was carried out on the basis of data obtained during the COVID-19 pandemic (2019-2021). Information on the mortality of employees of JSC "Russian Railways" is formed on the basis of the data of the CHUZ of JSC "Russian Railways". Information about the natural movement of the working-age population was formed on the basis of data from the Unified State Register of Civil Status Records. Results. During the pandemic, the mortality rate in JSC "Russian Railways" was 2.2 times lower compared to the working-age population of the country. Excess mortality by road polygons was different. The maximum mortality rate (3.4 per 1000 employees) was among employees of enterprises of central subordination, the minimum (2.1) was on the Northern Railway. 82.5% of deaths occurred in men, while the mortality rate among men is 2 times higher compared to women. The main cause of death of workers were diseases of the circulatory system (BSC) — 28.7%. The mortality rate from BSK in JSC "Russian Railways" was 0.656, which is 2.9 times lower than for the working-age population of Russia. Conclusion. The study showed that under the conditions of a new coronavirus infection, the mortality rate from circulatory system diseases in Russian Railways employees is lower than in working-age population of Russia. Ethics. We have carried out this study in accordance with the rules of good clinical practice and the Helsinki Declaration. The study did not require the conclusion of the Ethics committee. © 2023, Izmerov Research Institute of Occupational Medicine. All rights reserved.
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Purpose. To present the practical experience of using databases of circulatory diseases patients in the Brest region by example of atrial fibrillation and to demonstrate the impact of structuring and analysis of information acquired on the quality of care in patients with atrial fibrillation, including the dynamics of medical and demographic indicators as a criterion for implementing the State Action Plan program "Health of the Nation and Demographic Security" for 2021–2025. Materials and methods. A sample of 200 subjects was generated as a pilot project based on materials of the experimental computerized database of patients with atrial fibrillation under dynamic outpatient follow-up in Baranovichi interdistrict cardiological center of the central polyclinic of the city of Baranovichi using the method of random non-repetitive selection. This amounted to 9.2% of all patients with atrial fibrillation under observation during the study period in this health care institution (a total of 2,164 patients). Based on the materials of the database, the results of the monitoring of prophylactic treatment measures related to anticoagulants intake and achievement of target international normalized ratio (INR);complications and mortality in atrial fibrillation;atrial fibrillation form ratios;presence of concomitant pathologies and their impact on the course of underlying pathology, including in those in the regions with significant deviations in social and economic (disability, hospitalization time, re-hospitalization) and medical and demographic variables (mortality, lethality, morbidity due to acute cerebral circulation disorders) indicators were evaluated. The dynamics of morbidity and in-hospital mortality due to acute cerebral circulation disorders during the period from 2010 to 2019 was studied and demonstrated, and the cost-effectiveness of implemented medical and organizational measures was calculated. Results. As shown by the analysis of the database on the example of Baranovichi region, the absence of control over dynamics of INR, HR, BP values while using anticoagulants affected the final results: although this group drugs were administered in 85% of cases, only 40% of target values were achieved in the study group patients;whereas in male patients this indicator was two times lower than in female patients, indicating low commitment both to treatment and to monitoring of the target values achievement. A particular attention should be paid to the prevention of thromboembolic complications at the present stage in patients who underwent COVID-19 infection, since the proportion of complications in this category of patients is rather high. As a result of the organizational experiment carried out in health care institutions following the example of Baranovichi Interdistrict Cardiological Center (hereinafter referred to as IRCC), the overall incidence of cerebral infarction in the general adult population of Brest region for the period from 2016 to 2020 decreased from 40.8 cases per 10 thousand population to 32.9 cases, respectively. The calculated cost-effect of organizational measures for the analyzed period is approximately 2,462,600 Belarusian rubles. Conclusion. The algorithm we developed could be used as a basis in the practice to create a registry of patients with atrial fibrillation. The use of such a register is necessary for monitoring the quality of their medical care, and it provides an opportunity to affect medical and demographic indicators in the region, determined by circulatory system diseases as a major socially significant pathology. © 2022, Professionalnye Izdaniya. All rights reserved.
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Coronavirus disease 2019 (COVID-19) is a severe acute respiratory disease with a high prevalence. According to the research and statistical data, in January 2021, there have been 92,262,621 confirmed cases of COVID-19 and more than two million deaths. Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the main cause of this disease. In addition to the respiratory system, the disease affects the gastrointestinal tract, central-peripheral nervous system, circulatory system, and kidneys. Therefore, any therapeutic action to reduce COVID-19-related symptoms and complications is essential. In this study, we conducted a systematic review of the published literature and preprints on the efficacy of erythropoietin (EPO) and recombinant human EPO as a safe stimulant and tissue protector in the treatment of COVID-19. We also briefly described the structure of coronavirus, its pathogenesis, and the structure of EPO and recombinant human EPO. All relevant articles published in the Science Direct, PubMed, and Google Scholar databases were searched. According to the results, EPO is a cytoprotective cytokine induced by hypoxia. The pleiotropic effects of EPO are associated with its erythrocyte-forming, anti-apoptotic, anti-inflammatory activities. It also exerts protective effects on the heart, lungs, kidneys, arteries, and central and peripheral nervous systems. It has been demonstrated that EPO can increase hemoglobin levels, thereby increasing oxygen delivery to the tissues. Therefore, recombinant human EPO therapy can be used for counteracting the adverse effects of COVID-19 including hypoxic myocarditis, acute renal failure, pulmonary edema, and brain-spinal cord ischemic injury. Overall, the use of EPO and recombinant human EPO therapy increases blood coagulation, tumor growth, thromboembolism, and purification of red blood cells, which must be accompanied by anticoagulants such as heparin.
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Objective: To investigate the effects of miR-221-3p on the proliferation and apoptosis of vascular smooth muscle cells (VSMC) in abdominal aortic aneurysm (AAA) by targeting tissue inhibitor of metalloproteinase- 2 (TIMP-2).
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This study aims at examining the chronological development of hospitalized cardiovascular and COVID-19 patients and comparing the effects on related sub-disciplines and main diagnoses for pre-pandemic (2017-2019) and pandemic (2020-2021) years in the setting of a German university maximum care provider. Data were retrospectively retrieved from the hospital performance controlling system for patient collectives with main diagnosis of diseases of the circulatory system (nCirculatory) and COVID-19 secondary diagnosis (nCOVID-19). The cardiovascular patient collective (nCirculatory = 25,157) depicts a steady state in terms of relative yearly development of patient numbers (+0.4%, 2019-2020, +0.1%, 2020-2021). Chronological assessment points towards monthly decline during lockdowns and phases of high regional incidence of COVID-19 (i.e., 2019-2020: March -10.2%, April -12.4%, December -14.8%). Main diagnoses of congestive heart failure (+16.1% 2019/2020; +19.2% 2019/2021) and acute myocardial infarction show an increase in case numbers over the course of the whole pandemic (+15.4% 2019/2020; +9.4% 2019/2021). The results confirm negative effects on the cardiovascular care situation during the entire pandemic in the setting of a university maximum care provider. A general increase in cardiac disorders and a worrisome turn in case development of acute myocardial infarction emphasize the feared cardiovascular burden of COVID-19.
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INTRODUCTION: COVID-19 is a highly contagious disease that was caused by the coronavirus family SARS-CoV-2 and which emerged in China in 2019. This study aimed to investigate the effect of chronic disease mortality on the COVID-19 fatality rate. METHODS: In our study, a total of 44 countries including 37 OECD countries were evaluated. A model was created with variables including death percentages of cardiovascular disease (CVD), cancer, chronic respiratory system diseases, diabetes and also age, gross domestic product (GDP), and the number of beds and the effect on COVID-19 fatality rate were evaluated. Multiple regression analysis was used to evaluate the model created. RESULTS: It was determined that the average age and diabetes deaths among the non-communicable disease deaths positively predicted the COVID-19 fatality rate. In the model created in the study, the effect of the number of patient beds, GDP, and deaths due to CVD, cancer, and chronic respiratory diseases on the COVID-19 fatality rate was not determined. DISCUSSION AND CONCLUSION: In the study, older age and diabetes deaths positively predicted the COVID-19 fatality rate. In regions with high average age and diabetes mortality, additional policies may be required to reduce the COVID-19 fatality rate.
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ObjectiveThe selection process to the British Army’s Brigade of Gurkhas is rigorous, demanding and competitive. The ethos of recruitment to the Gurkhas is grounded in an overarching tenant: that selection is free, fair and transparent. The aim of this study was to retrospectively review reasons for potential recruits (PRs) to be deemed medically unsuitable or deferred suitability on medical grounds for selection to the Brigade of Gurkhas.MethodsA retrospective review was conducted by extracted data from published post-exercise reports for the past four years to ascertain numbers of PRs deemed medically fit, medically unsuitable or deferred suitability on medical grounds. The International Classification of Disease version 11 (ICD-11) codes were retrospectively assigned to code medical reasons for non-progression. Rates of medical non-progression were compared by year.ResultsA total of 3154 PRs were analysed between 2018 and 2021. There was no significant difference between PRs deemed medically fit and those deemed medically suitable or deferred on medical grounds over the study period (p=0.351). There was a significant difference in the ratio of PRs deferred on medical grounds and those deemed medically unsuitable over the study period (p<0.05).ConclusionSelection to the Gurkhas is extremely competitive. These data demonstrate that, overall, reasons for medical deferral or unsuitability have remained constant despite the impact of a global pandemic. These data reinforce the central tenant of Gurkha selection;that it continues to be free, fair, and transparent.
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This article is focused on the topicality of assessing complications and mortality from diseases of the circulatory system during the COVID-19 pandemic. The main variants of damage to the cardiovascular system, the mechanisms of their development, and risk factors are given. The long-term consequences of the new coronavirus infection for the heart and blood vessels are considered. In addition, the necessary measures to reduce the burden of disease after the pandemic are discussed.
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BACKGROUND: There are few studies on mortality on individuals entering treatment for cannabis use disorders. OBJECTIVES: To estimate mortality risk for individuals treated for cannabis use disorders comparing patients with concomitant alcohol use disorders to those with only cannabis use disorders. METHODS: Follow-up study on 1136 residents in Northern Italy who turned to health services following problems caused by cannabis use disorders between 2009 and 2019. Individuals with concomitant use of opioids, amphetamines, cocaine, or injecting drugs were excluded. Crude mortality rates per 1000 Person Years (CMR), and standardized mortality ratios adjusted for age, sex and calendar year (SMR) were calculated. RESULTS: Elevated CMRs (CMR 4.4, 3-6.4), higher among patients with concomitant alcohol use disorders (CMR 10.2, 6.6-15.6) compared to those with only cannabis use disorders (CMR 1.8, 0.9-3.6) were found. Regarding excess mortality with respect to the general population, SMRs were higher and statistically significant (SMR 5.4, 3.7-7.8), both among patients with concomitant alcohol use disorders (SMR 10.2, 6.6-15.6) and among those with only cannabis use disorders (SMR 2.3, 1.1-4.5). CONCLUSIONS: The results of this study show that individuals with only cannabis use disorders have a lower mortality risk compared to those with both cannabis and alcohol use disorders.
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Alcoholism , Cannabis , Substance-Related Disorders , Alcoholism/epidemiology , Analgesics, Opioid , Cause of Death , Follow-Up Studies , HumansABSTRACT
Objective: To characterize the mortality rate of residents in Minhang District of Shanghai from January to April in 2016-2020, and to determine the change in the epidemic Coronavirus Disease 2019 (COVID-19) in 2020.
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Background: Cardiovascular diseases (CVD) are a major cause of disability and the leading cause of death worldwide. To reduce mortality and morbidity, prevention strategies such as following an optimal diet are crucial. In recent years, low-gluten and gluten-free diets have gained strong popularity in the general population. However, study results on the benefits of a gluten-reduced or gluten-free diet are conflicting, and it is unclear whether a gluten-reduced diet has an effect on the primary prevention of CVD. Objectives: To determine the effects of a gluten-reduced or gluten-free diet for the primary prevention of CVD in the general population. Search methods: We systematically searched CENTRAL, MEDLINE, Embase, CINAHL and Web of Science up to June 2021 without language restrictions or restrictions regarding publication status. Additionally, we searched ClinicalTrials.gov for ongoing or unpublished trials and checked reference lists of included studies as well as relevant systematic reviews for additional studies. Selection criteria: We planned to include randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs), such as prospective cohort studies, comparing a low-gluten or gluten-free diet or providing advice to decrease gluten consumption with no intervention, diet as usual, or a reference gluten-intake category. The population of interest comprised adults from the general population, including those at increased risk for CVD (primary prevention). We excluded cluster-RCTs, case-control studies, studies focusing on participants with a previous myocardial infarction and/or stroke, participants who have undergone a revascularisation procedure as well as participants with angina or angiographically-defined coronary heart disease, with a confirmed diagnosis of coeliac disease or with type 1 diabetes. Data collection and analysis: Two review authors independently assessed eligibility of studies in a two-step procedure following Cochrane methods. Risk of bias (RoB) was assessed using the Cochrane risk of bias tool (RoB2) and the 'Risk Of Bias In Non-randomised Studies - of Interventions' (ROBINS-I) tool, and the certainty of evidence was rated using the GRADE approach. Main results: One RCT and three NRSIs (with an observational design reporting data on four cohorts: Health Professionals Follow-up Study (HPFS), Nurses' Health Study (NHS-I), NHS-II, UK Biobank) met the inclusion criteria. The RCT was conducted in Italy (60 participants, mean age 41 +or- 12.1 years), two NRSIs (three cohorts, HPFS, NHS-I, NHS II) were conducted across the USA (269,282 health professionals aged 24 to 75 years) and one NRSI (Biobank cohort) was conducted across the UK (159,265 participants aged 49 to 62 years). Two NRSIs reported that the lowest gluten intake ranged between 0.0 g/day and 3.4 g/day and the highest gluten intake between 6.2 g/day and 38.4 g/day. The NRSI reporting data from the UK Biobank referred to a median gluten intake of 8.5 g/day with an interquartile range from 5.1 g/day to 12.4 g/day without providing low-and high-intake categories. Cardiovascular mortality: From a total of 269,282 participants, 3364 (1.3%) died due to cardiovascular events during 26 years of follow-up. Low-certainty evidence may show no association between gluten intake and cardiovascular mortality (adjusted hazard ratio (HR) for low- versus high-gluten intake 1.00, 95% confidence interval (CI) 0.95 to 1.06;2 NRSIs (3 cohorts)). All-cause mortality: From a total of 159,265 participants, 6259 (3.9%) died during 11.1 years of follow-up. Very low-certainty evidence suggested that it is unclear whether gluten intake is associated with all-cause mortality (adjusted HR for low vs high gluten intake 1.00, 95% CI 0.99 to 1.01;1 NRSI (1 cohort)). Myocardial infarction: From a total of 110,017 participants, 4243 (3.9%) participants developed non-fatal myocardial infarction within 26 years. Low-certainty evidence suggested that gluten intake may not be associated with the development of non-fatal myocardial infarction (adjust