Extrapulmonary complications of COVID-19: A multisystem disease?

The outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been recently declared a pandemic by the World Health Organization. In addition to its acute respiratory manifestations, SARS-CoV-2 may also adversely affect other organ systems. To date, however, there is a very limited understanding of the extent and management of COVID-19-related conditions outside of the pulmonary system. This narrative review provides an overview of the current literature about the extrapulmonary manifestations of COVID-19 that may affect the urinary, cardiovascular, gastrointestinal, hematological, hematopoietic, neurological, or reproductive systems. This review also describes the current understanding of the extrapulmonary complications caused by COVID-19 to improve the management and prognosis of patients with COVID-19.

COVID-19 y enfermedades cardiovasculares. Por el Dr. Iván Mendoza

Primera conferencia del Ciclo de videoconferencias sobre el “Abordaje cardiovascular durante la COVID-19”. Por el Dr. Iván Mendoza, Sociedad Venezolana de Cardiología Realizada el 25 de agosto de 2020, con el apoyo de la OPS en Venezuela.

Abordaje cardiovascular durante la COVID-19 Dra Susana Blanco

Abordaje cardiovascular durante la COVID-19 Dra Susana Blanco

Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases.

Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be documented in various tissues, but the frequency of cardiac involvement as well as possible consequences are unknown. Objective: To evaluate the presence of SARS-CoV-2 in the myocardial tissue from autopsy cases and to document a possible cardiac response to that infection. Design, Setting, and Participants: This cohort study used data from consecutive autopsy cases from Germany between April 8 and April 18, 2020. All patients had tested positive for SARS-CoV-2 in pharyngeal swab tests. Exposures: Patients who died of coronavirus disease 2019. Main Outcomes and Measures: Incidence of SARS-CoV-2 positivity in cardiac tissue as well as CD3+, CD45+, and CD68+ cells in the myocardium and gene expression of tumor necrosis growth factor α, interferon γ, chemokine ligand 5, as well as interleukin-6, -8, and -18. Results: Cardiac tissue from 39 consecutive autopsy cases were included. The median (interquartile range) age of patients was 85 (78-89) years, and 23 (59.0%) were women. SARS-CoV-2 could be documented in 24 of 39 patients (61.5%). Viral load above 1000 copies per µg RNA could be documented in 16 of 39 patients (41.0%). A cytokine response panel consisting of 6 proinflammatory genes was increased in those 16 patients compared with 15 patients without any SARS-CoV-2 in the heart. Comparison of 15 patients without cardiac infection with 16 patients with more than 1000 copies revealed no inflammatory cell infiltrates or differences in leukocyte numbers per high power field. Conclusions and Relevance: In this analysis of autopsy cases, viral presence within the myocardium could be documented. While a response to this infection could be reported in cases with higher virus load vs no virus infection, this was not associated with an influx of inflammatory cells. Future investigations should focus on evaluating the long-term consequences of this cardiac involvement.

Long-term follow-up of biopsy-proven viral myocarditis: predictors of mortality and incomplete recovery.

OBJECTIVES: This study sought to evaluate the long-term mortality in patients with viral myocarditis, and to establish the prognostic value of various clinical, functional, and cardiovascular magnetic resonance (CMR) parameters. BACKGROUND: Long-term mortality of viral myocarditis, as well as potential risk factors for poor clinical outcome, are widely unknown. METHODS: A total of 222 consecutive patients with biopsy-proven viral myocarditis and CMR were enrolled. A total of 203 patients were available for clinical follow-up, and 77 patients underwent additional follow-up CMR. The median follow-up was 4.7 years. Primary endpoints were all-cause mortality and cardiac mortality. RESULTS: We found a relevant long-term mortality in myocarditis patients (19.2% all cause, 15% cardiac, and 9.9% sudden cardiac death [SCD]). The presence of late gadolinium enhancement (LGE) yields a hazard ratio of 8.4 for all-cause mortality and 12.8 for cardiac mortality, independent of clinical symptoms. This is superior to parameters like left ventricular (LV) ejection fraction, LV end-diastolic volume, or New York Heart Association (NYHA) functional class, yielding hazard ratios between 1.0 and 3.2 for all-cause mortality and between 1.0 and 2.2 for cardiac mortality. No patient without LGE experienced SCD, even if the LV was enlarged and impaired. When focusing on the subgroup undergoing follow-up CMR, we found an initial NYHA functional class >I as the best independent predictor for incomplete recovery (p = 0.03). CONCLUSIONS: Among our population with a wide range of clinical symptoms, biopsy-proven viral myocarditis is associated with a long-term mortality of up to 19.2% in 4.7 years. In addition, the presence of LGE is the best independent predictor of all-cause mortality and of cardiac mortality. Furthermore, initial presentation with heart failure may be a good predictor of incomplete long-term recovery.

Prevención en infecciones de la cirugía cardiovascular neonatal y pediátrica / Infections prevention in neonatal and pediatric cardiovascular surgery

Con la introducción de los principios de antisepsia, logró disminuir sustancialmente las infeccionespostoperatorias y la mortalidad. El riesgo de infección del sitio quirúrgico depende de una relación entre el número de bacterias, la virulencia y la susceptibilidad del huésped. La principal fuente de patógenos es la flora endógena del paciente y la flora exógena. Los factores de riesgo para las infecciones del sitio quirúrgico (ISQ) en cirugía cardiovascular pediátrico no están claramente definidos. Las ISQ se consideran asociadas al cuidado de la salud o antes llamadas intrahospitalarias si ocurren dentro de los siguientes 30 días luego del procedimiento quirúrgico independiente que el paciente se encuentre o no hospitalizado. En conclusión, las ISQ en cirugía cardiovascular pediátrica aumentan la morbilidad, la mortalidad y los costos.

With the introduction of the principles of antisepsis, possible to substantially reduce postoperativeinfections and mortality. The risk of surgical site infection depends on a relationship between thenumber of bacteria, virulence and host susceptibility. The main source of pathogens is the patient'sendogenous flora and exogenous flora. Risk factors for surgical site infections (SSIs) in pediatriccardiovascular surgery are not clearly defined. SSIs are associated with the health care or formerly known as nosocomial if they occur within 30 days after the independent surgical procedure the patient is hospitalized or not. In conclusion, the SSI in pediatric cardiovascular surgery, increased morbidity, mortality and costs.

Influenza-attributable mortality in Australians aged more than 50 years: a comparison of different modelling approaches.

This study aimed to compare systematically approaches to estimating influenza-attributable mortality in older Australians. Using monthly age-specific death data together with viral surveillance counts for influenza and respiratory syncytial virus, we explored two of the most frequently used methods of estimating excess influenza-attributable disease: Poisson and Serfling regression models. These approaches produced consistent age and temporal patterns in estimates of influenza-attributable mortality in older Australians but some variation in the magnitude of the disease burden. Of Australians aged >50 years, average annual estimated influenza-attributable deaths (all cause) ranged from 2314 to 3457 for the Serfling and Poisson regression models, respectively. The excess influenza-attributable disease burden was substantial under all approaches.