Postmortem Histopathologic Findings and SARS-CoV-2 Detection in Autopsy Kidneys of Patients With COVID-19: A Systematic Review and Meta-Analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to investigate the prevalence of postmortem kidney histopathologic features of patients with coronavirus disease 2019 (COVID-19) in addition to the rate of renal tropism in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We searched Web of Science, PubMed, Embase, and Scopus up to September 2022 to identify eligible studies. A random-effects model was used to estimate the pooled prevalence. Cochran Q test and Higgins I2 were used to assess evidence of heterogeneity. RESULTS: In total, 39 studies were included in the systematic review. The meta-analysis included 35 studies consisting of a total of 954 patients, with an average age of 67.1 years. The pooled prevalence of acute tubular injury (ATI)-related changes was the predominant finding (85% [95% confidence interval, 71%-95%]), followed by arteriosclerosis (80%), vascular congestion (66%), and glomerulosclerosis (40%). Endotheliitis (7%), fibrin microthrombi (12%), focal segmental glomerulosclerosis (1%), and calcium crystal deposits (1%) were seen in a smaller number of autopsies. The overall average rate of virus detection was 47.79% in the pooled data of 21 studies (272 samples). CONCLUSIONS: The main finding-ATI-correlated to clinical COVID-19-associated acute kidney injury. The presence of SARS-CoV-2 in kidney samples in addition to vascular lesions in kidneys can be linked to direct kidney invasion by the virus.

Low dose ultra-slow infusion thrombolytic therapy (LDUSITT) as an alternative option in a COVID-19 patient with free-floating right atrial thrombus: a case report and review of literature.

The hyper-coagulopathy nature of COVID-19 is a prevalent consequence among patients. Free-floating right atrial thrombi are a relatively rare finding and the optimal therapy is a therapeutic dilemma.We present a 37-year-old woman with acute dyspnea and fatigue. Several ground glass opacities were shown on computed tomography of chest that further proved to be associated with severe COVID-19 disease. A transthoracic echocardiography revealed a mobile right atrial mass with bilateral pulmonary embolism. She was considered high risk for surgical therapy by cardiovascular surgeons. She was then started on anticoagulation therapy for 5 days however the size regression of the thrombus remained unchanged. A regimen of low dose (24 mg) ultra-slow (24 h) intravenous infusion of alteplase, without bolus was initiated. Following the third day of thrombolytic therapy, the control echocardiography demonstrated complete resolution of the thrombus.Prolonged infusion of low dose fibrinolytics can be an alternative treatment to surgery for right heart thrombi.

The relationship between the severity of coronary artery disease in angiography and the incidence of short-term major cardiovascular events of patients with Covid-19 and myocardial infarction: a cross-sectional study in Iran (preprint)

Background Coronary artery disease (CAD) has been frequently recognized as a risk factor for poor prognosis in COVID-19 patients. Syntax score is an invasive coronary angiographic-based tool used to determine the severity of CAD. In this study, we aim to investigate the prognostic significance of syntax score for mortality and morbidity among COVID-19 patients.Methods In this cross-sectional study, we have included patients with confirmed COVID-19 diagnosis who underwent percutaneous coronary intervention (PCI). Based on angiographic records, the CAD complexity was measured by Syntax score, and echocardiographic variables were documented. The laboratory data were obtained from the HISS database of the hospital. All patients were followed up one month after discharge for new cardiovascular events, rehospitalization, heart failure (HF), stent thrombosis, cerebrovascular accidents, and death.Results In one month, 108 patients were included in the study. The mean age was 64.8 ± 11.6, and 74% were male. The Cox regression model found no association between the Syntax score and the composite outcomes. In the univariate cox proportional HR model, MPV, LDH, and ESR were found to have predictive significance for in-hospital death. AKI was resulted to be significantly associated with rehospitalization in multivariate analysis.Conclusion The present study did not find a significant association between adverse outcomes and syntax score in COVID-19 patients referred for PCI. Acute kidney injury and duration of ICU stay was found to be the main factor predicting rehospitalization and HF. Future studies are needed to confirm these findings.