ABSTRACT
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.
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Multisystem inflammatory syndrome (MIS) is a well-known potential sequela of COVID-19 infection. Though prevalence is higher in certain populations, this syndrome is a rare occurrence in children. Beyond MIS, there has been increasing research into COVID infection and the subsequent onset of autoimmune conditions, such as diabetes. However, evidence of a poly-endocrinopathy developing after COVID infection is lacking, and evidence within the pediatric population is virtually nonexistent. In this case, we present the evolution of an autoimmune polyglandular syndrome (APS) type 2 phenotype, consisting of type 1 diabetes, Graves' disease, and adrenal insufficiency, after diagnosis of multisystem inflammatory syndrome of children (MIS-C) in a pediatric patient. A 15-year-old biracial female without significant past medical history tested positive for COVID-19 and two weeks later presented with respiratory symptoms and other systemic signs. She was admitted for further evaluation and was found to have elevated inflammatory markers, EKG (electrocardiogram) abnormalities, and lab evidence of organ damage. The patient was diagnosed with MIS-C, and treatment was initiated with eventual discharge. One year after this initial visit, the patient returned to the hospital due to weight loss, difficulty breathing, polyuria, polydipsia, nausea, vomiting, and fatigue. A steroid course for MIS-C treatment had been completed three months prior. Exam and lab results confirmed diabetic ketoacidosis (DKA), and the patient was diagnosed with new-onset type 1 diabetes. Further testing determined that she was glutamic acid decarboxylase 65 (GAD-65) positive. DKA was managed in the hospital, and the patient was subsequently discharged with an insulin regimen and endocrine follow-up. A couple of months later, the patient returned to the emergency department (ED) due to two weeks of dyspnea on exertion and dizziness. Since her previous admission for DKA, the patient had contracted COVID-19 again and recovered from her respiratory symptoms. Physical exam and labs were grossly unremarkable; however, the patient had EKG abnormalities and an episode of severe bradycardia, prompting hospitalization. Thyroid workup revealed thyrotoxicosis due to Graves' disease. Due to intermittent hypotension, adrenal labs were obtained. She was found to have adrenal insufficiency as well, with a positive 21-hydroxylase antibody. Throughout these hospitalizations, the patient suffered from skin and hair changes as well, ultimately requiring dermatological intervention.
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IntroductionThe aim of this study was to determine the impact of the COVID-19 pandemic on the provision of clinical services (perioperative clinical outcomes and productivity) of the department of endocrine and general surgery at a teaching hospital in the UK.MethodsA retrospective chart review was conducted of all patients who were operated in our department during two periods: 1 April to 31 October 2019 (pre-COVID-19 period) and 1 April to 31 October 2020 (COVID-19 period). The perioperative clinical outcomes and productivity of our department for the two time periods were compared.ResultsIn the pre-COVID-19 period, 130 operations were carried out, whereas in the COVID-19 group, this reduced to 89. The baseline characteristics between the two groups did not significantly differ. Parathyroid operations decreased significantly by 68% between the two study periods. Overall, during the COVID-19 phase, the department maintained 68% of its operating workload compared with the respective 2019 time period. The clinical outcomes for the patients who had a thyroid/parathyroid/adrenal operation were not statistically different for the two study periods. There were no COVID-19 related perioperative complications for any of the operated patients and no patient tested positive for COVID-19 while an inpatient. For the COVID-19 group, the department maintained 67% of its outpatient appointments for endocrine surgery and 26% for general surgery pathologies.ConclusionsThe COVID-19 pandemic significantly reduced the clinical activity of our department. However, it is possible to continue providing clinical services for urgent/cancer cases with the appropriate safety measures in place.
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The coronavirus 2019 (COVID-19) disease has long-term effects, known as post-COVID conditions (PCC) or long-COVID. Post-COVID-19 syndrome is defined by signs and symptoms that occur during or after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection which persist for more than 12 weeks and cannot be supported by an alternative diagnosis. The cardiovascular damage caused by COVID-19 in the severe forms of the disease is induced by severe systemic inflammation, considered to be one of the causes of myocardial lesions, with increased levels of circulating cytokines and toxic response mediators. We have focused on conditions that can induce long-COVID-19, or multisystem inflammatory syndrome in adults or children (MIS-C/MIS-A), with an emphasis on endocrinological and metabolic disorders. Although described less frequently in children than in adults, long-COVID syndrome should not be confused with MIS-C, which is an acute condition characterized by multisystem involvement and paraclinical evidence of inflammation in a pediatric patient who tested positive for SARS-CoV-2. At the same time, we mention that the MIS-A symptoms remit within a few weeks, while the duration of long-COVID is measured in months. Long-COVID syndrome, along with its complications, MIS-A and MIS-C, represents an important challenge in the medical community. Underlying comorbidities can expose both COVID-19 adult and pediatric patients to a higher risk of negative outcomes not only during, but in the aftermath of the SARS-CoV-2 infection as well.
Subject(s)
COVID-19 , Adult , COVID-19/complications , COVID-19/pathology , Child , Humans , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/epidemiology , Post-Acute COVID-19 SyndromeABSTRACT
Background: Under the declaration of the state of alarm (SA) in efforts to control COVID-19, normal development of health programs was threatened. The aim of the study was the evaluation of COVID 19 emergency and SA approval impact on neonatal Endocrine and Metabolic Disorders Program (EMDP) and Neonatal Hearing Program (HP) in Madrid.
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Introduction. Based on the WHO statistical overview of the past year the overall mortality rate across the EU showed a significant upward trend compared to the preceding three-year period, i.e. excessive mortality rates. In Bulgaria, during the COVID-19 pandemic, over the last year mortality rates peaked by 61.4% compared to the average rates observed in the period from 2017 to 2019. Data from official sources show that in the region of Plovdiv the number of confirmed COVID-19 cases is 36,484, of them - 1579 fatalities. Aim. An attempt to investigate and analyze the mortality rates due to COVID-19 and the most common related underlying medical conditions over a year period at St. George Hospital in Plovdiv was made. Materials and methods. The study is a retrospective analysis of descriptive design;a review of patient's medical records was applied for the last year. Results. In the study period registered deaths due to COVID-19 in the hospital were 492. The mortality rate in males was approximately twice, exceeding that of females - 316 (64.2%). The average age of diseased patients was 70.40 (SD +or-11.93), the youngest and oldest were 31 and 97 years of age, respectively. Deaths are more frequent in the age group over 65 (70.1%), compared to the 18 to 64.99 age group (29.9%). Conclusions. Hospital mortality rate due to COVID-19 is higher in men. The most frequent underlying medical conditions in deceased patients with COVID-19 are cardiovascular disorders, followed by endocrine diseases.
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Relevance: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. The prevalence rates of PCOS depend on the diagnostic criteria used and the characteristics of the population sample, and in the general population of women of reproductive age, the prevalence of the syndrome ranges from 6-9% to 19.9% [1,2]. According to modern criteria adopted by the consensus in Rotterdam, then systematically updated by ESHRE / ASRM (2014), the presence of two of the three criteria in a patient simultaneously allows to diagnose PCOS if other pathological conditions are excluded (thyroid pathology, congenital adrenal hyperplasia, adrenogenitalsyndrome, androgen-secreting tumors, Itsenko-Cushing syndrome). Modern international diagnostic criteria include the following signs: (1) signs of polycystic ovaries according to information from pelvic ultrasound investigation (the presence of more than 10 follicles in each ovary);(2) oligo-anovulation;(3) clinical (presence of hirsutism) or biochemical (increased androgen levels) development of ovarian hyperandrogenism [3, 4]. Polycystic ovary syndrome is closely related to many diseases, including metabolic syndrome. Although insulin resistance is an important risk factor for metabolic syndrome and other diseases associated with PCOS, hyperandrogenismmay also be an independent risk factor for type 2 diabetes, obesity, cardiovascular disease (CVD), and metabolic syndrome in female patients. Obesity is the most common symptom in PCOS patients (33-88%), which has a large impact on fertility and can lead to adverse effects such as menstrual irregularities, anovulation, infertility and abortion. Therefore, weight management in early PCOS is essential to improve fertility and quality of life. Hyperandrogenism plays a decisive role in abdominal obesity in obese women during adolescence, adulthood and menopause [5]. Although some studies have shown a negative association between plasma androgen levels (A4, DHEA and DHEAS) and obesity [6,7]. But the mechanism of how androgens affect fat cells in women is poorly understood. A number of observations show that among obese women with PCOS, metabolic disorders associated with insulin resistance and obesity, in many cases, play a more important role in the mechanism of anovulation in PCOS than excess androgens. In recent years, it has been established that in PCOS there is a frequent combination of hyperandrogenism and insulin resistance. With insulin resistance, there is a decrease in the response of insulin-sensitive tissues to the hormone insulin with its sufficient level in the blood. Insulin resistance is found in 30-70% of patients with PCOS who are overweight or obese, and in patients with normal body weight it occurs in 20-25% of cases. The above facts, as well as our own observations, prompted us to analyze the studied women of fertile age with impaired reproductive system against the background of overweight and obesity. Considering the above, the aim of this study was to identify the relationship between insulin resistance and reproductive disorders in women with overweight and obesity. Material and research methods. The study included 123 women with clinical development of HA and impaired reproductive function, who consulted the consultative clinic of the RSSPMC of Obstetrics and Gynecology of the Ministry of Health of the Republic of Uzbekistan. The criteria for inclusion in the main group were: age of women from 18 to 35 years (average age was 25.8 .. 3.28 years), absence of pregnancy, body mass index over 25 kg / m2. Exclusion criteria from the main group: type 1 and 2 diabetes, pituitary tumors, hypogonadotropichypogonadism, congenital adrenal hyperplasia, hypothyroidism, severe somatic pathology. All patients who applied for the consultation underwent: (1) Collection of anamnestic information. (2) Measurement of anthropometric indicators (height, weight, waist and hip circumference) and assessment of body hair growth using the Ferriman-Hallway scale. (3) Body mass index was
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Pet ownership (PO) exerts beneficial effects on the physical and psycho-emotional health of the people with whom they live, even in pandemic contexts. Animals benefit from receiving attention and care and avoiding health risks, based on the ..One Health.. approach. Considering the contributions and importance of the subject, a compilation study of works carried out by the authors was carried out to determine the perception of the benefits of PO in different population sectors. These were exploratory and descriptive studies, cross-sectional and quantitative conducted at the National Institute of Endocrinology and the main Veterinary Clinic of Havana, in which people responsible for companion animals (PO). These people had chronic diseases (cardiovascular and endocrine-metabolic), sexual and reproductive health conditions (infertility) and sexual identity (homoerotic and transsexual sexual orientation), in different stages of life (middle and elderly), from 2013 to 2020 (during the context of the COVID-19 pandemic). Selfadministered questionnaires prepared by the research team were used. The results were processed using descriptive statistics and ethical aspects were considered. Most of the participants expressed satisfaction with PO, perceived its benefits on their physical and emotional health, motivated them to take better care of themselves and engage in physical activities, and during the COVID- 19 pandemic. Besides, PO decreased the negative effects of social distancing. Dogs and cats were the preferred animals for emotional reasons.
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Introduction: Temporary disability due to COVID-19 was expressly regulated, through various rules and instructions, covering both isolation by contact, by infection or for sensitive workers. It involved the integration of preventive labor protection covered by its protection in a financial benefit with the highest amount. Analyzing the consequences of the pandemic in the first wave, confinement, de-escalation and return to normality, months from March to October, the ..collapsing.. impact of COVID-19 on the health system led to the paralysis and increase of waiting lists for tests, operations and non-urgent consultations of the rest of pathologies, and consequently a high increase in the average duration of sick leave for all processes, in confinement and de-escalation in 84.48% and in 25.27% the prolonged casualties that reached more than 365 days. Consequently, COVID-19 as a collateral effect led to a poor evolution of the rest of the processes, prolonging the duration of temporary disabilities, which implies a worsening of occupational health, a greater risk of not returning to work that occurs during sick leave long, higher risk of unemployment, higher spending on benefits and economic decline for companies and the self-employed. Temporary disability due to COVID-19 accounted for 38.73% of all casualties at the end of October 2020. Conclusions: The pandemic forced to prioritize resources around COVID-19, collapsing the care of the rest of pathologies, except for emergencies or vital treatments. This meant an increase in waiting lists for non-urgent consultations, tests or surgical interventions, as well as the cancellation or postponement of consultations or treatments and therefore an increase in the longer duration of sick leave and also the worsening of occupational health, consequently, by not being able to have treatment in a timely manner. In confinement and de-escalation, the average duration of casualties increased by 84.48%;by processes, the increase was 503.58% in respiratory diseases, 215.88%, in infectious diseases, 60.73% in endocrine diseases, 45;42% of blood diseases, 45 09% for digestive diseases, 35.63% for osteomyoarticular disorders, 34.12% for neoplasms, 33.37% for circulatory diseases, 31.94% for ..procedures.., and 29.56% of mental disorders. Long-term sick leave (PIT) that reached 365 days increased by 25.27%, compared to the month of October of the previous year. Prolonged sick leave due to endocrine and nutritional diseases increased by 28.50, from mental disorders by 28.20%, from musculoskeletal disorders by 26.70, from neoplasms by 26.49%, from respiratory diseases in 24.27%, for diseases of the nervous system in 22.79%, for cardiovascular diseases in 20.48%, and for digestive diseases in 19.24%. As a consequence of COVID-19, the working population was exposed to an added and new risk;health and social health workers suffered the disease as a direct consequence of their work due to illness of an undoubted professional nature. The effects of COVID-19 on the delay of tests, surgeries or treatments in ..No COVID-19.. processes and the difficulties of contact with care worsened occupational health, prolonging disability situations and increasing the risk of prolonged non-COVID-19 disabilities, return to work due to the expected poor evolution of any process when it cannot be treated and attended to early.
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BACKGROUND: Team-based learning (TBL) combines active and collaborative learning, while incorporating aspects of the flipped classroom approach and problem-based learning. The COVID-19 pandemic presented certain challenges in the delivery of TBL in class. In this study, we investigated the impact of TBL on the academic performance of final year Biomedical Sciences' undergraduate students in the context of an "Endocrine Disorders" study block. We did so by comparing the classical in-person approach and online delivery due to the COVID-19 pandemic. METHODS: A non-compulsory TBL session was introduced to the curriculum of this block, which followed the traditional 2-h lecture delivery. Comparative analysis was performed for the exam and coursework performance of students who attended the TBL sessions (online and in-person) and those that did not. RESULTS: Both cohorts of students who attended either in-person (n = 66) or online TBL sessions (n = 109) performed significantly better in their exams (p < 0.05) and a related coursework (p < 0.001 and p < 0.05, respectively) when compared to those that did not attend. For both these cohorts the exam mark distribution was much narrower compared to those that did not attend the TBL sessions where the majority of fails and "no shows" were recorded. CONCLUSIONS: Online and in-person TBL, can successfully supplement traditional lecture-based teaching and enhance the learning/performance, for complex medical subjects/topics. Our findings demonstrate that it is possible to deliver these sessions online with demonstrable benefit for students suggesting that there is greater flexibility in the use of TBL in higher education.
Subject(s)
COVID-19 , Educational Measurement , Group Processes , Humans , Pandemics , Problem-Based Learning , SARS-CoV-2 , StudentsABSTRACT
BACKGROUND: Some maternal characteristics indicate worse prognosis in pregnant women with coronavirus disease 2019 (COVID-19). OBJECTIVE: To describe the prevalence of endocrine disorders in pregnancies involving COVID-19, and its impact on maternal outcomes. SEARCH STRATEGY: Search terms were "pregnancy" and "COVID-19". SELECTION: PubMed, Embase, medRxiv, and Cochrane worksheet from February to July 2020 were searched. DATA COLLECTION AND ANALYSIS: Articles describing endocrine disorders in pregnancies with and without COVID-19 involvement were considered. We performed meta-analyses of prevalence using random-effect models and estimated relative risk and 95% confidence intervals (CI) of maternal outcomes relative to presence of endocrine disorders. MAIN RESULTS: Articles included (n = 141) were divided into three data sets: individual (119 articles, 356 women), case series (17 articles, 1064 women), and national registries (7 articles, 10 178 women). Prevalence of obesity ranged from 16% to 46% and hyperglycemia in pregnancy (HIP) ranged from 8% to 12%. In data set 1, HIP and obesity were risk factors for severe disease in crude and age-adjusted models, although not for intensive care unit admission. In data from two national registries, risk of dying was 5.62 (95% CI 0.30-105.95) in women with diabetes and 2.26 (95% CI 1.03-4.96) in those with obesity. CONCLUSION: Obesity and HIP were prevalent in pregnant women with severe COVID-19.
Subject(s)
COVID-19 , Endocrine System Diseases/epidemiology , Hyperglycemia/epidemiology , Obesity/epidemiology , Pregnancy Complications, Infectious/epidemiology , Adult , COVID-19/diagnosis , COVID-19/epidemiology , Female , Hospitalization , Humans , Pregnancy , Pregnancy Outcome , Prevalence , SARS-CoV-2ABSTRACT
The objective of the study was to identify symptoms of men presenting for an outpatient urology visit that prompted referral for a Home Sleep Apnea Test (HSAT) to assess for obstructive sleep apnea (OSA) by a single provider. To assess the proportion of patients referred for the HSAT who underwent the test and, out of these patients, the proportion of men diagnosed with sleep apnea, we performed a retrospective chart review of men 18-99 years old seen by a single provider in the Department of Urology referred for an HSAT to evaluate for presenting symptoms. Patients with a prior diagnosis of OSA were excluded. Eighteen patients were identified (mean age at time of referral 51 + SD 13 years). Half of patients reported erectile dysfunction/concerns, 56% reported nocturia, 44% had been diagnosed with testosterone deficiency, and 39% reported low libido. Nearly all (89%) of patients snored, all reported fatigue, 56% were over the age of 50, 44% had a BMI >35, and 78% had hypertension. Twelve patients completed the HSAT, all of whom were diagnosed with OSA for which continuous positive airway pressure (CPAP) therapy was initiated. Men presenting with genitourinary concerns to an outpatient urology clinic may also have OSA. About half of included patients reported genitourinary concerns. Hundred percent of patients who completed their sleep study were diagnosed with OSA. Genitourinary concerns, in addition to signs and symptoms commonly associated with OSA, should prompt consideration of sleep apnea evaluation.
Subject(s)
Home Care Services , Sleep Apnea, Obstructive/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , Continuous Positive Airway Pressure , Humans , Male , Male Urogenital Diseases/complications , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Sleep Apnea, Obstructive/therapyABSTRACT
BACKGROUND: The coronavirus 19 (COVID-19) pandemic has affected all aspects of life, including the routine follow-up of patients with chronic illnesses. In this study, we aim to share our experience of telemedicine in our pediatric endocrinology clinic during the pandemic. METHODS: We were able to continue caring for children with endocrine disorders using various communication methods such as e-mail and e-message. RESULTS: A total of 267 patients received telemedicine care over the course of 608 contacts. The number of hospital visits and physical contact was effectively reduced to help protect against the COVID-19 infection. The patients were supported in terms of receiving their prescriptions and patient education also continued. No complications were observed. CONCLUSION: The advantages and disadvantages of telemedicine were discussed and consequently, we propose that telemedicine can be utilized to maintain and continue the care of children with endocrine disorders during and even after the pandemic. Further studies are needed to standardize this method for general use.
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COVID-19 , Telemedicine , Ambulatory Care Facilities , Child , Humans , Pandemics , Telemedicine/methodsABSTRACT
Background: Coronavirus-19 (COVID-19) is a disease caused by the SARS-CoV-2 virus, the seventh coronavirus identified as causing disease in humans. The SARS-CoV-2 virus has multiple potential pathophysiologic interconnections with endocrine systems, potentially causing disturbances in glucose metabolism, hypothalamic and pituitary function, adrenal function and mineral metabolism. A growing body of data is revealing both the effects of underlying endocrine disorders on COVID-19 disease outcome and the effects of the SARS-CoV-2 virus on endocrine systems. However, comprehensive assessment of the relationship to endocrine disorders in children has been lacking. Content: In this review, we present the effects of SARS-CoV-2 infection on endocrine systems and review the current literature on complications of COVID-19 disease in underlying paediatric endocrine disorders. We provide recommendations on management of endocrinopathies related to SARS-CoV-2 infection in this population. Summary and outlook: With the surge in COVID-19 cases worldwide, it is important for paediatric endocrinologists to be aware of the interaction of SARS-CoV-2 with the endocrine system and management considerations for patients with underlying disorders who develop COVID-19 disease. While children and adults share some risk factors that influence risk of complications in SARS-CoV-2 infection, it is becoming clear that responses in the paediatric population are distinct and outcomes from adult studies cannot be extrapolated. Evidence emerging from paediatric studies provides some guidance but highlights the need for more research in this area.
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COVID-19/complications , Endocrine System Diseases/complications , Child , Disease Management , HumansABSTRACT
BACKGROUND AND AIMS: The novel coronavirus disease (COVID-19) pandemic and the resulting nationwide lockdowns have posed a major challenge to the management of pre-existing and newly diagnosed endocrine disorders. Herein, we have summarized the management approaches of common endocrine disorders amid the ongoing pandemic. METHODS: We have performed an extensive literature search for articles in PubMed, EMBASE and Google Scholar databases till 25 May 2020, with the following keywords: "COVID-19", "diabetes mellitus", "thyroid disorders", "primary adrenal insufficiency", "Cushing's syndrome", "pituitary tumors", "vitamin Dâ³", "osteoporosis", "primary hyperparathyroidism", "hypoparathyroidism", "management", "treatment" and "guidelines" with interposition of the Boolean operator "AND". RESULTS: We have summarized the most feasible strategies for the management of diabetes mellitus, thyroid disorders, primary adrenal insufficiency (including congenital adrenal hyperplasia), Cushing's syndrome, pituitary tumors, osteoporosis, primary hyperparathyroidism and hypoparathyroidism amid the constraints laid down by the raging pandemic. In general, medical management should be encouraged and surgical interventions should be deferred whenever possible. Ongoing medications should be continued. Sick-day rules should be sincerely adhered to. Regular contact with physicians can be maintained through teleconsultations and virtual clinics. CONCLUSIONS: Considering the burden of endocrine disorders in the general population, their management needs to be prioritized amid the ongoing COVID-19 pandemic.