ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic, uses the surface angiotensin-converting enzyme 2 (ACE2) receptor as the site of entry into host cardiac, respiratory, intestinal, renal, and nervous system cells. Predisposing risk factors such as cardiovascular disease increase the risk of developing severe disease. Hypertension is characterized by the stimulation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin 2 receptor blockers (ARBs), medications used to treat hypertension, inhibit RAAS and its downstream effects; however, they have also been shown to upregulate ACE2 receptors. In this review, we aim to evaluate the effectiveness of ACEi/ARBs as an adjunct therapy in patients with SARS-CoV-2 as well as examine the possible protective effects and impact on infection rate and disease severity. A PubMed literature search excluding sources outside the United States and duplicates was performed using the following search criteria: "COVID-19 AND cardiovascular disease AND ACEi AND ARB", "SARS-COVID-19 OR COVID-19, AND ACEi AND ARB AND Infection rate", "COVID-19 AND ACEi and ARB", "Omicron BA.1 and BA.2 AND ACE2 OR ARBs", "Omicron AND ACEi AND ARBs". This resulted in 33 final sources. The review concluded that ACEi/ARB therapy may continue to improve COVID-19 survival as previous treatment is associated with positive clinical outcomes. Patients taking ACEis or ARBs were found to have a decreased risk of hospitalization, reduced severity of COVID-19 pneumonia, a lesser need for mechanical ventilation, and an overall reduction in mortality rate. No statistically significant association between ACEi/ARB use and enhanced COVID-19 infectivity was found. The Omicron variant is theoretically more infectious and was associated with increased negative clinical outcomes in those undertreated with ACEis/ARBs. The majority of the literature supports the current guidelines from the American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), and Heart Failure Society of America (HFSA), which state that ACEi and ARB medications should not be withdrawn from or initiated on patients with cardiovascular disease who are infected with SARS-CoV-2. More research needs to be conducted on the association between the emerging COVID-19 variants and ACEis/ARBs to give clinicians confidence when treating patients within this subgroup of the population.
ABSTRACT
This article constitutes a translation from the Russian of G.E. Sukhareva's research report entitled (in English) 'Toward the problem of the structure and dynamics of children's constitutional psychopathies (Schizoid forms)', which she delivered at the 'behavioral' conference in Leningrad in early 1930. Lev Vygotsky also presented on 'difficult children' in the same session of this conference. Sukhareva worked as a clinician for many years in residential and out-patient psychiatric settings at the Psycho-Neurological Institute in Moscow. This is (at least) the third of Sukhareva's publications on schizoid children, preceding her subsequent work on schizophrenia and oligophrenia (intellectual disability). Here she offers new case material, and further theoretical elaboration, concerning children diagnosed as schizoid, who closely resembled what we now think of as autistic children. We include background information useful to contextualize this work historically, and commentary on some of the questions raised for the 'history of autism' by Sukhareva's work.
Subject(s)
Autistic Disorder , Intellectual Disability , Schizophrenia , Female , Humans , Child , Antisocial Personality Disorder/diagnosis , RussiaABSTRACT
We introduce and compare three different modalities to study seismocardiogram (SCG) and its correlation with cardiac events. We used an accelerometer attached to the subject sternum to get a reference measure. Cardiac events were then approximately identified using echocardiography. As an alternative approximation, we used consecutive Cine-MRI images of the heart to capture cardiac movements and compared them with the experimental SCG. We also employed an anatomically accurate, finite element base electromechanical model with geometry built completely from DT-MRI to simulate a portion of the cardiac cycle as observed in the SCG signal. The preliminary results demonstrate the usability of these newly proposed methods to investigate the mechanism of SCG waves and also demonstrate the usability of echocardiograph in interpretation of these results in terms of correlating them to underlying cardiac cycle events.
