Is the prognosis of non-hypertensive, COVID-19 patients treated with renin-angiotensin-aldosterone system inhibitors more uncertain?

Previous studies suggested that ongoing treatment with renin-angiotensin-aldosterone system (RAAS) inhibitor drugs may alter the course of SARS-CoV-2 infection and promote the development of more severe forms of the disease. The authors conducted a comparative, observational study to retrospectively analyze data collected from 394 patients admitted to ICU due to SARS-CoV-2 pneumonia. The primary aim of the study was to establish an association between the use of RAAS inhibitor drugs and mortality in the ICU. The secondary aims of the study were to establish an association between the use of RAAS inhibitor drugs and clinical severity at ICU admission, the need for tracheal intubation, total days of mechanical ventilation, and the ICU length of stay. The authors found no statistically significant difference in ICU mortality between patients on RAAS inhibitor drugs at admission and those who were not (31.3% versus 26.2% mortality, p-value 0.3). However, the group of patients taking RAAS inhibitor drugs appeared to be more critical at ICU admission, and this difference became statistically significant in the subgroup of non-hypertensive patients. ICU mortality in the subgroup of non-hypertensive patients treated with RAAS inhibitor drugs also tended to be higher. Overexpression of the angiotensin-converting enzyme 2 (ACE2) in human cells, induced by RAAS inhibitor drugs, promotes viral entry-replication of SARS-CoV-2 and alters the basal balance of the RAAS, which may explain the findings observed in the present study. These phenomena may be amplified in non-hypertensive patients treated with RAAS inhibitor therapy.

Predictive Factors of Surgical Complications in the First Year Following Kidney Transplantation.

BACKGROUND: In the recent years, an increased use of marginal donors and grafts and a growing prevalence of peripheral arterial disease in the recipients have been observed. Meanwhile, the open surgical technique for kidney transplantation has not changed. The aim of this study is to analyze all surgical complications occurring in the first year after kidney transplant and to determine potential predictive risk factors. METHODS: Data of the 399 patients who underwent kidney transplant in our University Hospital between January 2006 and December 2015 were retrospectively reviewed. The primary endpoint was the overall rate of vascular, parietal and urological complications at 1 year following kidney transplantation. The secondary outcomes were graft and patient' survival rates, and the identification of predictive factors of the surgical complications. RESULTS: 24% of patients developed 134 complications. Vascular complication represented 39% of all complications and resulted in 9 graft losses. Parietal and urological complications represented 46-15% of all complications, respectively, No parietal or urological complications were associated with graft loss. 5 patients died during the 1st year, none of these cases was associated with graft loss. The graft survival rate reached 96% at 1 year, including patients still alive. The occurrence of surgical complication was associated with reduced graft survival at 1 year. Using a multivariate analysis, 4 predictive factors were identified: age, deceased donor, operative time and dyslipidemia. CONCLUSION: Surgical complications after kidney transplantation remained frequent and age, deceased kidney donors, and operative time were identified as risk factors. As vascular complications were a major cause of early graft loss, efforts should aim to reduce their occurrence to increase graft survival.

S100B Blood Level Determination for Early Management of Ski-Related Mild Traumatic Brain Injury: A Pilot Study.

Background: Mild traumatic brain injury (mTBI) management in emergency departments is a complex process involving clinical evaluation, laboratory testing, and computerized tomography (CT) scanning. Protein S100B has proven to be a useful blood biomarker for early evaluation of mTBI, as it reduces the required CT scans by one-third. However, to date, the ability of S100B to identify positive abnormal findings in the CT scans of patients suffering from mTBI caused by ski practice has not been investigated. Thus, the primary aim of this study was to investigate the diagnostic performance of S100B as an mTBI management biomarker in patients with ski-related mTBI. Materials and Methods: One hundred and thirty adult mTBI patients presenting to the emergency department of Hôpital du Valais in Sion, Switzerland, with a Glasgow Coma Scale (GCS) score of 13-15 and clinical indication for a CT scan were included in the study. Blood samples for S100B measurement were collected from each patient and frozen in 3-hour post-injury intervals. CT scans were performed for all patients. Later, serum S100B levels were compared to CT scan findings in order to evaluate the biomarker's performance. Results: Of the 130 included cases of mTBI, 87 (70%) were related to ski practice. At the internationally established threshold of 0.1 µg/L, the receiver operating characteristic curve of S100B serum levels for prediction of abnormal CT scans showed 97% sensitivity, 11% specificity, and a 92% negative predictive value. Median S100B concentrations did not differ according to sex, age, or GCS score. Additionally, there was no significant difference between skiers and non-skiers. However, a statistically significant difference was found when comparing the median S100B concentrations of patients who suffered fractures or had polytrauma and those who did not suffer fractures. Conclusion: The performance of S100B in post-mTBI brain lesion screenings seems to be affected by peripheral lesions and/or ski practice. The lack of neurospecificity of the biomarker in this context does not allow unnecessary CT scans to be reduced by one-third as expected.

[Internal medicine, seen from the mouth]. / La médecine interne vue depuis la bouche.

Many diseases affect the oral cavity. Therefore, the mouth is an organ that internists should observe carefully. Hereafter we present five illustrations of oral semiology that reflect a systemic condition: a strawberry tongue, an ulceration, a labial lesion, a gingival hyperplasia and a gingival hyperpigmentation. Each time, a differential diagnosis is to be considered, potentially allowing the identification of severe diseases.

Un grand nombre de pathologies ont une répercussion sur la sphère buccale. Pour l'interniste, la bouche est par conséquent un organe à observer soigneusement. Nous présentons cinq illustrations de sémiologie buccale qui traduisent une affection systémique : une langue framboisée, une ulcération, une lésion labiale, une hyperplasie gingivale et une hyperpigmentation gingivale. À chaque fois, un diagnostic différentiel doit être évoqué, permettant potentiellement l'identification de maladies sévères.

Rapid-deployment aortic valve replacement versus standard bioprosthesis implantation.

OBJECTIVE: To compare the outcome and the 1-year hemodynamic results of the rapid-deployment Intuity valve versus the Perimount Magna bioprosthesis in matched populations. METHODS: Between March 2014 and May 2015, 32 patients underwent aortic valve replacement with the Intuity valve (Intuity-group). These patients were compared to a matched population of Perimount valves implanted during the same period of time (Perimount-group). Clinical data were compared and echocardiographic 1-year follow-up was performed. RESULTS: There were more female patients in the Intuity-group (47% vs 22%, p = 0.035); mean age was 78 ± 5.6 and 72.5 ± 6 years in the Intuity-group and Perimount-group (p < 0.001); coronary disease was more common in the Intuity-group (65% vs 25%, p = 0.005). Other characteristics were similar. Implants were 100% successful. Mean cross-clamp (50.3 ± 25 vs 53 ± 22 min, p = 0.004), cardiopulmonary bypass (68 ± 27 vs 72 ± 31.8 min; p = 0.006), and surgical times (156.8 ± 54 vs 165 ± 40 min; p = 0.018) were shorter with the Intuity despite more concomitant procedures. Mean valve size was 23.7 mm (Intuity-group) and 24.1 mm (Perimount-group); hospital mortality was zero (Intuity-group) and 3% (Perimount-group); new pacemaker implants were 6% (Intuity) and 3% (Perimount) (p = 0.55) and hospital stay was equivalent. Mean gradients were: 9.9 ± 3.4 (Intuity) versus 12.5 ± 3.8 mmHg (Perimount) (p = 0.022) at discharge and 9 ± 4 mmHg (Intuity) versus 14 ± 4 mmHg (Perimount) (p = 0.02) at follow-up. At discharge, one Intuity valve had 3+ aortic insufficiency (AI) which was unchanged at 1 year and will require an intervention. Another patient had 1 + AI which progressed to 2+ at 1 year. There were no paravalvular leaks in the Perimount valves at discharge and follow-up. CONCLUSION: Intuity valves showed lower gradients compared to Perimount valves with the same mean size. Paravalvular leaks identified at the time of implantation in Intuity valves need to be addressed at the time of surgery.