COVID-19 from a cardiovascular perspective / COVID-19 desde una perspectiva cardiovascular

Currently, myocardial injury has been reported in patients hospitalized with coronavirus disease 2019 (COVID-19). The studies also show a correlation between cardiac events and severe forms of the disease. COVID-19 begins with an early infection phase in which the virus infiltrates the lung parenchyma and proliferates. It then progresses to the pulmonary phase, where the initial inflammatory process, characterized by vasodilation, vascular permeability, and leukocyte recruitment, leads to lung damage, hypoxemia, and cardiovascular stress. The renin angiotensin aldosterone system is important in the pathophysiology of severe acute respiratory syndrome coronavirus 2 infection and in the propagation of systemic inflammation. Within this system, the pathway mediated by angiotensin-converting enzyme 2 (ACE2) produces vasodilation, cardioprotection, anti-oxidation, and anti-inflammation. Furthermore, the free form of ECA2 prevents binding of the virus to host cells and reduces its damage to the lung.

Actualmente, se ha reportado injuria miocárdica en pacientes hospitalizados por enfermedad por coronavirus 2019 (COVID-19). Los estudios, además, demuestran una correlación entre los eventos cardiacos y formas severas de la enfermedad. La COVID-19 comienza con una fase de infección temprana en la que el virus infiltra el parénquima pulmonar y prolifera. Luego progresa a la fase pulmonar, donde el proceso inflamatorio inicial, caracterizado por vasodilatación, permeabilidad vascular y reclutamiento de leucocitos, lleva a daño pulmonar, hipoxemia y estrés cardiovascular. El sistema renina angiotensina aldosterona es importante en la fisiopatología de la infección por el coronavirus 2 del síndrome respiratorio agudo grave y en la propagación de la inflamación sistémica. Dentro de este sistema, la vía mediada por la enzima convertidora de angiotensina 2 (ECA2) produce vasodilatación, cardioprotección, antioxidación y antiinflamación. Además, la forma libre de la ECA2 previene la unión del virus a las células huésped y reduce su daño al pulmón.

Tocilizumab in COVID-19: enthusiasm vs. evidence.

Based on the pathophysiological characterization of COVID-19, initial studies suggested the use of tocilizumab (TCZ), a recombinant humanized monoclonal antibody of the immunoglobulin G1 class, for management of the cytokine storm witnessed in severe cases. Thus, we decided to present a case series of 18 patients with severe COVID-19 treated with TCZ at our hospital. Our results coincide with the fact that the routine use of TCZ in severe COVID-19 is not robustly supported. We believe that the efficacy and safety of this drug and other related molecules should be validated in large randomized clinical trials.

Diabetes increases the risk of COVID-19 in an altitude dependent manner: An analysis of 1,280,806 Mexican patients.

AIMS: The objective of this study is to analyze how the impact of Diabetes Mellitus [DM] in patients with COVID-19 varies according to altitudinal gradient. METHODS: We obtained 1,280,806 records from adult patients with COVID-19 and DM to analyze the probability of COVID-19, development of COVID-19 pneumonia, hospitalization, intubation, admission to the Intensive Care Unit [ICU] and case-fatality rates [CFR]. Variables were controlled by age, sex and altitude of residence to calculate adjusted prevalence and prevalence ratios. RESULTS: Patients with DM had a 21.8% higher prevalence of COVID-19 and an additional 120.2% higher prevalence of COVID-19 pneumonia. The adjusted prevalence was also higher for these outcomes as well as for hospitalization, intubation and ICU admission. COVID-19 and pneumonia patients with DM had a 97.0% and 19.4% higher CFR, respectively. With increasing altitudes, the probability of being a confirmed COVID-19 case and the development of pneumonia decreased along CFR for patients with and without DM. However, COVID-19 patients with DM were more likely to require intubation when residing at high altitude. CONCLUSIONS: The study suggests that patients with DM have a higher probability of being a confirmed COVID-19 case and developing pneumonia. Higher altitude had a protective relationship against SARS-CoV-2 infection; however, it may be associated with more severe cases in patients with and without DM. High altitude decreases CFR for all COVID-19 patients. Our work also shows that women are less affected than men regardless of altitude.

Methylprednisolone pulse therapy: An alternative management of severe COVID-19.

We present two cases of severe COVID-19 that were rejected by medical institutions. The management of the disease was done at home with methylprednisolone (MP) pulse therapy for three days. This resulted in a favorable evolution and resolution of most symptoms. COVID-19 infection presents as asymptomatic disease, non-severe symptomatic disease, and severe respiratory inflammatory disease. The first two forms are dependent on viral response and a "cytokine storm" is responsible for the progression into severe disease. Glucocorticoids (GC) reduce inflammation by different mechanism depending of their concentration. Pulses lead to overall apoptosis of immune cells. Studies using pulse MP as treatment for SARS-CoV-1 showed clinical improvement and decreased incidence of ARDS compared with patients who received low dose steroid treatment. Inhibition of excessive inflammation through timely administration of GC in the early stage of inflammatory cytokine storm effectively prevents the occurrence of ARDS.