Analysis of Cardiovascular Complications during Delivery Admissions Associated with COVID-19

BACKGROUND: Persons with Coronavirus Disease 2019 (COVID-19) infection have an increased risk of pregnancy-related complications. However, data on acute cardiovascular complications during delivery admissions remain limited. OBJECTIVE(S): To determine whether birthing individuals with COVID-19 have an increased risk of acute peripartum cardiovascular complications during their delivery admission. METHOD(S): This population-based retrospective cohort study used the National Inpatient Sample (2020) by utilizing ICD-10 codes to identify delivery admissions with a diagnosis of COVID-19. A multivariable logistic regression model was developed to report an adjusted odds ratio for the association between COVID-19 and acute peripartum cardiovascular complications. RESULT(S): A total of 3,458,691 weighted delivery admissions were identified, of which 1.3% were among persons with COVID-19 (n=46,375). Persons with COVID-19 were younger (median 28 vs. 29 years, p<0.01) and had a higher prevalence of gestational diabetes mellitus (GDM), preterm births and Cesarean delivery (p<0.01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, COVID-19 remained an independent predictor of peripartum cardiovascular complications including preeclampsia (aOR 1.33 [1.29-1.37]), peripartum cardiomyopathy (aOR 2.09 [1.54-2,84]), acute coronary syndrome (ACS) (aOR 12.94 [8.85-18.90]), and cardiac arrhythmias (aOR 1.55 [1.45-1.67]) compared with no COVID-19. Likewise, the risk of in-hospital mortality, AKI, stroke, pulmonary edema, and VTE was higher with COVID-19. For resource utilization, cost of hospitalization ($5,374 vs. $4,837, p<0.01) was higher for deliveries among persons with COVID-19. CONCLUSION(S): Persons with COVID-19 had a higher risk of preeclampsia, peripartum cardiomyopathy, ACS, arrhythmias, in-hospital mortality, pulmonary edema, AKI, stroke, and VTE during delivery hospitalizations. This was associated with an increased cost of hospitalization. Keywords: COVID-19, Pregnancy, GDM, PCOS, Preeclampsia, CVD, Cardiovascular Disease Abbreviations: COVID-19: Coronavirus disease-2019, GDM: Gestational Diabetes Mellitus, PCOS: Polycystic Ovary Syndrome, National Inpatient Sample: NIS, AHRQ: Agency for Healthcare Research and Quality, HCUP: the Healthcare Cost and Utilization Project Funding and Conflicts of Interest Dr. Michos reports Advisory Board participation for Amgen, AstraZeneca, Amarin, Bayer, Boehringer Ingelheim, Esperion, Novartis, Novo Nordisk, and Pfizer. The remaining authors have nothing to disclose.Copyright © 2023

Fitness Assessments of Women with Polycystic Ovary Syndrome: A Prospective Process Feasibility Study

Background: Fitness is a marker of physiological and mental health. The purpose of this pilot study was to assess the feasibility of processes to recruit women with polycystic ovary syndrome (PCOS) during the Covid pandemic and collect their health and fitness data. Additionally, the data was used to explore possible associations between anthropometrics, PCOS biomarkers, health-related quality-of-life (HRQoL), and depressive symptoms with that of fitness and self-reported physical activity levels among women with PCOS. Method(s): A convenience sample of women with PCOS (n = 15) were recruited via flyers and the snowball method. Participants completed surveys, anthropometrics, a dual energy x-ray absorptiometry scan, blood work, and a fitness assessment. Data were statistically analyzed using Spearman correlations. Result(s): Feasibility measures of recruitment and retention rates were 83% and 100%, respectively. Fidelity measurement for process averaged 97%. Participants (age 25.9 (+/- 6.2), mostly White (80%), single (60%), and employed full-time (67%)) were categorized as obese (body mass index (BMI) 32.2 kg/m2 +/- 8.3, percent bodyfat 41.1% +/- 8.1) with <=1 comorbidity. Most participants were not regularly physically active and had high free testosterone levels (7.6 pg/mL+/-4.3), elevated high-density lipoprotein (63.2 mg/dL+/-12.9), fair cardiovascular capacity, and below average muscular strength/endurance. The following statistically significant and strong associations were found: (1) VO2 max with percent bodyfat (-0.59;p = 0.02), sex hormone binding globulin (0.73;p = 0.00), HRQoL (0.72;p = 0.00), and depressive symptoms (-0.67;p = 0.00), (2) abdominal strength with BMI (-0.66;p = 0.01) and high density lipoprotein (HDL) (0.59;p = 0.02), (3) physical activity level with percent bodyfat (-0.72;p = 0.00), and (4) resistance training with low density lipoprotein (LDL) (-0.52;p = 0.05). Conclusion(s): Collecting health and fitness data from women with PCOS is a feasible research approach. Randomized controlled trials in which health and fitness data are collected from women with PCOS are needed to confirm possible associations between fitness and PCOS clinical features and is in the planning process. Copyright: Copyright © 2023 The Author(s).

Polycystic Ovary Syndrome and COVID-19.

Polycystic ovary syndrome (PCOS) is generally characterized by hyperandrogenism, obesity, chronic low-grade inflammation, abnormalities in carbohydrate and lipid metabolism, vit. D deficiency and gut microbiota dysbiosis. Each of the aforementioned disturbances might be considered as a risk factor for increased SARS-CoV-2 susceptibility and more severe COVID-19 infection in women with PCOS. Hyperandrogenism is thought to play an essential role for determining the grade of susceptibility as well as the risk of severe COVID-19 infection in PCOS. It could be explained by the expression of a specific cellular co-receptor - transmembrane serine protease-2 (TMPRSS2), the process of androgen-dependent immune modulation and that of the stimulated renin-angiotensin system (RAS). Android obesity, commonly seen in PCOS, represents a condition of chronic low-grade inflammation that leads to the development of immune dysfunction and increased sensitivity to SARS-CoV-2 among the carriers of this syndrome. In addition, vit. D deficiency and gut dysbiosis have been described as other potential pathophysiological factors contributing to an increased risk for severe COVID-19 in women with PCOS.Copyright © 2022 Medical Information Center. All rights reserved.

Polycystic Ovary Syndrome and COVID-19.

Polycystic ovary syndrome (PCOS) is generally characterized by hyperandrogenism, obesity, chronic low-grade inflammation, abnormalities in carbohydrate and lipid metabolism, vit. D deficiency and gut microbiota dysbiosis. Each of the aforementioned disturbances might be considered as a risk factor for increased SARS-CoV-2 susceptibility and more severe COVID-19 infection in women with PCOS. Hyperandrogenism is thought to play an essential role for determining the grade of susceptibility as well as the risk of severe COVID-19 infection in PCOS. It could be explained by the expression of a specific cellular co-receptor - transmembrane serine protease-2 (TMPRSS2), the process of androgen-dependent immune modulation and that of the stimulated renin-angiotensin system (RAS). Android obesity, commonly seen in PCOS, represents a condition of chronic low-grade inflammation that leads to the development of immune dysfunction and increased sensitivity to SARS-CoV-2 among the carriers of this syndrome. In addition, vit. D deficiency and gut dysbiosis have been described as other potential pathophysiological factors contributing to an increased risk for severe COVID-19 in women with PCOS.Copyright © 2022 Medical Information Center. All rights reserved.

Polycystic Ovary Syndrome and COVID-19.

Polycystic ovary syndrome (PCOS) is generally characterized by hyperandrogenism, obesity, chronic low-grade inflammation, abnormalities in carbohydrate and lipid metabolism, vit. D deficiency and gut microbiota dysbiosis. Each of the aforementioned disturbances might be considered as a risk factor for increased SARS-CoV-2 susceptibility and more severe COVID-19 infection in women with PCOS. Hyperandrogenism is thought to play an essential role for determining the grade of susceptibility as well as the risk of severe COVID-19 infection in PCOS. It could be explained by the expression of a specific cellular co-receptor - transmembrane serine protease-2 (TMPRSS2), the process of androgen-dependent immune modulation and that of the stimulated renin-angiotensin system (RAS). Android obesity, commonly seen in PCOS, represents a condition of chronic low-grade inflammation that leads to the development of immune dysfunction and increased sensitivity to SARS-CoV-2 among the carriers of this syndrome. In addition, vit. D deficiency and gut dysbiosis have been described as other potential pathophysiological factors contributing to an increased risk for severe COVID-19 in women with PCOS.Copyright © 2022 Medical Information Center. All rights reserved.

Is The Co-administration of Metformin and Clomiphene Superior to Induce Ovulation in Infertile Patients with Poly Cystic Ovary Syndrome and Confirmed Insulin-resistance: A Double Blind Randomized Clinical Trial

Objective: This study aimed to compare the effects of clomiphene citrate (CC) combined with metformin or placebo on infertile patients with poly cystic ovary syndrome (PCOS) and insulin resistance (IR). Material(s) and Method(s): We included 151 infertile women with PCOS and IR in a university hospital from November 2015 to April 2022 in this prospective, double-blind, randomized, placebo-controlled trial. Patients were randomized into two groups;group A: received CC plus metformin (n = 76) and group B: received CC plus placebo (n = 75). The ovulation rate was the main outcome measure. Clinical pregnancy, ongoing pregnancy, live birth and abortion rates were secondary outcome measures. Result(s): There was no remarkable difference in ovulation rate in two groups. Moreover, no significant changes were observed in clinical pregnancy, ongoing pregnancy, live birth and abortion rates between two groups. A larger proportion of women in group A suffered from side effects of metformin (9.3% versus 1.4%;p=0.064), although this was not significant. Conclusion(s): In IR infertile women with PCOS, metformin pre-treatment did not increase the ovulation, clinical pregnancy and live birth rates in patients on clomiphene citrate.Copyright © 2023 Tehran University of Medical Sciences.

74th Annual Congress of the Japan Society of Obstetrics and Gynecology

The proceedings contain 429 papers. The topics discussed include: a short peptide encoded by long non-coding RNA small nucleolar RNA host gene 6 promotes cell migration and epithelial-mesenchymal transition by activating transforming growth factor-beta/SMAD signaling pathway in human endometrial cells;a short peptide encoded by long non-coding rna small nucleolar rna host gene 6 promotes cell migration and epithelial-mesenchymal transition by activating transforming growth factor-beta/smad signaling pathway in human endometrial cells;compatible cut-off values for luteinizing hormone and the luteinizing hormone/follicle-stimulating hormone ratio in diagnostic criteria of the Japan society of obstetrics and gynecology for polycystic ovary syndrome;intracytoplasmic sperm injection cycle success in patients under 35 years old with diminished ovarian reserve plus severe male factor;assisted reproductive technology and neonatal intensive care unit: a retrospective observational study from a single center;the value of clinical symptoms, the neutrophil-to-lymphocyte ratio, and ultrasonographic features in predicting adnexal torsion: a case-control study;construction of a diagnostic classifier for cervical intraepithelial neoplasia and cervical cancer based on xgboost feature selection and random forest model;and impact of the COVID-19 pandemic on surgery for benign diseases in gynecology: a nationwide survey by the japan society of obstetrics and gynecology.

The Role of Microparticles in Polycystic Ovarian Syndrome. An Updated Review

Microparticles (MPs) are vesicles of less than 1 mum in diameter (submicron vesicles) shed from plasma membranes to cell activation, injury, and apoptosis response. They consisted of membrane proteins and cytosolic material from the cell they originated. These vesicles are vital mediators of pathological and physiological cellular processes. Polycystic ovary syndrome (PCOS) is a regular endocrine, menstrual and metabolic condition that affects 10-15% of females in their reproductive period. Numerous researches have described the association between low-grade chronic inflammation and PCOS;however, the relation is not well understood. Chronic low-grade inflammation is reflected as a risk factor for cardiovascular disease, atherosclerosis, and endothelial dysfunction, and it is linked to abdominal obesity and insulin resistance (IR). MPs may be useful biomarkers for the early detection of cardiovascular disease and thrombosis in PCOS patients. In March 2020, the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) became pandemic, wreaking havoc on healthcare systems worldwide and the global economy. Obesity, diabetes, and cardiovascular disease have all been linked to COVID-19 increased risk of infection. PCOS patients have recently been identified as an underserved and potentially high-risk demographic for COVID-19 problems. This article tried to review and present recent studies that explored the role of microparticles in polycystic ovarian syndrome.Copyright © 2022 International Journal of Pharmaceutical Research and Allied Sciences. All rights reserved.

Acute macular neuroretinopathy following COVID- 19 infection

Purpose: We aim to highlight a case of COVID-19 associated acute macular neuroretinopathy (AMN), an outer retinopathy known to occur following febrile and flu-like illnesses. Method(s): Case report. Result(s): A 23-year-old Caucasian female presented with a 10-day history of sudden onset bilateral paracentral scotomata which developed following confirmed SARSCoV- 2 infection. The patient's medical history was significant for polycystic ovary syndrome and use of the combined oral contraceptive pill (OCP). Fundoscopic examination revealed multiple reddish-brown, wedge shaped lesions in both eyes perifoveally. Optical coherence tomography of these lesions demonstrated areas of ellipsoid zone disruption associated with overlying hyperreflectivity of outer retinal layers. The lesions were hyporeflective on infrared imaging. The location of lesions at the macula correlated nearly identically with Amsler grid recordings as illustrated by the patient. As a result, the patient was diagnosed with AMN. Other inflammatory, infective and hypercoaguable causes of outer retinopathy were excluded. While OCP use is a risk factor for AMN, the aetiology was determined to be associated with COVID-19, given the onset of visual symptoms closely following the onset of acute febrile illness. Conclusion(s): We report a rare case of AMN occurring in the context of recently diagnosed COVID-19, on the background of OCP use. More broadly, this case report aims to contribute to the broader literature regarding COVID- 19 associated ocular sequelae. Clinicians should consider asking about recent COVID-19 infection when encountering patients presenting with symptoms of AMN.

A RARE PRESENTATION OF COVID-19-ASSOCIATED CENTRAL VENOUS THROMBOSIS

SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Due to a wide range of clinical presentations, central venous thrombosis (CVT) is a rare neurologic condition that can be difficult to diagnose. Since the COVID-19 pandemic, more cases of venous thromboembolic events have emerged and been found associated with COVID-19. We detail a potential case of COVID-19 associated CVT. CASE PRESENTATION: A 28-year-old female with past medical history of obesity, polycystic ovary syndrome, recurrent sinusitis, and presumed history of COVID-19 infection with anosmia, ageusia, and sinusitis symptoms three- months prior presented to the hospital with 1-month history of worsening, right-sided pain behind her ear, eye, head, posterior neck and shoulder, nausea, and photophobia, which had worsened in the last 5 days. She initially tried over-the-counter medications with no improvement. Vital signs were unremarkable. Examination was notable for frontal sinus and right postauricular tenderness to palpation. C- reactive protein was elevated at 26.2 mg/L. Non- contrasted brain computed tomography (CT) was concerning for right transverse sinus and superior sagittal sinus thrombosis. Brain magnetic resonance imaging (MRI) showed early signs of cortical edema and venous infarction and findings concerning for right mastoiditis. Intracranial venous MRI showed complete thrombosis of the right transverse and sigmoid sinus, superior sagittal sinus, and most of the superior draining cortical veins. Heparin drip was started. Initial empiric antibiotics for mastoiditis were stopped. Hyper-coagulopathy work-up with beta- 2 glycoprotein 1 antibodies and phospholipid antibodies were negative. As there were no other inciting factors for CVT found and no history of positive COVID-19 test, a COVID-19 antibody immunoassay was obtained and returned positive. The patient did not have a history of COVID vaccination. She was discharged on warfarin and enoxaparin. Anticoagulation was stopped after 6 months with repeat imaging showing resolution of clot burden. DISCUSSION: Usual risk factors associated with CVT are morbid obesity, hormone replacement therapy, oral contraceptive use, hereditary thrombophilia, and pregnancy. Literature on CVT related to COVID-19 is limited. In 41 documented cases, the average age of incidence is 50 years old and median onset of neurological symptoms from initial COVID-19 diagnosis is 7 days [0 to 21 days]. Our patient's neurological symptoms began about 3 months after her initial diagnosis, potentially making it the first known case of COVID-19 associated CVT with symptom onset past 21 days. Anticoagulation is the mainstay treatment for CVT, and duration depends on the presence of provoking factor. CONCLUSIONS: In patients with new neurologic symptoms and recent diagnosis of COVID-19, CVT should be considered in the differential diagnosis as it can initially present in a subtle manner. Early recognition could improve patient morbidity and mortality. Reference #1: Abdalkader, M., Shaikh, S. P., Siegler, J. E., Cervantes-Arslanian, A. M., Tiu, C., Radu, R. A., Tiu, V. E., Jillella, D. v., Mansour, O. Y., Vera, V., Chamorro, Á., Blasco, J., López, A., Farooqui, M., Thau, L., Smith, A., Gutierrez, S. O., Nguyen, T. N., Jovin, T. G. (2021). Cerebral Venous Sinus Thrombosis in COVID-19 Patients: A Multicenter Study and Review of Literature. Journal of Stroke and Cerebrovascular Diseases. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105733 Reference #2: Idiculla, P. S., Gurala, D., Palanisamy, M., Vijayakumar, R., Dhandapani, S., Nagarajan, E. (2020). Cerebral Venous Thrombosis: A Comprehensive Review. European Neurology (Vol. 83, Issue 4). https://doi.org/10.1159/000509802 Reference #3: Ostovan VR, Foroughi R, Rostami M, et al. Cerebral venous sinus thrombosis associated with COVID-19: a case series and literature review. Journal of Neurology. 2021 Oct;268(10):3549-3560. DOI: 10.1007/s00415-021-10450-8. PMID: 33616740;PMCID: PMC7897893. DI CLOSURES: No relevant relationships by Shu Xian Lee No relevant relationships by Arif Sarwari No relevant relationships by Benita Wu

A Case of Rapidly Progressive Interstitial Lung Disease Due to Antisynthetase Syndrome

Introduction: Antisynthetase syndrome is a rare autoimmune disease. Clinical characteristics include interstitial lung disease (ILD), myositis, Raynaud's phenomenon, mechanic's hands, and arthritis. The condition is characterized by antibodies targeting an aminoacyl transfer RNA synthetase. Compared to other inflammatory myopathies, there is a higher prevalence and increased severity of ILD. Case Report: A 34-year-old female with a history of polycystic ovarian syndrome presented with progressive dyspnea during her third trimester of pregnancy. Initial computed tomography angiography (CTA) chest showed widespread multifocal and multilobar ground-glass opacities and nodular areas of consolidation. COVID-19 testing was negative. She went into preterm labor and delivered her baby at 30 weeks. About 10 days after delivery, her respiratory symptoms worsened. Transbronchoscopic lung biopsy was nondiagnostic. She subsequently underwent surgical lung biopsy which revealed organizing pneumonia and interstitial fibrosis. Laboratory studies revealed a high Jo-1 antibody of 1033U (normal less than 20U), positive ANA, creatine kinase 186 U/L, as well as aldolase 22.3 U/L leading to a diagnosis of antisynthetase syndrome. The patient continued to be dyspneic and developed increased oxygen requirements. Treatment was initiated with 1 dose of 125 mg of methylprednisolone followed by 1 g of methylprednisolone for 3 days, after which she was continued on oral prednisone. She was additionally started on 250 mg of mycophenolate mofetil. Despite these therapies she continued to have increased oxygen requirements, eventually requiring noninvasive positive pressure ventilation and ultimately intubation with mechanical ventilation. Chest x-ray demonstrated worsening bilateral patchy infiltrates. Given her clinical deterioration, she underwent 5 treatments of plasma exchange after which she received 1000 mg of rituximab. The patient improved on this therapy and was able to be extubated after 3 days. Her oxygen requirements subsequently decreased and she was discharged on a prednisone taper;mycophenolate with a goal dose of 1000 mg twice daily;and plan for continued rituximab infusions. At 2 months follow-up, the patient was doing well without the need for supplemental oxygen. Discussion: This case demonstrates a rare disease in a peripartum patient. A high suspicion for antisynthetase syndrome is required to initiate autoimmune testing, particularly since there can be ILD predominant phenotypes without significant evidence of a myositis. Treatment is not standardized but typically consists of corticosteroids and other immunosuppressive agents. In severe cases of antisynthetase syndrome that are refractory to initial corticosteroid therapy, therapeutic plasma exchange can be performed.

BILATERAL PLEURAL EFFUSIONS WITHOUT SIGNIFICANT ASCITES IN AN OVARIAN HYPERSTIMULATION PATIENT RECOVERED FROM COVID-19: A CASE REPORT

OBJECTIVE: To describe a patient who developed severe ovarian hyperstimulation syndrome (OHSS) with uncharacteristic features after recent COVID-19 infection. MATERIALS AND METHODS: A patient with prior mild COVID-19 developed an atypical case of OHSS with significant bilateral pleural effusions requiring bilateral thoracentesis and only minimal abdominal ascites. Isolated pleural effusions without significant ascites in not frequently found in patients with OHSS, with only one case with an effusion requiring a thoracentesis in 771 patients in a 1995 Canadian study. COVID-19 is known to cause inflammatory responses in the lung, however, pleural effusions are a rare symptom and usually only in those with severe disease. Long-standing damage from COVID-19, or ''post-COVID conditions'' is still under active investigation but can occur in patients even with mild disease. RESULTS: A 25yo G0 (BMI 27, AMH 9) without significant past medical or surgical history underwent IVF due to male factor infertility and polycystic ovarian syndrome (PCOS). She was diagnosed with COVID-19 5 weeks prior to stimulation and reported a mild course not requiring hospitalization. She underwent a long agonist protocol with a peak E2 of 6700 on day of HCG trigger (5000u) and had 42 oocytes retrieved. On POD #3, she presented with abdominal pain with distension and shortness of breath. A therapeutic paracentesis was performed with 500 ml drained and minimal improvement of symptoms. Due to significant response, she had a freeze all embryo cycle. On POD #5, she had worsening shortness of breath and underwent a CT pulmonary embolism (PE) protocol which did not demonstrate a PE but did show significant bilateral pleural effusions without abdominal ascites. She then underwent a bilateral thoracentesis with 800 ml drained from left lung and 1000 ml drained from right lung. She had significant improvement and returned to baseline after two days. CONCLUSIONS: OHSS is an uncommon side effect of gonadotropin stimulation, but this patient had multiple risk factors including age, PCOS diagnosis, AMH level, peak E2 level and number of oocytes retrieved. Ascites typically appears before pleural effusions. We postulate that the recent COVID-19 infection may have increased fluid accumulation preferentially to the lungs rather than the abdomen. IMPACT STATEMENT: With the ever increasing knowledge of post- COVID conditions, one must consider its potential long-term sequalae. Unexpected or atypical presentations may be due to COVID-19. The physiologic changes that occur with fertility treatment may be exacerbated by recent, even mild, COVID-19 illness.

Lipid Lowering Effects of Herbal Supplements: A Review

As cardiovascular diseases are still a major cause of death in most countries, it is still relevant to look into treatment of such diseases. Dyslipidemia is one of the important identified risk factors for cardiovascular diseases. As this is largely driven by lifestyle and diet, it may be difficult to control it with lifestyle modifications alone. Currently, Statins remains to be the mainstay therapy for dyslipidemia but this is also met by problems within certain patient population. The drug may be contraindicated in certain patient groups;some patients tend to not respond to Statins;while certain patients may not tolerate the adverse events. This study looked into available literature on studies done on dyslipidemia using plant-based formulations using randomized clinical trial. Based on the review conducted, there are several plant-based formations with potential to be similar in efficacy to Statins. Some of the plants used are abundant or may be easily sourced. With the increasing popularity of food supplements or nutraceuticals, exploration on the potential of plant-based products is attractive. Despite the promising results of some studies, these will need further investigations and targeting a larger population size. Formulation options may need to be explored also focused on its stability. © RJPT All right reserved.