The main causes of death in patients with COVID-19.

By March 21, 2022, 6.1 million deaths from COVID-19 were reported, most of them in the United States, Brazil, and India. Between January 1, 2020, and December 31, 2021, the global estimated mortality due to the COVID-19 pandemic was 120.3 deaths (113.1-129.3) per 100,000 of the population for all ages. So far, many of the potentially fatal mechanisms of COVID-19 have been reported. In this manuscript, we analyzed the available data on the causes of deaths from COVID-19. This analysis suggests that the primary attributable cause of death from COVID-19 is multiple organ failure resulting from numerous pathological mechanisms, including genetic predisposition to the severe inflammatory response. Increased inflammatory response affects the lungs locally as well as systemic thrombotic microangiopathy. It seems that many comorbidities associated with an increased mortality rate among patients with COVID-19 per se predispose them to an increased risk of thrombotic changes. Furthermore, the role of inflammation in the lungs and the changes that lead to hypoxia cannot be overlooked. However, the thrombotic changes in microcirculation seem to be the most dominant.

The endocrine system function disturbances during and after SARS-CoV-2 infection.

Several receptors for the angiotensin-converting enzyme 2 (ACE2), essential for the penetration of SARS-CoV-2 into cells, are located in the tissues of the endocrine glands. Therefore, it has been suggested that SARS-CoV-2 infection results in the development of hormonal disturbances. To date, several cases of endocrine disturbances related to the dysfunction of all endocrine glands during and after SARS-CoV-2 infection have been described. In this review, we discuss the endocrine system disturbances in patients with COVID-19 and post-COVID-19 syndrome. Based on the case reports described in the literature, patients with COVID-19 may develop endocrine disturbances that are immediately life-threatening. In addition, patients with post-COVID-19 syndrome may develop chronic endocrine disturbances. In summary, the diagnostics of endocrine system disturbances based on clinical symptoms should be taken into account in both patients with COVID-19 and post-COVID-19 syndrome.

COVID-19 and obesity: the confrontation of two pandemics.

In 2009, obesity was identified for the first time as a risk factor for increased disease severity and mortality in patients infected with the H1N1 influenza A virus. During the current COVID-19 pandemic, overweight and obesity have been described as independent risk factors of disease severity and mortality due to COVID-19. Excess visceral fat is associated with systemic chronic microinflammation, changes in adipokine release, and oxidative stress. These disturbances result in an impaired immune response, including dysfunction in lymphocyte action and antibody production. Moreover, obesity is a cause of endothelial dysfunction, pro-coagulation state, and enhanced expression of angiotensin-converting enzyme 2 (ACE-2), which contributes to the infection itself and the severity of the disease. We analyzed both the impact of obesity on the severity of COVID-19 and the potential mechanism that influences this severity. Moreover, we discuss the effect of obesity complications on the severity of disease and mortality of patients with COVID-19. Furthermore, we summarize the effectiveness of COVID-19 vaccination in patients with obesity. Finally, we analyzed the effect of the COVID-19 pandemic on mood disturbances and emotional eating and, as a consequence, the development of obesity or an increase in its severity. In summary, the studies conducted during the COVID-19 pandemic indicate that effective obesity treatment should be initiated at once. In addition, the data confirm the need to organize efficient obesity treatment systems for the sake of not only the individual but also society.

Components of metabolic syndrome in relation to plasma levels of retinol binding protein 4 (RBP4) in a cohort of people aged 65 years and older.

PURPOSE: Elevated plasma concentration of retinol binding protein 4 (RBP4) has recently emerged as a potential risk factor as a component of developing metabolic syndrome (MS). Therefore, this study aimed to analyse the relationship between components of MS and concentrations of plasma RBP4 in a population of subjects 65 years and older. METHODS: The study sample consisted of 3038 (1591 male) participants of the PolSenior study, aged 65 years and older. Serum lipid profile, concentrations of RBP4, glucose, insulin, C-reactive protein, IL-6, and activity of aminotransferases were measured. Nutritional status (BMI/waist circumference) and treatment with statins and fibrates were evaluated. Glomerular filtration rate (eGFR), de Ritis ratio, and fatty liver index (FLI), as well as HOMA-IR were calculated. RESULTS: Our study revealed a strong relationship between components of MS and RBP4 in both sexes: plasma RBP4 levels were increased in men by at least 3×, and in women by at least 4×. Hypertriglyceridemia was most strongly associated with elevated plasma RBP4 levels. Multivariate, sex-adjusted regression analysis demonstrated that chronic kidney disease [OR 1.86 (95% CI 1.78-1.94)], hypertriglyceridemia [OR 1.52 (1.24-1.87)], hypertension [OR 1.15 (1.12-1.19)], low serum HDL cholesterol [OR 0.94 (0.92-0.97)], and age > 80 years [OR 0.86 (0.81-0.90)] were each independently associated with RBP4 concentration (all p < 0.001). CONCLUSIONS: In Caucasians 65 years and older, RBP4 serum levels are associated with a number of components of MS, independent of sex and kidney function. Hypertriglyceridemia as a component of MS is most significantly related to RBP4 concentration.

Neurological symptoms associated with cerebral hyperperfusion syndrome after CEA and CAS--one centre study.

BACKGROUND: There are two equivalent in efficacy methods of the treatment of carotid artery stenosis: endarterectomy (CEA) and stenting (CAS), in which the blood flow increases in most patients by 20-40% over baseline, in some exceeding 100% and being symptomatic and leading to cerebral hyperperfusion syndrome (CHS). AIM: The aim of this study is to analyze the structure of neurological symptoms associated with CHS in patients with carotid artery revascularization. PATIENTS AND METHODS: Retrospective analysis included 1386 consecutive patients treated in the Department of General and Vascular Surgery between 2005 and 2011, with 625 of them were subjected to CEA and 761 to CAS. If neurological symptoms occurred, patients were consulted by a neurologist and ultrasonography (USG) examination and CT were performed. Neurological symptoms in patients with new onset of headache ipsilateral to the carotid revascularization were extracted from medical records and nursing documentation. RESULTS: Neurological symptoms attributed to CHS were observed in 66 (10.6%) of CEA and 61 (8.0 %) of CAS group. The frequency was similar in both groups (p = 0.43). The occurrence of epileptic attacks was similar in both study groups. The only difference was the less frequent falling of the lip in CAS group. Transient bradycardia and/or hypotension were observed in CAS (8.8% vs. 10.4% and 1.3% vs. 1.3%, respectively). No difference in stroke appearance between groups were found. CONCLUSIONS: The occurrence of neurological symptoms attributable to cerebral hyperperfusion syndrome after carotid artery revascularization in short term observation is similar regardless of the method used.

Resting energy expenditure and gut microbiota in obese and normal weight subjects.

OBJECTIVES: It is suggested that gut microbiota play a role in the pathogenesis of obesity enhancing energy utilization from digested food. The influence of gut microbiota on resting energy expenditure (REE) has not been evaluated yet. AIM: The aim of the study is to assess the composition on gut microbiota and its association with REE in obese and normal weight subjects. SUBJECTS AND METHODS: REE measurement and semi-quantitative analysis of gut microbiota composition in aerobic and anaerobic conditions were performed in 50 obese and 30 normal weight subjects without concomitant diseases. RESULTS: A count of bacterial colony was greater in obese than in normal weight subjects. However, the proportion of Bacteroides spp. and Firmicutes was similar in both study groups. A positive correlation between REE (kcal/d) and total bacterial count (r = 0.26, p < 0.05), as well as between REE and the percentage of Firmicutes (r = -0.24, p < 0.05) was found. The multiple regression analysis did not prove an independent impact of total bacterial as well as Bacteroides spp. and Firmicutes counts on REE. CONCLUSIONS: The composition of gut microbiota is not associated with the level of resting energy expenditure. The proportion of Bacteroides and Firmicutes in gut microbiota is not related to body mass.

The influence of Body Mass Index on chronic venous disorders therapy.

AIM: Obesity is of importance among the risk factors predisposing for chronic venous disorders (CVD). Little is known how obesity affects the management of CVD. As the data concerning the treatments of CVD in the obese are incomplete, we performed an analysis of the different CVD therapies managements with respect to body mass index and the obesity. METHODS: We analyzed 9797 CVD patients from of a previous large national CVD survey, in regard to their Body Mass Index (BMI), CVD class and CVD therapies. Among them 2213 patients presented class I, 516 class II or morbid obesity. RESULTS: BMI was significantly associated with the method of CVD therapy. Logistic regression showed that venoactive drugs are preferentially used except in class I obesity patients but also when therapy is managed by general practitioner. Logistic regression analysis showed that class II and morbid obesity is associated with more frequent prevalence of previous surgical procedures related to CVD (OR=2.62 with 95% confidence interval of [2.16-3.17]) and topical agent use, (OR=1.77, [1.38-2.25]) but with a significant decreased compliance with compression therapy (OR=0.74, [0.61 - 0.89]), regardless of the clinical course of the disease, and socio-demographic factors. While class I obesity increased the adherence with VADs. CONCLUSION: The therapy of CVD is affected by body mass index. Class II and morbid obese CVD patients are less frequently compliant with compression therapy but are willing to accept surgical procedures and the use of topical agents.

Compliance in pharmacotherapy in patients with chronic venous disorders.

AIM: The aim of this study was to evaluate the factors that limit the use of venoactive drugs (VADs), especially in patient with chronic venous disorders (CVD) noncompliant with compression therapy in a nationwide survey. METHODS: Analysis included 5134 CVD patients compliant with compression therapy and 4663 of those not accepting such method of therapy, participating in a large survey. RESULTS: Venoactive drugs (VADs) and topical agents were used significantly less frequently by patients noncompliant with compression therapy compared to the compliant population (95.2% vs. 97.7%, P<0.001 and 70.1% vs. 79.9%, P<0.001, respectively). There were also less patients on two VADs concurrently in these subgroups (14.6% vs. 24.6%, P<0.001 respectively). Logistic regression analysis confirmed that noncompliant also have decreased adherence to Ruscus aculeatus extracts (OR=0.870), micronized purified flavonoid fraction (MPFF) preparations (OR=0.886), and topical agents (OR=0.877), but not horse chestnuts seed extracts. Coexisting obesity and other chronic illnesses were among the factors that decreased the use of Ruscus aculeatus extracts and micronized purified flavonoid fraction (MPFF) preparations. The use of topical agents was reduced with age, male sex, patients with coexisting chronic illnesses, obesity and adverse to accepting compression therapy. Additionally diuretics, antiplatelet agents and low-molecular weight heparins were less frequently used in the noncompliant population. CONCLUSIONS: Patients who are not compliant with compression therapy are more frequently not adherent to pharmacological therapy. Coexisting obesity and other chronic illnesses demonstrate decrease in adherence to CVD pharmacotherapy.

Prevalence of metabolic syndrome and insulin resistance in overweight and obese women according to the different diagnostic criteria.

AIM: Metabolic syndrome (MS) is a cluster of risk factors favoring the development of type 2 diabetes and cardiovascular diseases. The prevalence of MS diagnosis is dependent of used diagnostic criteria. The aim of the study is to compare the prevalence of MS in overweight and obese women without concomitant diseases according to the different diagnostic criteria and their sensitivity to identify subjects with insulin resistance. METHODS: The study involved 126 overweight and obese women without concomitant diseases. In all subjects body mass, height, waist circumference and blood pressure were measured and plasma glucose, insulin and lipids levels were determined. MS was diagnosed using WHO, NCEP ATP III, IDF 2005 and IDF 2009 modified criteria. The insulin resistance was assessed based on the homeostatic model assessment insulin resistance (HOMA-IR≥2.5). RESULTS: The prevalence of MS was 43.8%, 43.8%, 38.1% and 18.1% according to IDF 2005, IDF 2009 modified, NCEP ATP III and WHO criteria, respectively. Insulin resistance was diagnosed in 89 women (70.6%). None of MS definitions allowed for proper discrimination of insulin resistant subjects. The highest sensitivity, but lowest specificity of insulin resistant discrimination had both IDF criteria (44.9% and 72.9%, respectively), while the highest specificity WHO criteria was missing sensitivity (91.8% and 17.9%, respectively). CONCLUSION: On the basis of both IDF criteria MS is diagnosed in significantly larger subset of overweight and obese women. However, NCEP ATPIII and both IDF criteria identify only less than half insulin resistant overweight and obese women as those with MS.

Compliance with compression stockings in patients with chronic venous disorders.

OBJECTIVE: The aim of this large survey was to evaluate non-compliance with compression stockings in chronic venous disorder (CVD) patients. METHOD: A total of 16,770 CVD patients participated in this study. RESULTS: Compression stockings were used by 25.6% of CVD patients and 46.6% of the patients were never prescribed compression therapy. Compression stocking use was found to increase with the clinical stage of CVD. The percentage of patients using compression stockings during control visits increased to 37.4%. Furthermore, 5.3% of the patients coming to control visits discontinued the use of compression stockings owing to high cost, sweating, itching, cosmetic reason, oedema exacerbation, exudation lesions of lower legs and application difficulty. Past episodes of vein thrombosis (OR = 0.80), of stroke (OR = 0.28) and of varicose veins surgery (OR = 0.28) were decreasing, while the management by a general practitioner was increasing the risk (OR = 1.36) of compression therapy cessation. CONCLUSION: (1) Compression stockings are too rarely prescribed and often unaccepted at early stages of CVD; (2) The common reason for discontinuation of compression therapy is its high cost.

The influence of a 3-month weight reduction therapy with Orlistat on serum vitamin B12 and folic acid concentration in obese women.

OBJECTIVE: Serum folic acid, but not the vitamin B(12) concentration, was found to be significantly lower in obese subjects than in the control ones. DESIGN: The aim of this study was to examine the levels of serum vitamin B(12) and folic acid in obese women before and after weight reduction therapy with Orlistat in comparison to healthy controls with normal body weight. SUBJECTS: Twenty obese women participated in a 3-month weight reduction therapy. The control group consisted of 20 healthy women. MEASUREMENTS: Body weight and height were measured and BMI was calculated. Body composition was analyzed with the impedance method using a Bodystat analyzer. In all patients before and after 3-month weight reduction therapy, serum concentrations of folic acid and vitamin B(12) were assessed. RESULTS: In obese women, serum concentrations of folic acid and vitamin B(12) did not change significantly after 3-month weight reduction therapy with Orlistat.