Effect of COVID-19 on outpatient services in patients with aortovascular disease: a UK multicentre study.

INTRODUCTION: The SARS-CoV-2 coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare services worldwide. Outpatient services have necessarily been restructured to accommodate COVID-19 patients and to maintain social distancing measures. The aim of our study was to investigate how the COVID-19 pandemic has affected outpatient healthcare provision for patients with aortovascular disease. METHODS: In this prospective study, a standardised proforma was circulated to seven aortic centres in the UK. Data on outpatient encounters were collected from March to July 2020. Captured data included demographic details, disease pattern, type of encounter (face-to-face, video or telephone), clinic outcome and availability of imaging. RESULTS: A total of 632 patients were included in the study, including 164 (25.9%) new referrals. In this cohort, clinic settings have shifted towards remote consultations, with 424 (67.1%) patients undergoing telephone appointments. Over a third of new patients (34.8%) had a delay in diagnostic tests, which might be attributable to the indirect effects of COVID-19. A total of 102 (16.1%) patients were added to a surgical waiting list following clinic. CONCLUSIONS: To the best of our knowledge, this is the largest study of outpatient activity during the COVID-19 pandemic in patients with aortovascular disease. We demonstrate how the speciality has adapted to accommodate government-endorsed changes in healthcare provision, and question how COVID-19 may have affected access to diagnostics. Finally, we discuss how COVID-19 will affect patients added to surgical waiting lists.

The correlation between bowel complications and cardiac surgery.

Although advances in knowledge and technology have improved outcomes in surgical cardiac patients over the last decade, complications following cardiac operations still remain to be potentially fatal. Gastrointestinal complications, in particular, tend to have high rates of reintervention and mortality following cardiac surgery, with ischemia and hemorrhage being two of the commonest underlying causes. The intention of this review is to identify which risk factors play important roles in predisposing patients to such complications and to gain better insight into the pathogenesis of the sequelae. Furthermore, strategies for prevention have been discussed to educate and increase awareness of how adverse cardiac surgical outcomes can be minimized.

Coronavirus disease 2019 (COVID-19) outcomes in HIV/AIDS patients: a systematic review.

OBJECTIVES: The aim of the study was to systematically review current studies reporting on clinical outcomes in people living with HIV (PLHIV) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search was conducted in Global Health, SCOPUS, Medline and EMBASE using pertinent key words and Medical Subject Headings (MeSH) terms relating to coronavirus disease 2019 (COVID-19) and HIV. A narrative synthesis was undertaken. Articles are summarized in relevant sections. RESULTS: Two hundred and eighty-five articles were identified after duplicates had been removed. After screening, eight studies were analysed, totalling 70 HIV-infected patients (57 without AIDS and 13 with AIDS). Three themes were identified: (1) controlled HIV infection does not appear to result in poorer COVID-19 outcomes, (2) more data are needed to determine COVID-19 outcomes in patients with AIDS and (3) HIV-infected patients presenting with COVID-19 symptoms should be investigated for superinfections. CONCLUSIONS: Our findings suggest that PLHIV with well-controlled disease are not at risk of poorer COVID-19 disease outcomes than the general population. It is not clear whether those with poorly controlled HIV disease and AIDS have poorer outcomes. Superimposed bacterial pneumonia may be a risk factor for more severe COVID-19 but further research is urgently needed to elucidate whether PLHIV are more at risk than the general population.

A late presentation of Loeys-Dietz syndrome associated with an aortic root aneurysm.

Loeys-Dietz syndrome (LDS) is characterised by a mutation in the transforming growth factor beta receptor, and is strongly associated with aortic aneurysms and rupture. Most cases of LDS present in the second decade of life, with the average life expectancy being 37 years. We report a case of suspected LDS (owing to significant family history of the disorder) that presented in the seventh decade of life. Our patient had aortic root dilation and was initially believed to have Marfan syndrome. However, subsequent tests were negative. On further investigation of her family history, it was revealed that she had a strong positive family history of aortic rupture and aneurysms associated with genetically confirmed atypical LDS. By reporting this case, we aim to highlight the importance of considering inherited connective tissue disorders when a patient presents with aortic aneurysms or dissections associated with a strong family history of aortic pathology.

A late presentation of Loeys-Dietz syndrome associated with an aortic root aneurysm.

Loeys-Dietz syndrome (LDS) is characterised by a mutation in the transforming growth factor beta receptor, and is strongly associated with aortic aneurysms and rupture. Most cases of LDS present in the second decade of life, with the average life expectancy being 37 years. We report a case of suspected LDS (owing to significant family history of the disorder) that presented in the seventh decade of life. Our patient had aortic root dilation and was initially believed to have Marfan syndrome. However, subsequent tests were negative. On further investigation of her family history, it was revealed that she had a strong positive family history of aortic rupture and aneurysms associated with genetically confirmed atypical LDS. By reporting this case, we aim to highlight the importance of considering inherited connective tissue disorders when a patient presents with aortic aneurysms or dissections associated with a strong family history of aortic pathology.