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1.
Br J Gen Pract ; 2022 Aug 30.
Article in English | MEDLINE | ID: covidwho-2099922

ABSTRACT

BACKGROUND: Ambulatory blood-pressure monitoring (ABPM) has become less frequent in primary care since the COVID-19 pandemic, with home blood-pressure monitoring (HBPM) often the preferred alternative; however, HBPM cannot measure night-time blood pressure (BP), and patients whose night-time BP does not dip, or rises (reverse dipping), have poorer cardiovascular outcomes. AIM: To investigate the importance of measuring night-time BP when assessing individuals for hypertension. DESIGN AND SETTING: Retrospective cohort study of two patient populations - namely, hospital patients admitted to four UK acute hospitals located in Oxfordshire, and participants of the BP in different ethnic groups (BP-Eth) study, who were recruited from 28 UK general practices in the West Midlands. METHOD: Using BP data collected for the two cohorts, three systolic BP phenotypes (dipper, non-dipper, and reverse dipper) were studied. RESULTS: Among the hospital cohort, 48.9% ( n = 10 610/21 716) patients were 'reverse dippers', with an average day-night systolic BP difference of +8.0 mmHg. Among the community (BP-Eth) cohort, 10.8% ( n = 63/585) of patients were reverse dippers, with an average day-night systolic BP difference of +8.5 mmHg. Non-dipper and reverse-dipper phenotypes both had lower daytime systolic BP and higher night-time systolic BP than the dipper phenotype. Average daytime systolic BP was lowest in the reverse-dipping phenotype (this was 6.5 mmHg and 6.8 mmHg lower than for the dipper phenotype in the hospital and community cohorts, respectively), thereby placing them at risk of undiagnosed, or masked, hypertension. CONCLUSION: Not measuring night-time BP puts reverse-dippers (those with a BP rise at night-time) at risk of failure to identify hypertension. As a result of this study, it is recommended that GPs should offer ABPM to all patients aged ≥60 years as a minimum when assessing for hypertension.

2.
Environ Health Prev Med ; 27: 43, 2022.
Article in English | MEDLINE | ID: covidwho-2098633

ABSTRACT

Humans have enjoyed forest environments for ages because of the quiet atmosphere, beautiful scenery, mild climate, pleasant aromas, and fresh, clean air. In Japan, since 2004, serial studies have been conducted to investigate the effects of forest environments (Forest bathing/Shinrin-yoku) on human health. My research team has established a new medical science called Forest Medicine. The Forest Medicine is a new interdisciplinary science, belonging to the categories of alternative medicine, environmental medicine and preventive medicine, which studies the effects of forest environments (Forest bathing/Shinrin-yoku) on human health. It has been reported that Forest bathing/Shinrin-yoku has the following beneficial effects on human health:1 Shinrin-yoku increases human natural killer (NK) activity, the number of NK cells, and the intracellular levels of anti-cancer proteins, suggesting a preventive effect on cancers. 2 Shinrin-yoku reduces blood pressure and heart rate showing preventive effect on hypertension and heart diseases. 3 Shinrin-yoku reduces stress hormones, such as urinary adrenaline and noradrenaline and salivary/serum cortisol contributing to stress management. 4 Shinrin-yoku increases the activity of parasympathetic nerves and reduces the activity of sympathetic nerves to stabilize the balance of autonomic nervous system. 5 Shinrin-yoku improve sleep. 6 Shinrin-yoku increases the levels of serum adiponectin and dehydroepiandrosterone sulfate. 7 In the Profile of Mood States (POMS) test, Shinrin-yoku reduces the scores for anxiety, depression, anger, fatigue, and confusion, and increases the score for vigor, showing preventive effects on depression. 8 Shinrin-yoku may apply to rehabilitation medicine 9 Shinrin-yoku in city parks also has benefits on human health. 10 Shinrin-yoku may have preventive effect on COVID-19 by boosting immune function and by reducing mental stress.Taken together, these findings suggest that Shinrin-yoku may have potential preventive effects on non-communicable diseases.


Subject(s)
COVID-19 , Walking , Humans , COVID-19/prevention & control , Forests , Blood Pressure , Health Promotion
3.
Am J Hypertens ; 35(11): 948-954, 2022 Nov 02.
Article in English | MEDLINE | ID: covidwho-2097304

ABSTRACT

BACKGROUND: Although hypertension is a risk factor for severe Coronavirus Disease 2019 (COVID-19) illness, little is known about the effects of COVID-19 on blood pressure (BP). Central BP measures taken over a 24-hour period using ambulatory blood pressure monitoring (ABPM) adds prognostic value in assessing cardiovascular disease (CVD) risk compared with brachial BP measures from a single time point. We assessed CVD risk between adults with and without a history of COVID-19 via appraisal of 24-hour brachial and central hemodynamic load from ABPM. METHODS: Cross-sectional analysis was performed on 32 adults who tested positive for COVID-19 (29 ± 13 years, 22 females) and 43 controls (28 ± 12 years, 26 females). Measures of 24-hour hemodynamic load included brachial and central systolic and diastolic BP, pulse pressure, augmentation index (AIx), pulse wave velocity (PWV), nocturnal BP dipping, the ambulatory arterial stiffness index (AASI), and the blood pressure variability ratio (BPVR). RESULTS: Participants who tested positive for COVID-19 experienced 6 ± 4 COVID-19 symptoms, were studied 122 ± 123 days after testing positive, and had mild-to-moderate COVID-19 illness. The results from independent samples t-tests showed no significant differences in 24-hour, daytime, or nighttime measures of central or peripheral hemodynamic load across those with and without a history of COVID-19 (P > 0.05 for all). CONCLUSIONS: No differences in 24-hour brachial or central ABPM measures were detected between adults recovering from mild-to-moderate COVID-19 and controls without a history of COVID-19. Adults recovering from mild-to-moderate COVID-19 do not have increased 24-hour central hemodynamic load.


Subject(s)
COVID-19 , Hypertension , Vascular Stiffness , Adult , Female , Humans , Blood Pressure Monitoring, Ambulatory/methods , Pulse Wave Analysis/methods , Cross-Sectional Studies , Blood Pressure , Vascular Stiffness/physiology , Hemodynamics
4.
European Review for Medical and Pharmacological Sciences ; JOUR(15):5587-5595, 26.
Article in English | Web of Science | ID: covidwho-2081698

ABSTRACT

- OBJECTIVE: The Coronavirus dis-ease 2019 (COVID-19) infection is associated with autonomic dysfunction. Data on the long-term re-lationship between COVID-19 infection, heart rate recovery (HRR), and exaggerated blood pressure response to exercise (EBPR) are very limited. In our study, we aimed at investigating the long-term association between COVID-19, HRR, EBPR, metabolic, and echocardiographic parameters.PATIENTS AND METHODS: The study includ-ed 65 patients in the study group (33 female, median age 46) and 57 in the control group (30 female, 39 median age) between 1 April 2020 and 1 January 2021. Office blood pressure mea-surement, 24-hour ambulatory blood pressure monitoring, treadmill test, echocardiography, and metabolic parameters were evaluated.RESULTS: The frequency of blunted HRR (25 subjects, 38.5%, p < 0.001) and EBPR (7 subjects, 10.8%, p = 0.014) were significantly higher in study group. The study group had higher levels of white blood cell (p = 0.002), neutrophil, c -reac-tive protein, and uric acid (p < 0.001). Diameters of left atrium, aortic root, and ascending aorta were significantly higher in study group (p < 0.05). Age adjusted multiple logistic regression analysis showed that neutrophil levels (odds ra-tio (OR), 9.21;95% confidence interval (CI), 1.52-55.75, p = 0.016), glomerular filtration rate (OR, 1.34;95% CI, 1.13-1.59, p = 0.001), basal heart rate (OR, 1.58;95% CI, 1.17-2.12, p = 0.003), and mean heart rate (OR, 1.22;95% CI, 1.03-1.45, p = 0.0021) were independently associated with COVID-19 infection.CONCLUSIONS: The frequency of blunted HRR and EBPR, and uric acid levels were significant-ly higher in the study group compared to the control group, suggesting autonomic dysfunc-tion as the possible sequelae of the COVID-19 infection and increased risk of cardiovascular events in the future.

5.
National Journal of Physiology, Pharmacy and Pharmacology ; 12(10):1578-1582, 2022.
Article in English | ProQuest Central | ID: covidwho-2067051

ABSTRACT

[...]frequent blood glucose monitoring and change in anti-diabetic drugs may be necessary to achieve good glycemic control. [...]it is important for both diabetic and hypertensives to strictly adhere to their prescribed medications and follow general COVID preventive measures to avoid COVID-19 infections and related complications. Medications of few patients (18%) were changed due to various reasons such as variations in blood pressure and blood sugar, adverse effect older drugs and also due to non-availability of medications during lockdown. DISCUSSION The present study has shown that lockdown has significantly reduced medication adherence and compliance and there was lack of access for consultation, blood sugar, and blood pressure monitoring.

6.
Journal of Acute Disease ; 11(4):161-164, 2022.
Article in English | EMBASE | ID: covidwho-2066827

ABSTRACT

Rationale: The impact of COVID-19 in patients with autoimmune liver disease treated with immunosuppressive therapy has not been described so far. This case report describes the clinical course of a patient with autoimmune hepatitis (AIH) who developed COVID-19 and the features of cytokine syndrome leading to its deterioration in our intensive care unit. Patient's Concern: A 28-year-old male presented with generalized anasarca for two weeks and chronic liver disease for 8 months. Diagnosis: AIH and Covid-19 with features of cytokine storm syndrome. Interventions: Intravenous furosemide, mannitol, syrup lactulose, steroids (prednisolone 40 mg), azathioprine 1 mg/kg body weight, rifaximin, vitamin K, and blood products. Outcomes: The patient had hepatic encephalopathy and AIH and died on the 10th day after admission despite ventilatory support, sustained low-efficiency hemodialysis, and resuscition. Lessons: The dramatic release of cytokines and the inflammatory-immune responses not only alter the pathophysiology but also affects the onset and severity of disease progression in patients with AIH.

7.
Journal of Pure and Applied Microbiology ; 16(3):1622-1627, 2022.
Article in English | EMBASE | ID: covidwho-2067515

ABSTRACT

Methicillin-resistant Staphylococcus aureus (MRSA) infections are a primary health concern. They are commonly differentiated as hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, based on their epidemiology, susceptibility findings, and molecular typing patterns. Therefore, appropriate contact precautions and isolation measures should be implemented. CA-MRSA mostly causes skin and soft-tissue infections, but the probability and incidence of it causing sepsis and invasive infections have increased dramatically in recent years. In this study, we report a case of CA-MRSA pneumonia with pan-pneumonic effusion in a 59-year-old male diabetic patient with preexisting comorbidities such as diabetic ketoacidosis and non-ST elevated myocardial infarction. The early reporting of the organism's identity and its antimicrobial susceptibility, as well as timely initiation of antibiotic therapy, aided in the successful management and cure of the patient.

8.
NeuroQuantology ; 20(10):6860-6870, 2022.
Article in English | EMBASE | ID: covidwho-2067308

ABSTRACT

The year 2019 is a outbreak year during which the whole globe has suffered from Covid19 pandemic which has been spotted initially in China and later spread to the whole world;as a result of this viral disease, the whole world had shut down affecting billions of people but till today the Covid battle is on and people are suffering not only from this disease but also in terms of economy, starving being jobless etc. This paper briefs about Corona virus, its types, and structure;the replication and spreading of this virus, Covid19 detection methods, research on vaccination developed across the world to curb this virus;virus impact on various sectors, precautions to be taken to stay away from this virus and Ayurvedic remedy for it. The waves of corona had taken many lives on the globe & have its effect on life style of people. To curb this virus, prevention vaccination has to be found and we people must change in a way so that we could avoid future consequences for the upcoming generation. Keywords.

9.
Obstetric Medicine ; 15(1 Supplement):30-31, 2022.
Article in English | EMBASE | ID: covidwho-2064390

ABSTRACT

Background: Hypertensive disorders of pregnancy (HDP) not only affect pregnancy outcomes but have implications for women's ongoing health, including at least double the lifetime risk of cardiovascular disease and Type 2 diabetes. Blood pressure postpartum (BP2) is a currently recruiting, 3-arm randomised trial of follow-up and lifestyle behaviour change strategies in the first year after HDP (Optimised Usual Care with GP;Brief Education Intervention with physician/dietitian at Postpartum Clinic;Extended Lifestyle Intervention including 6 months Get Healthy Service telephone-based coaching). This qualitative sub-study within BP2 aimed to investigate the barriers and enablers to healthy behaviours after a pregnancy complicated by HDP. Method(s): Thirty-four women from all three arms of BP2 were interviewed March 2020 to April 2021, approximately 10 to 12 months postpartum (4-6 months after randomisation and intervention commencement). The semi-structured interviews were conducted by telephone, transcribed verbatim prior to thematic analysis, following the methods suggested by Braun and Clarke. Result(s): The interviews explored women's experiences following a HDP. Major themes included: * Impact of a young baby on healthy lifestyles (exhaustion, limited time, costs, other priorities). * Importance of support (partners, extended family, Get Healthy Service/ BP2 intervention). * Awareness of HDP-related risks (varied recognition of risk of future cardiovascular disease, BP2 intervention brought greater awareness). * Moving on (plans for return to work both negative and positive impacts, baby developing, future pregnancies, post-COVID world). Conclusion(s): Interviewees outlined varying views of their post-HDP world. Some women clearly embraced the future health implications and their ability to positively influence this through lifestyle, while others appeared overwhelmed by their current parenting demands. Perceptions varied with individual circumstances including support, previous experience of healthy practices, finances and access to the full intervention. Findings support potential utility of structured post-HDP follow-up, including psychosocial supports, and postpartum lifestyle intervention. However, future interventions should recognise that timing (and degree) of women's readiness to engage shows considerable variation.

10.
Hypertension. Conference: American Heart Association's Hypertension ; 79(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2064363

ABSTRACT

Background: Connected health technology can enable healthcare professionals to provide multiple solutions to meet the growing demand of care and control of COVID-19 infected patients, by optimizing economic resources and extending the scope of monitoring beyond the hospital. An innovative mobile device, the BioBeat Watch, developed in Israel, with an APP that can be downloaded directly to the Smart Phone, is characterized by sensors already validated according to the regulations of the Food and Drug Administration for vital signs, the ECG track and the European Society Hypertension for the detection of blood pressure. Purpose(s): Wearable medical devices and the BioBeat software platform are appropriate for use in different settings for the management of acute, chronic cardiovascular, respiratory and inflammatory pathology, a tool capable of early identification of the instrumental signs of deterioration even before the exclusively clinical recognition that becomes even more difficult if we consider the patients at home.The aim of this study is to test the sensitivity and specificity of the biobeat wearable system applied in patients with paucisymptomatic COVID-19 infection (group A) and in those with previous SARS-COV2 disease discharged from the hospital who still needed post-acute monitoring (group B) and compared with clinical control, managing to determine early the clinical signs of worsening. Method(s): The data recorded by individual patients are systolic and diastolic blood pressure, heart and respiratory rate, peripheral oxygen saturation and body temperature. The criteria of deterioration or worsening of the clinical condition are represented by the need to hospitalize the patient, alteration of one of the criteria grouped in the ABCDE. Result(s): We calculated the sensitivity of the methodology related to the alerts detected and the outcome of the patients. Sensitivity was 86.3% with a 95% CI of 0.71 to 1.03 and a specificity of 7.7%. Conclusion(s): Continuous monitoring with biobeat watch showed a high sensitivity in detecting early any alerts predictive of worsening of the disease.

11.
Hypertension. Conference: American Heart Association's Hypertension ; 79(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2064360

ABSTRACT

Introduction: Despite being an AHA Class 1 recommendation to achieve a blood pressure (BP) < 130/80 for secondary stroke prevention, only an estimated 20% of the general population can achieve this benchmark. Furthermore, it has been suggested that stroke patients may be at higher risk for an inability to achieve this goal. We aimed to examine real world clinic data to evaluate BP control among stroke patients. Method(s): We conducted a population-based retrospective study using electronic health records collected during routine care at our institution for all adult patients 18 years or older with a diagnosis for stroke between January 2019 to November 2021. BP measurements were taken in an outpatient setting between 90 and 180 days from the index stroke. Descriptive statistics using R (R Core Team, 2022, r-project.org) were reported as the mean and standard deviation for continuous variables and frequencies and proportions for categorical variables. Result(s): Our review identified a total of 1,583 patients with a new diagnosis of acute ischemic stroke (AIS: 1,252;79.1%) or intracerebral hemorrhage (ICH: 331;20.9%). AIS patients were 45.7% female with a mean age of 68 years old, compared to 47.7% female and 59 years old for ICH patients. AIS patients had a higher proportion of secondary medical issues, including 34.7% with diabetes, 33.0% congestive heart failure, 19.2% cardiac disease, and 33.9% renal disease (compared to 22.2%, 16.1%, 8.8%, 19.2% respectively for ICH patients). In follow-up, only 11.7% of AIS patients were at goal (defined as a BP < 130/80) at 3 months, 17.3% at 6 months, 11.6% at 9 months, and 8.9% at 12 month follow-up. Conversely, ICH patients were slightly better controlled with 21.6%, 32.8%, 15.8%, and 12.2% controlled at 3, 6, 9, and 12 month follow-up respectively. Patients with stroke after March 2020 (post-COVID19 pandemic) had lower rates of blood pressure control compared to those diagnosed one year prior to the pandemic. Conclusion(s): Patients with AIS have lower rates of BP control compared to the general population, which was further amplified by the COVID19 pandemic. These results may suggest that stroke patients face unique barriers in BP management and highlight the need to perform targeted treatment for this especially vulnerable group.

12.
Hypertension. Conference: American Heart Association's Hypertension ; 79(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2064359

ABSTRACT

About 1 out of 10 patients infected with Sars-CoV2 have persistent symptoms beyond 4 weeks and some of them meet diagnostic criteria for postural tachycardia syndrome (Long-COVID POTS). The pathophysiology of Long-COVID POTS is unknown, but autonomic dysfunction may play a role. We hypothesize Long-COVID POTS patients have impaired cardiovascular autonomic reflexes and cardiac sympathovagal balance. We conducted a case-control study with patients recruited from the Vanderbilt Autonomic Dysfunction Center and an historical population of healthy controls. Hemodynamic parameters were measured before and during 75degree head up tilt. Supine ECG and finger blood pressure were continuously measured for spontaneous heart rate variability analysis. The Low Frequency (0.04-0.15Hz, LF ) and High Frequency (0.15-0.4 Hz, HF ) oscillatory modulations of sino-atrial node discharge were computed. We included 14 Long-COVID POTS patients and 15 controls matched by age (34+/-11 vs 28+/-7;p=0.09) and BMI (26.1+/-5.3 vs 23.0+/-2.6;p=0.06). As expected, the orthostatic HR increase was higher in Long-COVID POTS compared to controls (40+/-18 vs 21+/-1, p<0.05). Spectral analysis of heart rate variability in 9 patients and 15 controls (Figure) showed that Long-COVID POTS had reduced HF (363+/-420 vs 933+/-1000 ms ;p<0.05) and similar LF (798+/-596 //////////vs 962+/-1075 ms ;p=0.68), resulting in a greater LF/HF ratio (3.7+/-2.9 vs 1.4+/-1.3;p<0.05). Patients with Long-COVID POTS have reduced markers of cardiovagal modulation, but normal cardiac sympathetic activation. Our results suggest that parasympathetic dysfunction contributes to the pathophysiology of Long-COVID POTS.

13.
Hypertension. Conference: American Heart Association's Hypertension ; 79(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2064358

ABSTRACT

Preeclampsia (PE), new onset hypertension (HTN) during pregnancy, is associated with placental ischemia and chronic inflammation that includes increased CD4+ T cells, B cells secreting agonistic autoantibodies against the angiotensin II type 1 receptor (AT1AA), and activation of the complement system. Previous studies have shown AT1-AA is produced in patients with COVID-19 infection. Interestingly, having had COVID-19 during pregnancy is associated with increased incidence of developing a PE phenotype during pregnancy. We have previously shown an important role for B cell depletion or AT1AA inhibition to attenuate HTN in rat models of PE. Collectively, this data suggests B cells contribute to PE development and that B cells may increase incidence of PE in patients with a history (Hx) of COVID-19 during pregnancy through production of the AT1AA. We hypothesize B cells from PE or CV Hx PE patients produce AT1AA resulting in HTN and complement activation in pregnancy. Placental B cells were isolated from normal pregnant (NP), PE, normotensive (NT) CV Hx, or PE CV Hx patients at delivery. B cells were transferred i.p. into pregnant athymic rats at gestation (GD) 12. On GD18, carotid catheters were inserted. On GD19, blood pressure was measured and tissues collected. PE B cell recipients had increased Mean Arterial Pressure (MAP) (115+/-3 mmHg n=6) compared to NP B cell recipients (97+/-4 mmHg n=6 p<0.05). PE B cell recipients had increased AT1AA (20+/-2 DELTABPM n=4) compared to NP B cell recipients (6+/-1 DELTABPM n=4 p<0.05). PE B cell recipients had increased markers of complement activation such as reduced plasma C4 (1302+/-169 mug/mL n=4) and C3 (516+/-45 mug/mL n=4) compared to recipients of NP B cells (2348+/-338 mug/mL n=4 p<0.05) and (790+/-66 mug/mL n=4 p<0.05) respectively. CV Hx PE B cell recipients had elevated MAP (108+/-3 mmHg n=4) compared to CV Hx NT B cell recipients (101+/-7 mmHg n=4) and increased AT1AA (24+/-3 DELTABPM n=3) compared to CV Hx NT B cell Recipients (4+/-1 DELTABPM n=4 p<0.05). Collectively, this study demonstrates an important role for B cells to cause HTN during pregnancy;and indicates that B cells contribute to a higher incidence of PE in women with a Hx of CV infection during pregnancy possibly by secreting AT1-AA.

14.
Gut ; 71(Suppl 3):A13-A14, 2022.
Article in English | ProQuest Central | ID: covidwho-2064219

ABSTRACT

OP06 Table 1Demographics of patients Valid (n=) Missing (n=) Mean Std. Deviation Minimum Maximum Age (years) 134 0 55.522 15.111 17 87 Metabolic risk factors BMI in kg/m2 129 5 34.875 7.168 21.5 59.3 HbA1c (mmol/mol) 118 16 47.398 14.793 27 94 Total cholesterol (mmol/L) 119 15 4.646 1.195 1.9 7.4 Triglyceride level (mmol/L) 104 30 2.117 1.211 0.6 7.1 Blood tests AST U/L 116 18 48.621 36.672 14 318 ALT U/L 134 0 61.515 49.304 8 367 Bilirubin umol/L 134 0 11.261 9.398 3 59 Albumin g/L 133 1 44.12 4.624 21 53 Platelet count (x10*9/L) 134 0 229.343 83.631 23 509 INR 98 36 1.052 0.22 0.9 2.5 Fibrosis assessment Enhanced liver fibrosis (ELF) 16 118 9.671 0.754 8.31 11.06 Elastography (kPa) 79 55 10.944 7.049 2.5 39 CAP score 78 56 315.808 59.388 104 400 ConclusionOur study showed that patients with underlying metabolic risk factors were treated in 80% of cases. TE is not performed in all patients due to social isolation limitation imposed by covid-19 infection. In those who had TE;the index diagnosis of cirrhosis was seen in around 20% at the time of TE.

15.
American Journal of Transplantation ; 22(Supplement 3):776, 2022.
Article in English | EMBASE | ID: covidwho-2063545

ABSTRACT

Purpose: COVID-19 infection in kidney transplant (KT) recipients is characterized by an unpredictable course and can be life-threatening. Prompt adjustment of immunosuppression and hospitalization when decompensated are potential strategies to increase survival. Our objective is to determine if advanced practice nurse (APN)-driven COVID-19 monitoring would result in better health outcomes for KT recipients. Method(s): We performed a retrospective study on KT patients diagnosed with COVID-19 between 4/1/2020 and 11/30/2021. The patients were stratified into two groups: (1) a control group who initially presented to the emergency department (ED) with COVID-19 symptoms, (2) an intervention group where patients were diagnosed with COVID-19 outside of the ED and followed by the APN team. The APNs monitored this group daily via telephone and/or video call for symptom assessment, immunosuppression adjustment, health counseling, and emotional support. If the patients were distressed, the APNs arranged admission to the nearest hospital or transplant center. Data were analyzed using Pearson Chi-squared for comparisons and linear or logistic regression modeling with adjustment for age, ethnicity, diabetes, and obesity Results: In our cohort, there were 102 KT patients that were infected with the SARS-CoV-2 virus. The majority were Hispanic ethnicity and male gender who presented with fever and flu like symptoms. Fourty-four patients required oxygen therapy. Immunosuppression was adjusted earlier in the intervention group . When the APNs recommended hospitalization, those patients experienced less acute kidney injury (AKI), shorter duration of illness, lower readmission rates, and greater survival than the control group. Conclusion(s): In this single transplant center study, KT recipients diagnosed with COVID-19 had better clinical outcomes when intervention occurred in a timely manner by the APN team. Possible explanations include earlier withdrawal of antimetabolites, prompt triage for hospitalization, and enforcing of nursing practices (dietary educations, blood pressure/glucose management, emotional support). Interpretation and generalization of these findings should be cautious due to a small sample size. As more treatment options for COVID-19 emerge, earlier interventions and close monitoring as demonstrated in our APN-driven model has the potential to achieve better health outcomes.

16.
Journal of Cardiopulmonary Rehabilitation and Prevention ; 42(4):E51, 2022.
Article in English | EMBASE | ID: covidwho-2063030

ABSTRACT

Background: Cardiac Rehabilitation (CR) is a supervised exercise and risk factor modification program for patients with cardiac conditions. Endothelial dysfunction is often present and is associated with worsening cardiac prognosis, and several studies have indicated that standard onsite CR has improved endothelial function in heart disease patients. However, during the COVID-19 pandemic, many CR programs transitioned to a virtual or hybrid model of care to increase safety of CR programs. Objective(s): The objective of this study was to determine vascular function of patients with coronary artery disease (CAD) measured before and after 4 months of outpatient CR using a virtual model of care. Method(s): Virtual CR included 1 virtual group session/week by videoconferencing and hybrid CR included 1 session/week (4 on-site and 12 virtual group sessions) for a total of 16 weeks. CAD patients (6 females, 4 males) mean age 68.1+/-7.5 years rested in a supine position to measure 1) brachial artery flow-mediated dilation (FMD), 2) microvascular function, and 3) augmentation index (AI) using ultrasound sonography (n=8) and an EndoPAT 2000 (n=9). Two patients completed virtual CR and the rest underwent hybrid CR. These measurements were obtained concurrently using an ultrasound transducer at the brachial artery proximal to a blood pressure cuff on the forearm with EndoPAT cuffs on the index fingers during 5-minute intervals of baseline, occlusion, and recovery. FMD results were analyzed using automated Cardiovascular Suite software. AI and Reactive Hyperemia Index (LnRHI) were determined using automatic analysis via the EndoPAT 2000. Anthropometrics, blood pressure, and food intake were recorded at each visit. Patients were advised to refrain from strenuous exercise, alcohol, caffeine, and highly saturated foods at least 12 hours prior to the study appointment. One tailed paired t-tests were conducted between baseline and completion. Result(s): Adherence to CR averaged 10.3+/-3.2 out of 16 sessions. FMD improved from (2.75+/-1.71% to 5.63+/-4.37%, p=0.048) while there was no improvement in AI (14.2+/-18.8 to 13.2+/-19.6, p=0.45) or LnRHI (0.56+/-0.12 to 0.52+/-0.20, p=0.24). Conclusion(s): While there was no improvement in LnRHI or AI after CR, FMD improved in CAD patients after 4 months of adapted CR. Our results indicate that while virtual and hybrid models of CR may not be sufficient for improving microvascular function and aortic stiffness in CAD, there is an improvement of endothelial function. Future studies should examine the effects of adherence, duration and exercise intensity within these alternative models of CR on aortic and microvascular improvements.

17.
Clinical Toxicology ; 60(Supplement 2):2, 2022.
Article in English | EMBASE | ID: covidwho-2062731

ABSTRACT

Background: Drug shortages represent a longstanding challenge for healthcare providers, including toxicologists, who continue to confront scarcities of antidotes and other agents used to treat poisonings. Prior research examining availability of drugs with toxicologic applications from 2001 to 2013 demonstrated broad shortages including anticholinergic, cholinergic, and cyanide antidotes, anti-hypoglycemics, chelators, antivenom, naloxone, sedative- hypnotics, and decontamination products, many of which were unresolved and involved xenobiotics without therapeutic alternative. Reports of vital agents being scarce or unobtainable have continued since 2013, and new pressures on global and US (United States) supply chains have emerged, most notably the COVID-19 pandemic. Given this, up-to-date analysis of shortages of agents used to treat poisonings is needed. Method(s): US drug shortage data from January 2012 to December 2021 were obtained from the University of Utah Drug Information Service. Shortage data for agents used to treat poisonings were analyzed. Information on drug type, formulation, shortage reason, shortage duration, number of manufacturing sources, substitute availability, and substitute agent shortage during the study period were investigated. Result(s): 1570 drug shortages were reported during the study period;230 (14.6%) involved agents used to treat poisonings. Of the 230 shortages, 21.3% were unresolved as of December 2021. Mean shortage duration was 13.6 months. The longest shortage involved intravenous calcium gluconate and lasted 78 months. Intravenous dextrose products were the agent most frequently affected by shortage, with 20 shortages in total. 58 agents had multiple shortages. Total shortages peaked in 2017 with 33 shortages reported. 20 shortages were reported in 2020 and 24 in 2021 during the COVID-19 pandemic. 10.9% of shortages involved single-source products;however, this number is limited by incomplete reporting. 80.9% of shortages involved parenteral products. Agent classes with the most shortages reported were: Sedative-hypnotics (12.2% of shortages), anti-hypoglycemics (9.6%), anticoagulant reversal (7.8%), vitamins/electrolytes (7.4%), blood pressure support (7%), antihypertensives (6.5%), antimuscarinic delirium (4.8%), and chelators (4.3%). Three naloxone shortages were reported, one of which is ongoing due to increased demand. Buprenorphine and methadone shortages were reported but are resolved as of December 2021. New shortages of multiple pressors and flumazenil were reported. The most common reason for shortage was a manufacturing issue, occurring in 36.1% of shortages. Shortage reason was not reported 37.8% of the time. For 77% of shortages an alternative therapeutic agent was available, however 97% of alternatives were also affected by shortage at some point during the study period. Conclusion(s): Shortages of agents used to treat poisonings remain problematic. For the time period 2011-2021 previously reported shortages of many products persist and new shortages have emerged. The ongoing naloxone shortage is particularly concerning given the continued rise in drug overdose deaths in the US in 2021, as are shortages of buprenorphine and methadone used to treat opioid use disorder. Despite supply chain stressors, total shortages did not peak during the COVID-19 pandemic.

18.
Clinical Toxicology ; 60(Supplement 2):32, 2022.
Article in English | EMBASE | ID: covidwho-2062722

ABSTRACT

Background: Azathioprine is a purine analog metabolized to 6- mercaptopurine (6-MP) utilizing glutathione. Its high oral bioavailability and longer duration of action make it viable as a treatment for ulcerative colitis or as an anti-rejection medication for renal transplant patients. Specific experience in overdose with this agent is limited although toxicity mimics 6-MP including hepatotoxicity, delayed leukopenia, and acute interstitial nephritis. Case report: A 46 year old female (64 kg) with a history of ulcerative colitis, migraines, and anxiety presented with a selfreported intentional ingestion of 1000mg azathioprine and presented to care approximately 8 h post-ingestion. Her compliance with azathioprine preceding the ingestion was unclear. She reported taking her other medications as prescribed (tadalafil, sulfasalazine, fioricet, alprazolam) the day prior to presentation. Other than one episode of emesis without pill fragments, myalgias, headache she had no other symptoms. Her presenting vital signs were HR 84, RR 22, BP 90/63, T 36.2 degreeC. Initial labs included a normal chemistry profile, undetectable serum acetaminophen and salicylates, an ethanol level of 50 mg/dL and venous lactate of 1.6mmol/L. She received a total of 3 L of crystalloid IV fluids with improvement in blood pressure to 125/66 and was transferred for higher level of care. Due to the delay in presentation and well appearance, activated charcoal and hemodialysis were considered but deferred. While inpatient she had laboratory evaluation including CBC and differential every 8 h. In the ED she developed a fever, 38.1 degreeC. PCR testing for COVID-19 was negative. Whole blood thiopurine metabolites (Prometheus Biosciences, Test 3200) were sent approximately 33 h from time of ingestion. 6-thioguanine levels were 108 pmol/8x10degree8 RBC, below the therapeutic reference range (230-400 pmol/8x10degree8 RBC). 6-methylmercaptopurine metabolites were below the lower limit of quantification (761pmol/8x10degree8 RBC). Genetic testing for thiopurine S-methyltransferase was declined by the patient. She was hospitalized for 4 days and did not develop any substantial vital sign abnormalities or creatinine elevation. Her absolute neutrophil count dropped to 500/mm3 approximately 76 h post-ingestion, but started to improve 84 h post-ingestion and granulocyte-macrophage colony-stimulating factor was deferred. Her peak AST was 113 IU/L, approximately 46 h post-ingestion and returned to normal (16 IU/L) upon follow-up 7 days postingestion. White blood cell count 7 days post-ingestion was 4.3 K/mm3. Discussion(s): Azathioprine overdose is rarely reported in the literature. Case reports describe delayed leukopenia and hepatotoxicity from repeat supratherapeutic ingestions, however, based upon limited experience serious toxicity from single acute ingestions appears rare. A report of a single acute ingestion of 7500mg of azathioprine resulted in moderate leukopenia (4.1 K/ mm3) 3 days post-ingestion. Peak immunosuppressive effects can take up to 2 weeks from initiation or change in dose. Symptoms in this case are consistent with effects from azathioprine including vomiting, transient hypotension, and myalgias. Conclusion(s): Intentional ingestions of azathioprine are infrequently reported and can result in serious delayed myelosuppression. We report a case of a single acute ingestion of >15 mg/kg resulting in delayed myelosuppression managed conservatively.

19.
Cardiology in the Young ; 32(Supplement 2):S241, 2022.
Article in English | EMBASE | ID: covidwho-2062124

ABSTRACT

Background and Aim: MIS-C is a hyperinflammatory syndrome caused by Sars-CoV-2 virus. Cardiovascular system impairment is observed up to 100 % of all MIS-C patients with a wide spectrum and severity of symptoms. It is important to identify the course of the disease and its outcome, which could significantly improve public health. Method(s): A single-centre study, prospective cohort study, con-ducted in the Children's Clinical University hospital in Latvia from January to December 2021. Patients between the ages of one to seventeen years who met the MIS-C criteria were included in the study. We evaluated blood pressure, left ventricular heart func-tion, size of coronary arteries and hospital course. Result(s): Thirty-one patients were included who met the MIS-C criteria. The median age was 8.0 years, 52% were boys. Of all patients 77% initially presented with hypotension of whom 42% required inotropic support. Treatment in PICU was required in 58% of all patients. Reduced left ventricular ejection fraction was observed in 35% of all patients. Mildly decreased ventricular ejection fraction (lt;55%) was observed in 19% of cases but mod-erate dysfunction (ejection fraction lt;45%) was observed in 16% of patients. Twelve percent of patients received milrinone to improve left heart function. Left heart function significantly improved in all patients during the hospitalisation. In 6 % of all patients coronary artery dilations was observed. All patients had dilations resolution at the time of discharge. Median length of hospitalisation was twelve days and median length of PICU stay was three days. Conclusion(s): All patients cardiovascular symptoms had resolved at the time of discharge. Whether patients will have chronic cardiac impairment is unknown therefore it is crucial to perform long-term follow-up.

20.
Cardiology in the Young ; 32(Supplement 2):S107-S108, 2022.
Article in English | EMBASE | ID: covidwho-2062098

ABSTRACT

Background and Aim: The Coronavirus disease 2019/COVID-19/exerts an unprecedented global impact on public health and health care delivery. The aim of this study was to evaluate the knowledge on SARS-CoV-2, epidemiology, clinical presentation including cardiovascular and immunological status in postCovid children. Method(s): A group of 70 children/previously healthy or with no pre-existing heart disease/from Sarajevo with positive postcovid history, formed this study. Patients were evaluated at the Polyclinic Eurofarm in Sarajevo, from October 2020 till April 2021. Following history and epidemiological data, a detailed cardio-vascular examination has been performed including oxygen satu-ration, pulse, blood pressure, electrocardiogram/ECG/, values of polymerase chain reaction (PCR), serological tests for corona, lab-oratory blood tests and echocardiography. Result(s): The group consisted of 70 children/40 boys/: infants: 10, 1-5 years: 20;6-10:12;11-15:21;16-18 years: 7;forming five groups. Symptoms differ depending on age group, younger chil-dren had no or mild symptoms in comparison to the older group of children. The values of immunoglobulin G were significantly higher in the older group of children with (p lt;0.05;p = 0.043) indicating that the immune system with age is more responsive to the virus. PCR test was negative in 9/70 children. The majority of children/64.3 %/were asymptomatic. Two boys aged 14 years, had palpitation on exertion, shortness of breath, ECG changes, lower oxygen saturation/91% and 94%/, elevated creatinine phosphokinase miofibrilae/CPKMB/: 38 and 45, in one patient the diameter of left coronary artery/LCA/was enlarged up do 3.8mm, no aneurysm, no skin changes, with normal ejection frac-tion of left ventricle. They were on short period/10-15days/of treatment with nonsteroids including low doses of Aspirin, vita-mins/C and D/, rest and no sport activities. After treatment and a regime of no activities, they were fully recovered, free of symptoms, with normal oxygen saturation, normal values of CPKMB, diameter of LCA was within a normal range according to age and body weight of the patient. Conclusion(s): Practitioners should consider the possibility of COVID-19 in children with atypical symptomatology and posi-tive or suspicious epidemiological survey, paying special attention to coronary and immunological status.

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