Environmental factors and their impact on the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in numerous cases of illness and death worldwide. Research has shown that there are associations between transmission, as well as the severity of SARS-CoV­2 (severe acute respiratory syndrome coronavirus 2) infections, and various environmental factors. For example, air pollution with particulate matter is thought to play a crucial role, and both climatic and geographical aspects must be considered. Furthermore, environmental conditions such as industry and urban lifestyle have a significant impact on air quality and thus on health aspects of the population. In this regard, other factors such as chemicals, microplastics, and diet also critically impact health, including respiratory and cardiovascular diseases. Overall, the COVID-19 pandemic has highlighted how closely health and the environment are linked. This review discusses the impact of environmental factors on the COVID-19 pandemic.

A practical approach for the treatment of post-COVID symptoms.

For the past 3 years, our daily lives have been largely dictated by the coronavirus disease 2019 (COVID-19) pandemic. In many people, this infectious disease leads to long-lasting symptoms, which can vary greatly in form and intensity between individuals. This report describes the case of a young patient who had no health restrictions until she came into contact with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As part of a post-COVID syndrome, she not only temporarily lost her ability to work, but was also no longer able to manage her daily life independently. A crucial therapeutic approach, in this case, was the use of heparin-induced extracorporeal LDL/fibrinogen precipitation (H.E.L.P.) apheresis.

Management of a severe abdominal compartment complicating fulminant cardiogenic-septic shock: An abdominal arterio-venous single-tube ECMO bypass saved a young patient's life after OHCA.

INTRODUCTION: In severe cardiogenic shock, for example, following cardiac arrest, the implantation of an extracorporeal hemodynamic assist device often seems to be the last option to save a patient's life. However, even though our guidelines provide a class-IIa-recommendation to implant a veno-arterial extracorporeal membrane oxygenation (vaECMO) device in these patients, the accompanying disease- and device-associated complications and their consequences remain challenging to handle. CASE PRESENTATION: A 43-year-old patient presented with severe cardiogenic-septic shock with a complicating abdominal compartment due to a prolonged out-of-hospital cardiac arrest (OHCA). A loss of function of the vaECMO, implanted immediately after admission, impended due to increasing intra-abdominal pressure. This dangerous situation was resolved by crafting an experimental "arterio-venous shunt," using the side port of the reinfusion (arterial) vaECMO cannula and a downstream large-volume central access in the right femoral vein toward the abdominal venous system, which led to the patient's full recovery. CONCLUSION: In patients with cardiogenic shock, the use of catecholamines and implantation of extracorporeal assist devices alone do not ensure successful therapy. To optimize the outcome, device- and disease-associated complications must also be managed in a timely and minimally invasive procedure.

Monocyte subpopulation profiling indicates CDK6-derived cell differentiation and identifies subpopulation-specific miRNA expression sets in acute and stable coronary artery disease.

Coronary artery disease (CAD) is a long-lasting inflammatory disease characterized by monocyte migration into the vessel wall leading to clinical events like myocardial infarction (MI). However, the role of monocyte subsets, especially their miRNA-driven differentiation in this scenario is still in its infancy. Here, we characterized monocyte subsets in controls and disease phenotypes of CAD and MI patients using flow cytometry and miRNA and mRNA expression profiling using RNA sequencing. We observed major differences in the miRNA profiles between the classical (CD14++CD16-) and nonclassical (CD14+CD16++) monocyte subsets irrespective of the disease phenotype suggesting the Cyclin-dependent Kinase 6 (CDK6) to be an important player in monocyte maturation. Between control and MI patients, we found a set of miRNAs to be differentially expressed in the nonclassical monocytes and targeting CCND2 (Cyclin D2) that is able to enhance myocardial repair. Interestingly, miRNAs as miR-125b playing a role in vascular calcification were differentially expressed in the classical subset in patients suffering from CAD and not MI in comparison to control samples. In conclusion, our study describes specific peculiarities of monocyte subset miRNA expression in control and diseased samples and provides basis to further functional analysis and to identify new cardiovascular disease treatment targets.

[Acute Coronary Syndrome (ACS) in Preclinical Emergency Medicine]. / Das akute Koronarsyndrom in der präklinischen Notfallmedizin.

Acute coronary syndrome (ACS) is a common diagnosis in preclinical emergency medicine. The term summarizes the acute manifestations of coronary artery disease. It ranges from unstable angina pectoris via cardiogenic shock to sudden cardiac death. The leading key symptom is chest pain. With this trigger symptom, a clinical diagnostic algorithm is initiated, acting quickly on the suspected diagnosis of acute myocardial infarction. Due to the potentially life-threatening course, rapid diagnosis and initiation of therapeutic measures is crucial. Pre-clinical antithrombotic medication and therapy for accompanying symptoms are paramount. As part of the initial assessment, important differential diagnoses should be considered and, within the first 10 minutes after medical contact, an ECG diagnosis should differentiate between ACS with and without ST segment elevations. If ACS is diagnosed, acetylsalicylic acid should be given to inhibit platelet aggregation. The benefits outweigh the very low risk of unnecessary administration. Patients with ACS should be taken to hospital immediately for coronary interventions (PCI). In the case of an ACS with ST segment elevations, reperfusion therapy should be carried out within 120 minutes. In the case of an ACS without ST segment elevations, the time limit (2 - 72 h) until reperfusion is based on the risk stratification. In the majority of cases, the coronary stenosis causing the infarction can be treated with PCI. However, invasive diagnostics show no significant stenosis in a significant proportion of patients with myocardial infarction (prevalence 1 - 14%). This is known as "myocardial infarction with non-obstructive coronary arteries" (MINOCA) and further differential diagnosis should be initiated in these patients.