Efficacy of Sildenafil in Patients with Severe COVID-19 and Pulmonary Arterial Hypertension.

Pulmonary arterial hypertension (PAH) is common in severe coronavirus disease 2019 (COVID-19) and worsens the prognosis. Sildenafil, a phosphodiesterase-5 inhibitor, is approved for PAH treatment but little is known about its efficacy in cases of severe COVID-19 with PAH. This study aimed to investigate the clinical efficacy of sildenafil in patients with severe COVID-19 and PAH. Intensive care unit (ICU) patients were randomly assigned to receive sildenafil or a placebo, with 75 participants in each group. Sildenafil was administered orally at 0.25 mg/kg t.i.d. for one week in a placebo-controlled, double-blind manner as an add-on therapy alongside the patient's routine treatment. The primary endpoint was one-week mortality, and the secondary endpoints were the one-week intubation rate and duration of ICU stay. The mortality rate was 4% vs. 13.3% (p = 0.078), the intubation rate was 8% and 18.7% (p = 0.09), and the length of ICU stay was 15 vs. 19 days (p < 0.001) for the sildenafil and placebo groups, respectively. If adjusted for PAH, sildenafil treatment significantly reduced mortality and intubation risks: OR = 0.21 (95% CI: 0.05-0.89) and OR = 0.26 (95% CI: 0.08-0.86), respectively. Sildenafil demonstrated some clinical efficacy in patients with severe COVID-19 and PAH and should be considered as an add-on therapy in these patients.

The Influence of the COVID-19 Pandemic on Women's Feelings during a Hospital Stay.

Introduction: The COVID-19 (coronavirus disease 2019) affected individuals and society and caused disruption, anxiety, stress, and loneliness. Being hospitalized during the pandemic increase a patient's negative feelings. This study aimed to evaluate the impact of the COVID-19 pandemic on patients' feelings (loneliness, depression, hope, self-efficacy) during a hospital stay. Materials and methods: This study included 207 women, aged from 15 to 83 years (55 ± 21.2) that were hospitalized during the pandemic in Bialystok, Lomza, and Biala Podlaska, Poland at internal medicine departments. The main reasons for hospitalization were cardiovascular diseases, abdominal pain, chronic obstructive pulmonary disease, pneumonia, diabetes, and unknown fever. Respondents were asked to complete the following questionnaires: Sense of Loneliness (the DJGLS), Depression Beck Inventory (BDI), Basic Hope (BHI-12), and Self-Efficacy (GSES). Results: Most of the studied group of women had an average sense of loneliness. A greater sense of loneliness was found among hospitalized women living in the countryside-the lowest sense of loneliness and depression was among women with higher education and the highest sense of effectiveness. One-third of respondents had a moderate degree of depression. Of the respondents, 39% had a relatively high level of basic hope. The assessment of self-efficacy demonstrated that 52% of the respondents showed a high sense of self-efficacy, an average sense of self-efficacy was shown by 35.5% of the respondents, and a low sense of self-efficacy was shown by 12.6% of the respondents. Conclusions: Numerous hospitalized women during the COVID-19 pandemic, despite experiencing moderate depression, had an average sense of loneliness and a high level of hope and self-efficacy.

Selected Aspects of the Mental Functioning of Women After Childbirth in a Hospital During a Pandemic.

Introduction: The COVID-19 pandemic is stressful for pregnant women, their families, and their unborn baby. Aim of the Study: The study aimed to assess the impact of a pandemic on the mental state of women after childbirth. Material and Methods: The study included 363 women hospitalized after delivery. The study used a diagnostic survey method using the proprietary questionnaire and the Family Affluence Scale (FAS), Edinburgh Postnatal Depression Scale (EPDS), Jong Gierveld Loneliness Scale (DJGLS), The Basic Hope Inventory (BHI-12), and General Self Efficacy Scale (GSES). Results: Suspicion of postpartum depression was found in 109 women (mean: 15.28 ± 2.22)-group I, and no suspicion of it in 254 subjects (mean: 6.03 ± 2.63)-group II. Mean values of the sense of loneliness in group I (27.11 ± 6.00) were higher than in group II (21.35 ± 7.02), and the basic hope-BHI-12, in group I-lower (27.92 ± 5.14) than in group II (31.75 ± 4.97). In the Generalized Own Efficacy Scale, the group I obtained lower mean values (28.07 ± 4.86 points and 5.87 ± 1.96 points) than group II (30.97 ± 3.77 points and 6.02 ± 1 points, 38 sten). Conclusions: As much as 30% of the respondents showed a risk of postpartum depression. The most felt was the limitation of family visits during the hospital stay. In addition, the respondents were most concerned about the child's health in both groups. The feeling of loneliness in group I was higher, and basic hope and generalized self-efficacy were lower than in group II. The differences between these relationships were statistically significant.

Comparison of the Effect of Unfractionated Heparin and Enoxaparin Sodium at Different Doses on the Course of COVID-19-Associated Coagulopathy.

BACKGROUND: COVID-19-associated coagulopathy (CAC) exacerbates the course of coronavirus infection and contributes to increased mortality. Current recommendations for CAC treatment include the use of low-molecular weight heparins (LMWH) at prophylactic or therapeutic doses, as well as the use of unfractionated heparin (UFH). METHODS: A randomised, controlled trial enrolled 126 patients hospitalised in the intensive care unit with severe COVID-19 complicated by CAC. The effects of LMWH at preventive and therapeutic doses and UFH at therapeutic doses on mortality and intubation rates were compared. RESULTS: The number of intubations and deaths showed no significant difference depending on the anticoagulant therapy used. However, multivariate logistic regression models revealed an increased risk of intubation (p = 0.026, odds ratio (OR) = 3.33, 95% confidence interval (CI) 1.15-9.59), and an increased risk of death (p = 0.046, OR = 3.01, 95% CI 1.02-8.90), for patients treated with LMWH at a prophylactic dose but not at a therapeutic dose as compared to patients treated with UFH when controlling for other risk factors. CONCLUSIONS: The use of unfractionated heparin in the treatment of COVID-19-associated coagulopathy seems to be more effective at reducing the risk of intubation and death than enoxaparin at prophylactic doses.

Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome.

BACKGROUND: Cytokine storm in COVID-19 is heterogenous. There are at least three subtypes: cytokine release syndrome (CRS), macrophage activation syndrome (MAS), and sepsis. METHODS: A retrospective study comprising 276 patients with SARS-CoV-2 pneumonia. All patients were tested for ferritin, interleukin-6, D-Dimer, fibrinogen, calcitonin, and C-reactive protein. According to the diagnostic criteria, three groups of patients with different subtypes of cytokine storm syndrome were identified: MAS, CRS or sepsis. In the MAS and CRS groups, treatment results were assessed depending on whether or not tocilizumab was used. RESULTS: MAS was diagnosed in 9.1% of the patients examined, CRS in 81.8%, and sepsis in 9.1%. Median serum ferritin in patients with MAS was significantly higher (5894 vs. 984 vs. 957 ng/mL, p < 0.001) than in those with CRS or sepsis. Hypofibrinogenemia and pancytopenia were also observed in MAS patients. In CRS patients, a higher mortality rate was observed among those who received tocilizumab, 21 vs. 10 patients (p = 0.043), RR = 2.1 (95% CI 1.0-4.3). In MAS patients, tocilizumab decreased the mortality, 13 vs. 6 patients (p = 0.013), RR = 0.50 (95% CI 0.25-0.99). CONCLUSIONS: Tocilizumab therapy in patients with COVID-19 and CRS was associated with increased mortality, while in MAS patients, it contributed to reduced mortality.