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Objective To explore the effect of WeChat group management on blood pressure control rate and drug compliance of hypertension patients during the epidemic of coronavirus disease 2019 (COVID-19) . Methods A total of 428 consecutive patients with essential hypertension in our outpatient department from Jan. 2020 to Dec. 2020 were enrolled and randomly divided into experimental group and control group with a ratio of 1 : 1. There were 214 patients in the experimental group, 110 males and 104 females, with an average age of (55.48+/-6.11) years. There were 214 cases in the control group, 108 males and 106 females, with an average age of (56.52+/-5.19) years. WeChat groups were established for the 2 groups separately. Information on education, supervised medication and lifestyle of hypertension was provided to the patients in the experimental group through WeChat, while no active intervention was given to the control group. The blood pressure control rate and medication possession ratio (MPR) were calculated at 1, 3, 6 and 12 months of intervention, and the differences between the 2 groups were compared. Results There were no significant differences in the blood pressure control rate (91.12%195/214 vs 90.65% 194/214, 86.67%182/210vs 89.62%190/212or MPR (0.90+/-0.03 vs 0.90+/-0.05, 0.85+/-0.04 vs 0.88+/-0.03) between the 2 groups at 1 or 3 months of intervention (all P>0.05). At 6 and 12 months, the blood pressure control rate (81.73%170/208vs 88.57%186/210,75.12%154/205vs 85.99%178/207) and MPR (0.74+/-0.04 vs 0.87+/-0.05, 0.58+/-0.05 vs 0.85+/-0.03) of patients in the experimental group were significantly higher than those in the control group (all P<0.05). Conclusion During the COVID-19 epidemic, WeChat group management of hypertension patients by doctors could improve patients' blood pressure control rate and drug compliance and strengthen patients' self-management ability.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Introduction: Bupivacaine is a local anesthetic which has been increasingly used in the post-operative state for pain control. Hepatotoxicity is a rare complication, and few cases are reported in patients with chronic liver disease. We present a case of acute liver injury from bupivacaine use in a healthy patient without prior history of liver disease. Case Description/Methods: A 68-year-old female with a past medical history of primary hypertension and recent nontraumatic complete tear of the right rotator cuff, presents to the hospital with fatigue, loss of appetite, and nausea. She recently underwent an arthroscopy of the right shoulder with repair of the rotator cuff two weeks prior. Her surgery was uncomplicated, and patient was started on bupivacaine ONQ pump infusion at 5 ml/hr for three days for post-operative pain. Further history reveals patient is non-alcoholic without prior liver disease, including cirrhosis. Review of systems is concerning for associated generalized abdominal discomfort. Physical exam demonstrated jaundice with scleral icterus with mild periumbilical tenderness to palpation without hepatosplenomegaly or ascites. Labs demonstrated elevated total bilirubin of 10.2 mg/dL with Alkaline phosphatase, ALT, and AST being 924 U/L, 429 U/L, and 279 U/L, respectively. Imaging studies including CT abdomen and pelvis with contrast, abdominal ultrasound, MRCP, and portal vein doppler were negative. Additional work up for underlying liver disease including acetaminophen and ethanol levels, SARS-CoV2, Hepatitis panel, EBV antigen, and urine toxicology were negative. It was determined patient had bupivacaine induced hepatotoxicity. Patient's health improved with conservative management and she was discharged with instructions for close monitoring of her LFTs. Discussion(s): Bupivacaine is an amino-amide anesthetic which binds to the intracellular portion of voltage-gated sodium channels and prevents depolarization of pain signals. It is metabolized by the liver and thus reports of hepatotoxicity, although rare, occur in patients with underlying liver pathology. Our patient became symptomatic with acute rise in LFTs. An extensive workup for other etiologies of acute liver toxicity was negative. Rapid vascular uptake of the drug is the most common reason for bupivacaine toxicity;and this remains a possibility for the mechanism of toxicity in our patient. A prior case report of bupivacaine hepatotoxicity demonstrated a cholestatic pattern, which is consistent with our findings.
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Objective To explore the effect of WeChat group management on blood pressure control rate and drug compliance of hypertension patients during the epidemic of coronavirus disease 2019 (COVID-19) . Methods A total of 428 consecutive patients with essential hypertension in our outpatient department from Jan. 2020 to Dec. 2020 were enrolled and randomly divided into experimental group and control group with a ratio of 1 : 1. There were 214 patients in the experimental group, 110 males and 104 females, with an average age of (55.48+/-6.11) years. There were 214 cases in the control group, 108 males and 106 females, with an average age of (56.52+/-5.19) years. WeChat groups were established for the 2 groups separately. Information on education, supervised medication and lifestyle of hypertension was provided to the patients in the experimental group through WeChat, while no active intervention was given to the control group. The blood pressure control rate and medication possession ratio (MPR) were calculated at 1, 3, 6 and 12 months of intervention, and the differences between the 2 groups were compared. Results There were no significant differences in the blood pressure control rate (91.12%[195/214] vs 90.65% [194/214], 86.67%[182/210]vs 89.62%[190/212])or MPR (0.90+/-0.03 vs 0.90+/-0.05, 0.85+/-0.04 vs 0.88+/-0.03) between the 2 groups at 1 or 3 months of intervention (all P>0.05). At 6 and 12 months, the blood pressure control rate (81.73%[170/208]vs 88.57%[186/210],75.12%[154/205]vs 85.99%[178/207]) and MPR (0.74+/-0.04 vs 0.87+/-0.05, 0.58+/-0.05 vs 0.85+/-0.03) of patients in the experimental group were significantly higher than those in the control group (all P<0.05). Conclusion During the COVID-19 epidemic, WeChat group management of hypertension patients by doctors could improve patients' blood pressure control rate and drug compliance and strengthen patients' self-management ability.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Context: The SARS-CoV-2 virus is dependent on components of the renin-angiotensin-aldosterone system for infectivity. Primary aldosteronism (PA) is a form of secondary hypertension mediated by autonomous aldosterone production. The intersection of COVID-19 and PA, both which may involve components of the renin-angiotensin-aldosterone system, remains unknown. Methods: We assessed PA as a risk factor for COVID-19 infection and compared management, severity of disease, and outcomes during COVID-19 with a matched population of patients with essential hypertension (EH) by conducting a retrospective observational cohort study. Results: Of the patients with PA, 81 had a negative PCR test for COVID-19, whereas 43 had a documented positive PCR test for COVID-19. Those patients with PA who tested positive for COVID-19 tended to be female (P = .08) and the majority of those with COVID-19 infection identified as non-White race (P = .02) and Hispanic ethnicity (P = .02). In a subanalysis, 24-hour urine aldosterone on initial PA diagnosis tended to be higher those in the PA group who developed COVID-19 compared with those in the PA group who did not develop COVID-19 [median (interquartile range): 36.5 (16.9, 54.3) vs 22.0 (15.8, 26.8) mcg, P = .049] and was an independent predictor of COVID-19 infection controlling for sex, race, and ethnicity. Angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, and mineralocorticoid receptor antagonist use did not differ between those patients with PA who did and did not have COVID-19 infection. Comparing those patients with PA and matched patients with EH (n = 286) who were COVID-19 PCR positive, there was a significantly higher incidence of cardiovascular complications (12 vs 2%, P = .004) in the PA vs EH group. Conclusion: These data begin to inform us as to whether PA should be a newly identified subpopulation at risk for COVID-19-related cardiovascular disease sequelae.
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Objective: This study aimed to estimate inpatient mortality rate for diabetes and identify its associated factors. Material(s) and Method(s): This is a cross-sectional study. The population was comprised between January 1 and December 31, 2019 in 32 public hospitals in Portugal, using summary hospital discharge data. We used both the Disease-Related Diagnosis Groups and the Disease Staging. Patients were grouped into survivors and non-survivors, and inpatient mortality was compared using competing event regression. Result(s): A total of 7980 patients were admitted with type 2 diabetes mellitus, there were 747 (10.3%) non-survivors. The advanced age (OR = 1.772;95% CI 1.625-1.932), the stage (3) severity of type 2 diabetes mellitus (OR = 4.301;95% CI 2.564-7.215), comorbid lung, bronchial or mediastinal malignant neoplasm (OR = 5.118;95% CI 2.222-11.788), comorbid bacterial pneumonia (OR = 3.214;95% CI 2.539-4.070), other respiratory system disorders (OR = 2.187;95%CI1.645-2.909),comorbidrhino-,adeno-andcorona-virus infections (OR = 1.680;95% CI 1.135-2.488) were determinants for inpatient mortality. Conclusion(s): Elderly patients with diabetes with micro- and macrovascular complications of the disease, who have bacterial pneumonia and who enter the emergency department are those who have a lower survival rate. Copyright © 2022 Via Medica. All rights reserved.
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Background: Subacute thyroiditis is an inflammatory disease associated with vaccinations. There have been reports of subacute painful thyroiditis following SARS-CoV-2 vaccination. However, only a few cases of painless thyroiditis have been reported and mostly were after mRNA vaccine. The authors presented a case of painless thyroiditis after viral vector SARS-CoV-2 vaccine. Case Report: A 60-year-old woman, who had no prior history of thyroid disease, presented with atrial fibrillation and no enlarged thyroid gland or neck pain. She had received ChAdOx1 nCoV-19 vaccine from AstraZeneca two weeks prior to the onset of symptoms. Her blood tests revealed primary thyrotoxicosis, and thyroid uptake confirmed thyroiditis. Discussion(s): Vaccine-induced thyroiditis has been reported in viral vaccines. The pathophysiology of SARS-CoV-2 vaccine-induced thyroiditis is still unknown. It is possible that the immune response to the SARS-CoV-2 vaccine will also cross-react and cause thyroiditis. Conclusion(s): It is possible that SARS-CoV-2 vaccine can cause painless thyroiditis. Copyright © 2022 Medical Association of Thailand. All rights reserved.
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SESSION TITLE: COVID-19 Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Pneumomediastinum is the presence of air or other gas in the mediastinum which can be due to trauma related to mechanical ventilation or spontaneous in preexisting lung diseases. Here, we present the case of Covid-19 pneumonia, who developed pneumomediastinum without any trauma or other risk factors. CASE PRESENTATION: A 56-year-old male COVID unvaccinated with a history of essential hypertension presented to the ED with shortness of breath and worsening cough for one week. He was living with his father, who was admitted to the ICU and receiving treatment for COVID pneumonia. The patient appeared to be in respiratory distress. His initial vital signs were temperature of 99.6 F, respiratory rate of 26 breaths per minute, blood pressure 125/71 mm Hg, heart rate 109 beats per minute with a regular rhythm, and oxygen saturation of 50% while he was breathing ambient air. Pulmonary examination revealed use of respiratory accessory muscle and widespread bilateral coarse rhonchi on auscultation. The rest of the physical examination was within normal limits. RT- PCR COVID -19 test was positive. The blood gas analysis reported respiratory alkalosis. Inflammatory markers were elevated: erythrocyte sedimentation rate (35.2 mg/L), C-Reactive Protein (17.70 mg/dL), Ferritin (1108.1 ng/mL), Lactate Dehydrogenase (813 U/L), Lactate (2.4 mg/dL), D-Dimer (35.20 mg/L) and Troponin High Sensitivity-236.6 ng/L. His CBC, electrolytes, and kidney function were normal. Chest X-ray showed Pneumomediastinum with dense basilar predominant consolidation. CT Angio Chest with contrast reported Pneumomediastinum likely from the left central airway source and bilateral dense ground glass consolidation. An echocardiogram showed an ejection fraction of 60-65%, no valvular abnormalities. He was placed on vapotherm(Oxygen 40L/min) with 100% FiO2. He was given Dexamethasone 6mg for ten days, Remdesivir, Barcitinib, and a 7-day course of Azithromycin and Ceftriaxone for community-acquired pneumonia. He was advised to practice prone positioning for 12 hours or more per day. Pulmonology, Infectious Disease, and Cardiology were consulted. Gradually, his oxygen requirement was weaned down and Pneumomediastinum resolved on serial chest x rays. He was discharged on home oxygen in a clinically stable condition. DISCUSSION: Pneumomediastinum in viral pneumonia is rare. The exact mechanism is unknown. Covid-19 pneumonia causes diffuse alveolar wall damage, which might cause air leakage into the mediastinum. The development of pneumomediastinum is an ominous sign in these patients. Fortunately, our patient did not worsen and was weaned off high flow oxygenation requirement. CONCLUSIONS: Few isolated reported cases of pneumomediastinum in a COVID-19 patient have been associated with life-threatening complications. It should be used as a prognostic marker, and close monitoring of these patients is advisable. Reference #1: Damous, S.H.B., dos Santos Junior, J.P., Pezzano, Á.V.A. et al. Pneumomediastinum complicating COVID-19: a case series. Eur J Med Res 26, 114 (2021) DISCLOSURES: No relevant relationships by Saad Ansari No relevant relationships by Akshit Chitkara No relevant relationships by Sudeshna Ghosh No relevant relationships by Femina Patel
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Purpose : To compare corneal transplant failure in patients who have been vaccinated against COVID-19 to a control group of patients who have received an influenza vaccination. Methods : A retrospective cohort study was conducted using TriNetX, a federated electronic health records research network comprising data from more than 50 health organizations in the United States. Patients who underwent corneal transplantation and either COVID-19 vaccination or Influenza A vaccination were identified by CPT and medication codes and separated into cohorts based which vaccination they had received. COVID-19 vaccination was defined as receiving either 2 doses of Moderna or Pfizer COVID19 Vaccine or 1 dose of J&J's COVID-19 Vaccine. Cohorts were matched for age, gender, body mass index, and medical comorbidities (essential hypertension, diabetes mellitus, chronic lower respiratory diseases, heart failure, nicotine dependence, and alcohol related disorders). The primary outcome was corneal graft failure at 120 days after corneal transplantation surgery. The relative risk for this outcome was compared between each cohort before and after 1:1 propensity score matching. Results : A study population of 784 corneal transplant patients who received COVID-19 vaccination and a control population of 1661 patients who received Influenza A vaccination were identified. After propensity matching, 715 matched patients from each cohort were compared. The incidence of corneal transplant failure rate was 1.8% for the COVID-19 vaccine cohort and 1.6% for the Influenza A cohort. While the rate of corneal transplant failure was slightly lower in COVID-19 vaccine recipients in comparison to Influenza vaccine recipients (RR=0.92%, CI 0.42-2.01), this result was not statistically significant (p 0.84). Conclusions : While there have been several case reports of corneal graft failure after COVID-19 or COVID-19 vaccination, there appears to be no statistically significant impact of the COVID-19 vaccine on corneal transplant failure in this retrospective cohort study. Additionally, corneal graft rejection in vaccinated patients was rare in our study.
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Introduction: Evidence regarding thrombotic microangiopathy related to covid-19 is reported in the literature, particularly in severe cases. We describe a case recovered from previous asymptomatic covid-19, presenting with acute renal failure, hemolytic anemia, and low platelets. Thrombotic microangiopathy (TMA) was confirmed by renal biopsy, without immunofluorescence staining for C3c and C1q, suggesting this case is not complement-mediated. Anticoagulant therapy led to kidney function improvement. Methods: Case report. Results: A 72-year-old women with a past medical history of primary hypertension was referred to the hospital for the diagnosis of acute renal failure. Three days prior to admission, she suffered abdominal pain, decreased urine output, her blood test revealed elevated serum creatinine of 393 umol/L, and low platelets of 43.6 K/uL. She denied history of hematologic or renal disorders, yet mentioned that she found asymptomatic covid-19 one month before admission. On admission, the vital signs was significant for a blood pressure of 140/80 mmHg. Physical examination was noted with facial oedema, upper abdominal pain, otherwise unremarkable. Laboratory test confirmed acute renal failure with the ongoing increase of serum urea 30.4 mmol/L and creatinine 575 umol/L. Her total blood count discovered thrombocytopenia and anemia, with the platelet count of 50 k/uL, and the hemoglobin of 94 g/L. Lactate dehydrogenase was in upper limit of 434 U/L, and the bilirubin level was in normal range. The peripheral blood smear showed “fragmented” RBCs. Coombs’ test was negative for both direct and indirect method. Stool examination failed to detect either red or white blood cell. Haptoglobin level was 1.14 g/L, which was in normal range (0.41-2.58 g/L). Ddimer was elevated 1376 ng/mL, and the fibrinogen 6.37 g/L. Immunology investigation was conducted with the result of normal level for both complement C3 and C4, negative reaction for anti-cardiolipin IgM and IgG, anti MPO, anti PR3, RF, anti-streptolysin O. Bone marrow aspiration did not show abnormalities. There were Forrest III gastric ulcers found by gastric endoscopy (two ulcers with diameter of 9mm and 10mm, with pseudo-membrane covered). Initially she was treated symptomatically with amlodipin, intravenous PPI, and IV furosemide. As the kidney function was getting worse, hemodialysis was initiated at day 1, day 3, day 6, and day 10 of admission. Renal biopsy was performed and showed active thrombotic microangiopathy. Given the normal complement profile, and negative C3c staining on immunofluorescence of renal biopsy investigation, complement mediated TMA may not be the pathogenesis of this case. The patient was started for anticoagulant therapy, initially subcutaneous low molecular weight heparin and then oral anti-vitamin K. She obtained dramatic recovery with dialysis off, increased urine output, normalized platelets and red cell count, and serum urea and creatinine back to nearly normal range at discharge. Conclusions: Complement related thrombotic microangiopathy is a rare and severe condition. This case of TMA after covid-19 reveals a non-complement mediated pathogenesis, with different treatment. Anticoagulation is an effective therapy in hypercoagulation induced TMA. No conflict of interest
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CASE: Patient is a 67-year-old white male who is from Ohio who has a past medical history significant for diabetes mellitus type 2, essential hypertension and hyperlipidemia. He presented to the emergency department with complaints of generalized weakness and shortness of breath. He was vaccinated against COVID about 3-4 months ago. Dyspnea has been progressive over several days. Initial laboratory values and vital signs in the emergency department were pertinent for a heart rate 92/min, blood oxygen saturation of 93% on 5 L nasal cannula, ESR 40, CRP 22.9, D-dimer 21.1, positive for COVID-19 on PCR. Chest x-ray showed developing multifocal infiltrates consistent with COVID-19 pneumonia. Patient was started on dexamethasone, remdesivir, ceftriaxone, azithromycin and was placed on low molecular weight heparin for DVT prophylaxis regimen during the first few hours of admission. We continued standard therapies but the patient's oxygen requirements increased. During this hospitalization patient became acutely unresponsive and was noticed that he was not moving his right side. A stroke work-up was undertaken MRI brain/head without contrast showed large left MCA territory infarction, no acute hemorrhage has been identified, loss of flow void within the left intracranial ICA, suggesting obstruction versus high-grade stenosis. Echo showed normal LV systolic function. MRA of the head and neck showed occluded left ICA and left MCA. Unfortunately due to the size of the infarction the patient was not a candidate for full dose anticoagulation.Eventually patient was not following commands, remained unresponsive and had persistent dysphagia for which he had PEG tube placement. Family has been updated on his clinical status and overall prognosis is poor. IMPACT/DISCUSSION: The incidence of stroke has been reported in 5.7% of patients with severe COVID-19 and in 0.8% of patients with nonsevere infection.The frequency of stroke detected in hospitalized COVID-19 patients was 1.1% associated with older age and stroke risk factors.Early-onset cerebrovascular disease is more common in COVID- 19 patients with underlying cerebrovascular risk factors including older age (>65 years).The significant increase in D- dimer levels like our patient suggests that COVID-19 can induce an inflammatory response and trigger a hypercoagulable state causing an acute ischemic stroke .The hypercoagulable state in patients with COVID-19 supports the formation of small and/or large blood clots in many organs such as the brain, which have the potential to cause cerebrovascular disease.Increased D-dimer levels confirm the theories of endothelial activation and hypercoagulability. CONCLUSION: Our case report highlights the fact that COVID-19 is a risk factor for acute ischemic stroke along with other underlying cerebrovascular risk factors such as diabetes, hypertension and hyperlipidemia like in our patient. We should be aware of these neurological symptoms and act promptly in the evaluation of stroke in COVID-19 patients.
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Background: The Thai government mandates BP measurement prior to COVID-19 vaccination to ensure safety for all vaccinees. However, there is neither large study regarding the prevalence of high BP nor CV complication during COVID-19 vaccination. Purpose: To describe the prevalence of high BP defined as SBP≥140 or DBP≥90 mmHg, predictors for high BP and outcome during vaccination day. Methods: We enrolled all vaccinees at a Thai hospital, during June 2021. We reviewed medical records and compared vaccination day BP with BP from prior 2 visits extracted from the computer database. We used a fully automated non-invasive sphygmomanometers. Diagnosis of hypertension were extracted from the past records using ICD-10 code (I1-). Grade of hypertension were defined according to the ESC guideline 2018. Prior well-controlled BP was defined as SBP < 130 and DBP < 80 mmHg in the 2nd prior visit. Results: There were 2308 vaccinees during the period and 2307 with complete data for analysis. Female accounted for 57%. The mean age was 49.69 ± 17.44 years old. Body mass index were 25.77 ± 14.10 kg/m2. Prime COVID-19 vaccines shot accounted for 73.6%. All vaccinees were pre-assigned to receive either ChAdOx1 nCoV-19 or CoronaVac: 54.2% and 45.8%, respectively. Essential hypertension was previously diagnosed in 21.5%, and 0.3% for secondary hypertension. The vaccination day mean SBP and DBP were 135.23 ± 17.97 and 76.14 ± 12.06 mmHg. There were 56%, 33%, 10.3% and 0.4% classified as normotension, gradeI, II and III hypertension, respectively. Estimated prevalence for any hypertension and grade II or III hypertension were 44% (95% CI 41.9-46.0) and 11% (95% CI 9.7-12.3), respectively. There were 1,335 participants with at least 2 previous BP measurements prior to the vaccination day. We compared BP change between group of 142 vaccinees who had grade II or III hypertension and group of 1193 vaccinees with normotension or grade I hypertension at vaccination day. There was a significant increase in SBP and DBP at vaccination day in both groups, and significantly higher BP from prior visits in grade II or III hypertension group (Figure 1). After adjusting for age, gender, type of vaccine, dose, previous diagnosis of hypertension and prior well-controlled BP, we found that the previous diagnosis of hypertension and prior well-controlled BP were independent predictors for grade II or III hypertension at vaccination day: OR 2.93 (95% CI 1.97-4.36) and 0.47 (95% CI 0.23-0.96), respectively. There were 3.38% who required on-site medical attention due to high BP, resulting in a delay to vaccination of 1 hour (IQR, 0.5- 2). Vaccination was postponed in 0.56%. All were diagnosed with hypertensive urgency by the onsite physicians. Conclusions: Prevalence of high BP was relatively high among Thai vaccinees but without CV event at vaccination day. BP measurement may be unnecessary in asymptomatic vaccinees with previously well-controlled BP. (Figure Presented).
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Objectives: Growing evidences suggest that COVID-19 infection should be considered as a systemic disease which involves multiple organ systems leading to numerous respiratory and non-respiratory complications. The current study evaluated all the potential complications associated with COVID-19 infections from administrative claims data. Methods: This retrospective, cross-over and observational study included patients diagnosed with COVID-19 infection between 1st April to 30th September 2020 with ICD-10 CM diagnosis recorded in the a large deidentified database of US health insurance claims. Only the patients having continuous eligibility between 4 months before (baseline period) to 1-month post (follow-up period) the first diagnosis of COVID-19 (index date) were included in study. Frequency of all ICD-10-CM diagnosis codes occurring during baseline period and during follow-up period were evaluated. For every ICD-10 CM diagnosis code, the risk estimates and odds ratios (ORs) of association with COVID-19 were evaluated. Results: The study included 208,886 patients with a mean (SD) age of 53.65 (21.4) years, 44% males and 56% females. 486 out of 1,564 ICD codes evaluated found to be statistically significant with COVID-19 infection exposure. Notable disorders having higher odds and high absolute risk included viral pneumonia (OR: 90.09;CI:73.12-111.00;absolute risk: 16.12%), acute respiratory distress syndrome (OR: 46.92;CI:28.42-77.48;absolute risk: 1.5%), respiratory failure (OR: 17.44;CI:16.18-18.81;absolute risk: 10.74%), sepsis (OR: 7.94;CI:7.21-8.75;absolute risk: 5.25%), acute kidney failure (OR: 5.70;CI:5.33-6.09;absolute risk: 6.30%), essential hypertension (OR: 1.78;CI:1.74-1.82;absolute risk: 16.77%), Ischemic heart disease (OR: 1.97;CI:1.88-2.05;absolute risk: 4.46%) and heart failure (OR: 2.39;CI:2.27-2.51;absolute risk: 3.58%). Conclusions: Apart from respiratory system which is the primary site of infection for COVID-19, many other organs like cardiovascular, kidney and liver with varying degree are also involved in COVID-19 infection.
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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infects host cells through angiotensin-converting enzyme 2 (ACE2). Concurrently, the product of ACE2 action, angiotensin 1-7 (Ang 1-7), binds to Mas receptors within the cardiovascular system and provides protective effects. Therefore, it is crucial to reveal the role of ACE2 inhibition, especially within pre-existing cardiovascular pathologies. In our study, we imitated the action of SARS-CoV-2 in organisms using the low dose of the ACE2 inhibitor MLN-4760 with the aim of investigating to what degree ACE2 inhibition is detrimental to the cardiovascular system of spontaneously hypertensive rats (SHRs), which represent a model of human essential hypertension. Our study revealed the complex action of MLN-4760 in SHRs. On the one hand, we found that MLN-4760 had (1) (pro)obesogenic effects that negatively correlated with alternative renin-angiotensin system activity and Ang 1-7 in plasma, (2) negative effects on ACE1 inhibitor (captopril) action, (3) detrimental effects on the small arteries function and (4) anti-angiogenic effect in the model of chick chorioallantoic membrane. On the other hand, MLN-4760 induced compensatory mechanisms involving strengthened Mas receptor-, nitric oxide- and hydrogen sulfide-mediated signal transduction in the aorta, which was associated with unchanged blood pressure, suggesting beneficial action of MLN-4760 when administered at a low dose.
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COVID-19 is an infectious disease caused by the virus SARS-CoV-2, which was first described at the end of 2019. Since then, it has affected a growing portion of the world's population because of its high transmissibility. Most patients are asymptomatic or present with mild symptoms, but approximately 5-10% of cases can develop more serious manifestations, such as severe acute respiratory syndrome, acute kidney injury, shock, myocardial injury and even death. These features seem to occur more commonly in patients with essential hypertension, diabetes mellitus, obesity and chronic pulmonary disease. However, there are few studies that clarify the natural history of the disease and its broad clinical spectrum owing to the fact that it is a new entity. Since individuals with malignancies tend to present some degree of immunological deficiency and are more prone to opportunistic infections, especially those being treated with immunosuppressive drugs, it is possible that this group has a higher incidence of COVID-19. The current recommendations of oncology specialists advise to postpone treatments and to use less toxic drugs when possible. However, we still do not know how much these measures will affect in cancer mortality. Also, the incidence of COVID-19 in this population remains undetermined. We do not know if infectious symptoms are a good parameter to motivate these therapeutic changes or if there is benefit to test asymptomatic patients. In this context, this research submitted 100 patients with hematological malignancies or solid tumors on chemotherapy at the Ribeirão Preto Medical School of the University of São Paulo's Hospital, asymptomatic for COVID-19, to RT PCR to determine the SARS-CoV-2 infection incidence in this population. Only two patients were diagnosed with COVID-19. Both had gastrointestinal cancer. One of them developed symptoms, but none presented severe manifestations. Both had their treatment postponed initially and reinitiated after the appropriate period of isolation. Hence, we believe that it's reasonable not to test every asymptomatic patient when the resource for that is scarce, prioritizing those at greater risk of infection and those more prone to severe outcomes as long as the appropriate preventive measures are being taken. Disclosures: Calado: Team Telomere, Inc.: Membership on an entity's Board of Directors or advisory committees;Agios: Membership on an entity's Board of Directors or advisory committees;Instituto Butantan: Consultancy;Alexion Brasil: Consultancy;AA&MDS International Foundation: Research Funding;Novartis Brasil: Honoraria.
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The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), responsible for the coronavirus disease of 2019 (COVID-19) pandemic, has affected and continues to affect millions of people across the world. Patients with essential arterial hypertension and renal complications are at particular risk of the fatal course of this infection. In our study, we have modeled the selected processes in a patient with essential hypertension and chronic kidney disease (CKD) suffering from COVID-19, emphasizing the function of the renin-angiotensin-aldosterone (RAA) system. The model has been built in the language of Petri nets theory. Using the systems approach, we have analyzed how COVID-19 may affect the studied organism, and we have checked whether the administration of selected anti-hypertensive drugs (angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs)) may impact the severity of the infection. Besides, we have assessed whether these drugs effectively lower blood pressure in the case of SARS-CoV-2 infection affecting essential hypertensive patients. Our research has shown that neither the ACEIs nor the ARBs worsens the course infection. However, when assessing the treatment of hypertension in the active SARS-CoV-2 infection, we have observed that ARBs might not effectively reduce blood pressure; they may even have the slightly opposite effect. On the other hand, we have confirmed the effectiveness of arterial hypertension treatment in patients receiving ACEIs. Moreover, we have found that the simultaneous use of ARBs and ACEIs averages the effects of taking both drugs, thus leading to only a slight decrease in blood pressure. We are a way from suggesting that ARBs in all hypertensive patients with COVID-19 are ineffective, but we have shown that research in this area should still be continued.