bluuebunny/crossref_metadata_2025 huggingface dataset:
CARDIOPROTECTIVE EFFECT OF TERIFLUNOMIDE IN AN EXPERIMENTAL MODEL OF MYOCARDIAL INFARCTION
Authors: Bhargava Poorva , Sharma Jatin , Bhatia Jagriti , Arya Ds
Published: June 2023

Objective:

MI is a major cause of mortality worldwide. Inflammation plays a key role in the pathology of MI. Teriflunomide (TERI), an orally active Dihydroorotate Dehydrogenase inhibitor, inhibits de novo pyrimidine synthesis. It decreases production of inflammatory cytokines and suppresses the activity and proliferation of activated lymphocytes.

Hypothesis: TERI, on account of its potent anti-inflammatory activity may attenuate Isoproterenol induced cardiac injury in rats. Thus, we aimed to investigate the cardio-protective effect of Teriflunomide in isoproterenol (Iso) induced myocardial infarction.

Design and method:

To induce myocardial infarction in rats, we administered 2 doses of Isoproterenol (85 mg/kg/day, s.c.) on days 13th and 14th, at an interval of 24 hours. Male albino Wistar rats were divided into 5 groups (n = 6); namely normal control, isoproterenol control, Teriflunomide groups to receive saline, isoproterenol, or Teriflunomide (1, 3 or 5 mg/kg/day, p.o.) for 14 days. On the 15th day, rats were anaesthetized and right coronary artery was cannulated to record hemodynamic parameters. Blood sample was collected via cardiac puncture, heart was excised and preserved for analysis of biochemical, histopathological and ultrastructural studies.

Results:

Isoproterenol administration to rats resulted in induction of MI with impairment of hemodynamic parameters. Teriflunomide pretreatment showed significantly improved hemodynamic (systolic, diastolic and mean blood pressures) and cardiac function parameters (normalized ± LV dP/dt and LVEDP) with reduction in the levels of cardiac injury markers (CK-MB, LDH). Further, Teriflunomide significantly reduced oxidative stress (enhanced levels of SOD, GSH, decreased MDA levels) and inflammation (reduced levels of TNF-alpha, IL-6), led to inhibition of active JNK and p38 proteins and activation of ERK1/2, a pro-survival kinase. Furthermore, it also ameliorated apoptosis by reducing the expression of pro-apoptotic proteins (Bax and Caspase-3) and increased expression of Bcl-2, an anti-apoptotic marker. In addition, pretreatment with Teriflunomide preserved morphological and ultra-structural architecture of the myocardium as seen by H & E staining and electron microscopy.

Conclusions:

Teriflunomide at 1 mg/kg offered cardio-protection by improving hemodynamic profile, oxidative stress profile, reduced inflammation, normalization of myocardial architecture.
COVID-19 AND CARDIOVASCULAR COMPLICATIONS. AN INAUSPICIOUS COMBINATION
Authors: Zbroch Edyta , Waszak Julia , Siwik Marcin , Bazarewicz Jakub , Piotrowska Weronika , Sielatycki Piotr
Published: June 2023

Objective:

The case report presents patient with COVID-19 history. Although the course of COVID-19 in most people is mild, most cases, including severe ones, mainly involve the respiratory system. In less common cases, association of SARS-CoV-2 infection with other systems, including cardiac, has been reported. Pericarditis is often associated with viral infection, mostly with Coxsackie B virus but it has been also reported as one of the rare cardiovascular manifestations of SARS-CoV-2 infection.

Design and method:

Case report of patient with COVID-19 and multiple comorbidities, including secondary hypertension and kidney transplantation. Observation of the symptoms suggested myocardial involvement in the course of SARS-CoV-2 infection and demanded further specialist treatment.

Results:

A 67-year-old female patient with secondary to chronic kidney disease hypertension, after kidney transplantation, with diabetes type 2 and many other comorbidities was admitted to the Department of Internal Medicine and Hypertension due to worsening of kidney function and COVID-19 infection, in a general bad condition with the shortness of breath and reduced exercise tolerance and low SatO2 - 79%. Chest angio-CT showed COVID-19 pneumonia and pericardial effusion. Echocardiography revealed severe left ventricular systolic failure with left ventricular ejection fraction 20%. Laboratory results showed a high level of inflammatory markers, creatinine and NT-pro-NBP as well as cardiac enzymes activation. The typical treatment was implemented. On the third day of hospitalization, a rapid attack of atrial fibrillation occurred. Attempted pharmacological cardioversion was unsuccessful. Due to respiratory failure, electrical cardioversion was rejected. Continuous intravenous infusion of amiodarone was introduced. The patient's condition deteriorated significantly. Myocardial involvement in the course of COVID-19 infection was suspected. The patient, in a serious general condition, was transferred to the Department of Cardiology and then to ICU where patient died.

Conclusions:

SARS-CoV-2 is mainly associated with the respiratory tract, but it also has multiple adverse effects on the cardiovascular system. Patients with many comorbidities, especially after organ transplantation on immunosuppression, are more likely to develop severe courses of the disease. This case highlights that although pericarditis is a rare cardiac complication of COVID-19, we should stay alerted about it.
MEDICAL STUDENTS’ EVALUATION BY SERIOUS GAME IN THE ERA OF COVID-19 INFECTION
Authors: Chamtouri Ikram , Jomaa Walid , Hamda Khaldoun Ben
Published: June 2023

Objective:

The aim of our study was to compare the results of medical students’ evaluation by virtual simulation using online SG and clinical case-based multiple choice questions (MCQ), and to assess the degree of satisfaction with these two evaluation methods.

Design and method:

Medical students from the same level of study voluntarily participated in this study. SG group had an evaluation by SG dealing with diagnosis and management of ST-segment elevation myocardial infarction (STEMI), already prepared on the following website: www.Mediactiv.com. Clinical case-based MCQ group was evaluated by clinical case-based MCQ having the same topic as SG group. Results of the two groups were compared. A satisfaction questionnaire was filled out by the two groups. The satisfaction degree was compared between the two groups.

Results:

In this study, 64 medical students (G1:31 and G2: 33) were enrolled. Obtaining complete notes in the questioning and clinical examination parts was significantly more important in SG group compared to clinical case-based MCQ group. No significant difference was noted between the two groups in terms of ECG interpretation and diagnosis of STEMI parts. A greater number of students in SG group obtained a full mark compared to clinical case-based MCQ group in the initial treatment part (54.8% vs. 39.4%; p = 0.04). A total of thirty learners (96.8%) in SG group obtained a total score more than 50% versus 69.7% in clinical case-based MCQ group (p = 0.004). The full score of 100% was obtained by three learners in SG group; however, no student scored 100% in clinical case-based MCQ group (p = 0.027). Medical evaluation using SG was reported to be more innovative, fun, and realistic compared to evaluation by clinical case-based MCQ. No significant difference was noted between the two methods in terms of stress.

Conclusions:

Simulation by SG could be an innovative and effective method in evaluating medical students, with a higher degree of satisfaction.
COVID-19: RISK AND CARDIOVASCULAR DISEASE. SYSTEMATIC REVIEW 2022
Authors: Rodero Eulalia Amador , Miranda Santiago Rodriguez , Segura Ana Maria , Esmeral Leslie Montealegre , Charris Martha Arteta
Published: June 2023

Objective:

To identify through a review of scientific literature the association between cardiovascular diseases and severity in the clinical picture of patients with Covid-19

Design and method:

To answer the PICO question: is there an association between cardiovascular diseases and the severity of the clinical picture of patients with Covid-19? An exhaustive review of scientific articles based on the PRISMA methodology was carried out, between June 16 and July 26, 2022, in the PubMed, UpToDate, ScienceDirect, Scielo, and National Library of Medicine databases. The terms Mesh, Patient, Men, Womans, Age, Sex, COVID-19, Coronavirus, Sars-Cov-2, Cardiovascular Diseases, Heart Disease, Risk Factors, Myocardial infarction, Stroke, were combined with Boolean AND OR NOT operators and were entered into database search engines. The established limits were type of study, type of document, language, date of publication. Studies referring to children and adolescents, pregnant women were excluded; Studies referring to adult patients with Covid-19 with and without a history of cardiovascular disease were included. The studies identified after passing the established filters were assessed for methodological quality with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) applied to observational studies. Those preselected underwent an assessment of the level of evidence with the proposal of the Oxford Center for Evidence-Based Medicine (CEBM), those who obtained a high level and grade of recommendation were included in this review.

Results:

Six studies that passed all the filters were selected. An association was identified between diseases and cardiovascular risk with the severity of the clinical picture and in some cases fatal outcome. Associated comorbidities were: diabetes (OR 3.39 95% CI, 2.14-5.37); p = 0.0001, z = 5.206; (OR 2.61, 95% CI: 2.02–3.39), (OR: 2.27, 95% CI: 1.87–2.74); cerebrovascular disease (OR 4.85, 95% CI: 3.11–7.57); cardiovascular disease (OR 4.81, 95% CI: 3.43–6.74), (OR:3.44, 95% CI: 2.65–4.48); hypertension (OR: 2.51, 95% CI: 2.13–2.95).

Conclusions:

The cardiovascular risk and diseases predispose to the development of critical illness, with longer hospital stays, admission to intensive care units, application of mechanical ventilation, and in some cases the death of patients who contract Covid-19.
PROTECTIVE EFFECTS OF CALCIUM CHANNEL BLOCKERS IN HYPERTENSIVE NON-VACCINATED PATIENTS WITH COVID-19
Authors: Stojanovic Milovan , Ilic Marina Deljanin , Trickovic Ljiljana , Stojanovic Sanja , Ilic Stevan
Published: June 2023

Objective:

Analysis of the effects of antihypertensive therapy on the prognosis and outcome of hypertensive non-vaccinated patients with COVID-19.

Design and method:

The study included 90 hypertensive non-vaccinated patients who underwent cardiovascular assessment in 2019 and suffered from COVID-19 in 2020. The cardiovascular evaluation included laboratory, heart ultrasound, exercise stress test, and 24h Holter ECG. The aim of our study was to analyze the effects of clinical and demographic characteristics and antihypertensive therapy on the prognosis and outcome of hypertensive non-vaccinated patients with COVID-19. Data were obtained by completing a telephone-based questionnaire. All pts were divided into three groups according to the way of treatment – pts who were treated ambulatory (A group, 56 pts), pts who were hospitalized and required oxygen therapy (H group, 25 pts), and patients who died due to COVID-19 (D group, 9 pts).

Results:

Groups didn’t differ in the presence of dyslipidemia. Obesity was the most prevalent in the A group (A 30.4%, H 20%, and D 11.1%), and smoking status in the H group (H 48%, A 33.9%, and D 33.3%). Diabetes was highly present in the D group (D 44.4%, H 25%, and A 32%), coronary artery disease in the H group (H 52%, A 41%, and D 33.3%), as well as atrial fibrillation (H 32%, A 28.57%, D 22.22%). Complex heart arrhythmias on 24h Holter ECG were the most prevalent in the H group (H 50%, A 20%. D 19.44%), and pts from the H group had the worst strain tolerance on exercise stress test (H 5.62 ± 2.37min, A 5.86 ± 2.77, and D 6.84 ± 3.39). Groups didn’t differ in using beta-blockers, diuretics, angiotensin II receptor antagonists, or angiotensin-converting enzyme inhibitors. On the other hand, only 28.57% of pts from the D group were taking calcium channel blockers (CCBs), while this percentage was significantly higher in the H (75%) and in the A group (52%).

Conclusions:

Our study showed that CCBs had a protective effect on the prognosis and outcome in hypertensive non-vaccinated pts with COVID-19.
PECULIARITIES OF THE COURSE OF ATRIAL FIBRILLATION IN PATIENTS WITH ARTERIAL HYPERTENSION AFTER A CORONAVIRUS INFECTION
Authors: Stasyshena Oksana , Sychov Oleg , Romanova Olena , Getman Taisia , Sribna Olga , Mikhalieva Tatiana , Marchenko Olena
Published: June 2023

Objective:

Arterial hypertension is one of the most common comorbid pathologies in patients with atrial fibrillation (AF). The aim of our study was to evaluate blood pressure indicators as a predictor of the development of AF after experiencing a coronavirus infection (CI).

Design and method:

187 patients (pts) aged 62,5±0,9 years (47% men, 53% women) were included in the study. The vast majority of pts (89%) had arterial hypertension (stage2 – 80%, stage3 – 9%). The first three groups formed 116 pts who had AF and underwent CI. The first group (G1) consisted of 36 pts who did not have AF before CI. The second group (G2) was represented by 25 pts in whom the transition of the paroxysmal form of AF into persistent, or persistent AF into its permanent form occurred. The third group (G3) consisted of 55 pts in whom the form of AF did not change. Two control groups were formed: K1 - 49 pts with AF who did not have a history of CI, and K2 - 22 pts with extrasystole who experienced CI, but who did not develop AF.

Results:

Arterial hypertension affected the possibility of developing and worsening the course of AF after CI in G2 pts compared with K1 pts (88,0% vs. 80,0%, p< 0,05), G1 compared with K2 patients. Concomitant hypertension was associated with an increase in the frequency and duration of AF paroxysms after COVID-19. Thus, G2, compared to G3, was characterized by more frequent detection of both 2nd degree hypertension (72% versus 65,5%; p<0,05) and 3rd degree hypertension (12% versus 3,6%, p<0.05).

Conclusions:

Arterial hypertension are predictors of the development of AF in patients after CI. The presence of AH significantly worsens the course of AF after CI, increasing the frequency of paroxysms of this arrhythmia and their duration.
IMPACT OF POST-COVID MENTAL STRESS DISORDERS ON BLOOD PRESSURE RESPONSE TO EXERCISE
Authors: Curcio Rosa , Mordeglia Lorenzo , Morgana Giovanni , Caparvi Camilla , Zacchero Lorenzo Andrea , Santoni Edoardo , Dominioni Irene , Sanesi Leandro , Cavallo Massimiliano , Santuro Emanuela , Meloni Sara , Bartoli Stefano , Pasticci Maria Bruna , Vaudo Gaetano , Pucci Giacomo
Published: June 2023

Objective:

Patients recovered from COVID-19 are at high risk of developing mental stress disorders over the long-term. Post-traumatical stress disorders (PTSD) are associated with increased BP and hypertension incidence. We tested the hypothesis that PTSD, occurring in patients after hospital discharge for severe COVID-19, is associated with an impaired BP response to exercise.

Design and method:

108 patients previously hospitalized for severe COVID-19 were evaluated after 5 months from hospital discharge. A Revised Impact of Event Scale (IES-r) score>33 indicated probable COVID-related PTSDs All subjects underwent maximal cardio-pulmonary exercise test on a cycle ergometer with incremental ramp protocol. Submaximal BP was recorded after 4 minutes, at a workload threshold of 75W.

Results:

95 subjects (mean age 58±10 years, 71% men) had complete data. Mean baseline BP was 128/82±12/11 mmHg. 51% were hypertensive. 32% had a IES-r score>33 (PTSD group). These patients were more frequently women (45% vs 20%, p = 0.01), whereas no differences in terms of age, BMI, hypertension history, other CV risk factors or diseases were found compared to non-PTSD group. Baseline BP did not differ between PTSD and non-PTSD groups (127/82±10/8 mmHg vs 129/82±15/9 mmHg, p = 0.43/0.88). By contrast, submaximal exercise SBP (eSBP) was increased in PTSD vs non-PTSD group (155±16 mmHg vs 146±14 mmHg, p<0.05). A strong sex-specific effect was found, being eSBP higher in PTSD vs non-PTSD women, but not in PTSD vs non-PTSD men (p for sex interaction = 0.01). Intrusion symptoms, such as unwanted and upsetting memories, nightmares and flashbacks, were more markedly associated with increased BP response to exercise.

Conclusions:

In people with mental stress disorders related to previous COVID-19 hospitalization, we showed increased submaximal BP during exercise. This finding showed a sex-specific association, being observed in women but not in men. Mental stress disorders could negatively impact on future CV risk in post-COVID-19 women through an exaggerated BP response to physical stressors.
BLOCK OF THE ANGIOTENSIN PATHWAYS EFFECTS FLOW-VOLUME SPIROMETRY IN PATIENTS WITH SARS-COV-2 INFECTION
Authors: Mancini Francesca , Marozzi Marialuisa Sveva , Loponte Luciana , Solimando Antonio Giovanni , Vacca Angelo , Cicco Sebastiano
Published: June 2023

Objective:

Angiotensin Converting Enzyme 2 (ACE2) pathways inhibitors have been first evaluated in COVID-19 patients for the risk of poor prognosis. Pulmonary function tests (PFTs) are the main diagnostic tools for most respiratory diseases. Few data are present in follow-up PFTs according to hypertension or treatment. We evaluated patients that are hypertensives and not and the role of ACE2i/ARB through flow-volume spirometry in follow-up after infection recovery.

Design and method:

We evaluated 112 Caucasian patients 3-6 months after Covid-19 disease, i.e. after the date of negative molecular/antigenic nasopharyngeal swab. The series of patients showed a great variability due to a wide spectrum of age, the severity of disease manifestations, hospitalization, invasive/non-invasive ventilation, comorbidities, the presence/absence of a previous pneumological diagnosis, and the variants of the virus. Patients were divided into those who were hypertensives (Group1, 18 females and 30 males, aged 63.47±14.24), and who were not (Group2, 32 females and 32 males, aged 53.03±16.66). Group1 was further analysed according to treatment: patients in ACEi/ARB treatment (Group1A, 23 females and 12 males, aged 63.63±10.40) and those who not (Group1B, 6 females and 7 males, aged 53.03±16.66). Distal airflow obstruction (DAO) was evaluate as forced expiratory flow (FEF) at 25%, 50% and 75% of total flow. PFTs values were related to age, sex and BMI before comparison.

Results:

Group1 presented lower peripheral oxygen saturation percentage (SpO2) vs Group2 (p<0.05). Spirometry data were worst in Group1: Forced expiratory volume at first minute (FEV1) (p<0.05), Forced vital capacity (FVC) (p<0.05), and Tiffenau Index (p<0.05). There was a DAO in Group1. In Group 1, we found also a reduction in FEF 25 (p<0.05), FEF 50 (p<0.05), and FEF 25-75 (p<0.05), and in FEF 75 (p<0.05). There was no difference in those parameters comparing Group1A vs Group1B.

Conclusions:

In hypertensives the indexes of respiratory function were shifted towards the lower limits (albeit within normal limits). These parameters were significantly reduced compared to controls. Treatment with ACEi/ARB didn’t affect PFTs at follow-up evaluation after recovery. Thus, COVID-19 is not only a pulmonary, but also a vascular disease worsening when a previous CV comorbidity.
DEMOGRAPHIC, CLINICAL CHARACTERISTICS AND IN-HOSPITAL OUTCOME OF HYPERTENSIVE COVID-19 POSITIVE PATIENTS
Authors: Kalimuddin Md , Malik Fazila-Tun-Nesa , Ishraquzzaman Mir , Ahmed Nazir , Badiuzzaman Mohammad , Ahmed Mir Nesaruddin , Dutta Ashok , Banik Dhiman , Laila Nazmun , Chowdhury Md. Shamim
Published: June 2023

Objective:

Less is known about the overall impact of hypertension on COVID-19 in Bangladeshi population. This study aimed to compare demographic and clinical characteristics and in-hospital outcome of hypertensive versus non-hypertensive COVID-19 positive patients.

Design and method:

All cardiac patients who became COVID-19 positive and healthcare personnel with COVID-19 infection were included in this prospective observational study. The study was conducted from April 2020 to November 2022 in the department of cardiology of National Heart Foundation Hospital & Research Institute which was COVID-non-dedicated tertiary care cardiac hospital. The patients were divided into two groups based on hypertension: hypertensive COVID-19 group and non-hypertensive COVID-19 group.

Results:

Among 2488 COVID-19 positive patients, 58.6% (1459) were hypertensive and 41.4% (1029) were non-hypertensive. Mean age of the COVID-19 positive hypertensive group was 56.38 ± 11.93 years and the non-hypertensive COVID-19 positive group was 41.65 ± 17.07 years (p = 0.001). In-hypertensive COVID-19 positive group, 71.8% patients were male and 28.2% were female & in non-hypertensive COVID-19 positive group, 60.1% patients were male and 39.9% were female (p = 0.001). In comparison to non-hypertensive COVID-19 positive patients, hypertensive COVID-19 positive patients were predominantly smoker (38.1% vs 19.8%; p = 0.001), diabetic (57.4% vs 15.1%; p = 0.001), dyslipidemic (31.9% vs 16.1%; p = 0.001), have positive family history of ischemic heart disease (IHD) (12.9% vs 7.8%; p = 0.001). Hypertensive COVID-19 positive patients had more symptomatic presentation (74.2% vs 66.6%; p = 0.001), more severe form of the disease (8.2% vs 3.6%; p = 0.001), higher in-hospital acute left ventricular failure-12.3% vs 5.5%; p = 0.001), in-hospital cardiogenic shock (3.8% vs 1.6%; p = 0.001) and in-hospital death (4.7% vs 2.9%; p = 0.02).

Conclusions:

Hypertensive COVID-19 positive patients were predominantly smoker, diabetic, dyslipidemic, have positive family history of IHD, had more symptomatic presentation, more severe form of disease, higher in-hospital complications & in-hospital death.
PRE-DISCHARGE SYSTOLIC BLOOD PRESSURE IN HOSPITALIZED COVID-19 PATIENTS IS AN INDEPENDENT PREDICTOR OF IMROVEMENT IN 6-MINUTE WALK TEST DURING 1-MONTH FOLLOW-UP
Authors: Honchar Oleksii , Ashcheulova Tetyana
Published: June 2023

Objective:

To study the relation of hypertensive status and systolic blood pressure (SBP) pre-discharge values to the dynamics of functional re-conditioning as assessed by 6-minute walk distance during the 1-month follow-up after hospitalization for COVID-19.

Design and method:

6-minute walk distance (6MWD) was assessed pre-discharge in 176 patients hospitalized for COVID-19 (40% hypertensive, 47% male, mean age 53,2 ± 13,5 years) using the 20 m walkway and an extended protocol that included monitoring of peripheral pulse and capillary blood oxygen saturation (SpO2) every 30 seconds via bluetooth-connected pulse oximeter. The repeated evaluation was performed after 1 month of follow-up.

Results:

Hypertensive participants were characterised by older age (57,8±11,8 vs 50,7±13,9, p < 0,001), higher weight and body mass index (31,7±5,3 vs 27,4±4,4 kg/m2, p < 0,001). As a result, 6MWD in them was shorter (378±57 vs 418±75 m, p = 0,001) but no difference in reached percent of predicted distance (6MWD%) was detected (63,0±8,5 vs 63,2±11,1 %, p = 0,939). The described relation persisted at 1 month, with no difference in absolute (72±43 vs 68±43 m, p = 0,324) and percentage gain of 6MWD (12,8±6,6 vs 11,2±7,5 %, p = 0,266) between groups.

Multiple regression analysis has allowed to build the model that accounted for 94% of variability in the 6MWD% gain between visits (85% for dedicated hypertensive cohort model). After adjustment for age, sex, height, weight, Remdesivir treatment, minimal SpO2 levels during acute COVID-19, changes of SpO2 and pulse rate throughout the 6MWT, SBP remained a potent independent predictor of 6MWD% gain, with 10 mmHg higher values at baseline evaluation being associated with 21,5% lesser 6MWD% gain in hypertensive subjects and 8,2% lesser – in normotensives.

Conclusions:

Hypertensive status did not have an impact on 6MWD% in pre-discharge COVID-19 patients. Moderate-to-high quality multiple regression models have demonstrated an independent role of SBP, demographic and anthropometric data, changes of SpO2 and pulse rate throughout the 6MWT in prediction of 6MWD% gain during 1 month after discharge, both in hypertensive and normotensive patients.
THE IMPACT OF HYPERTENSION AND OTHER COMORBIDITIES ON THE SEVERITY AND OUTCOME OF COVID-19 INFECTION IN SUDANESE HOSPITALIZED PATIENTS AT JABRA ISOLATION CENTRE 2021
Authors: Beheiry Hind , Elhassan Marwa , Almarrani Zakarya , Hazaa Shehab , Abdulsamad Gaafar , Ahmed Doaa , Moheieldin Mariam , Alhaj Waleed , Farhan Osman , Jaber Mohammed , Ali Zein , Elhadi Hussam , Daffalla Shima , Abdelwahab Omar , Ali Ibtisam , Shaheen Mahasin
Published: June 2023

Objective:

Covid-19 has rapidly spread throughout the globe ever since it was declared as a pandemic in March 2020, it was associated with increased morbidity and mortality worldwide. In Sudan, (3rd January 2020 - 27th January 2023) there had been 63,736 confirmed cases of COVID-19 with 5,001 deaths, reported by WHO.

Objective:

To measure the effects of Hypertension and other comorbidities on the severity and outcome of COVID 19 hospitalized patients at Jabra Isolation Centre.

Design and method:

A descriptive hospital-based study conducted in 2022 based on 2021 records at Jabra COVID-19 Isolation Centre/Sudan. The severity was assigned according to the hospital based categorized zones at Jabra Centre, and shown on admission sheets either to ICU red, HDU yellow, or floor green zones.

Results:

308 patients were enrolled, 197 (64%) were males; and 132 (42.9%) were hypertensive, 122 (39.6%) were diabetic, 25 (8.1%) had a cardiac disease, 23 (7.5%) had a kidney disease, 16 (5.2%) were asthmatic, 12 (3.9) had a thyroid disease, 11 (3.6%) had a cerebrovascular disease, and 7 (2.3%) had a history of a malignant disease. It was found that about 172 (55.8%) of the hospitalized patients were >60 years. All deaths were 177 (57.5%); of which 74 (41.8%) were hypertensive, 62 (35%) were diabetic, 17 (9.6%) of the death had cardiovascular disease, 16 (9%) had kidney disease, 9 asthmatic patients and 9 cerebrovascular disease patients died respectively. By age distribution, 105 (59.3%) of all deaths were >60 years; 80 (45.2%) of total deaths were ICU admitted patients. There was a significant association between the age and severity (P 0.017); and between the severity and the outcome (P 0.002).

Conclusions:

The presence of Hypertension and other comorbidities led to increased adverse outcomes in the hospitalized Covid-19 patients. The deaths were (57.5%) of which the hypertensive was (41.8%) and the diabetic were 35%. There was significant association between the severity the disease and the outcome, and the age and the severity.
COMORBIDITIES AND MORTALITY IN PATIENTS WITH COVID-19 AMONG AGED 18 YEARS AND OLDER IN DILCHORA HOSPITAL-DIRE DAWA, EASTERN ETHIOPIA, 2022
Authors: Ayele Dagmawi Abebe , Roba Hirbo Shore
Published: June 2023

Objective:

To describe the outcome and assess factors associated with mortality among hospitalized COVID-19 adult patients with chronic diseases in Dilchora hospital, Dire Dawa, Eastern Ethiopian, 2022

Design and method:

A retrospective cohort study was used. Data was collected using a data extraction form by reviewing medical records of all hospitalized adult COVID-19 patients from May 3, 2021-January 26, 2022. The data extraction form consists of demographic and clinical information. Descriptive statistics were used to summarize data, mean, frequency, and percentages were used. Multivariate binary logistic regression was applied to assess the factors associated with mortality. Adjusted Odds ratio (AOR) with 95% CIs were used. Variables with a p-value of <0.05 were considered statistically significant.

Results:

A total of 196 COVID-19 positive patients were included in the study. More than half, 107 (54.6%) were male. The mean age of the patients was 51 (SD = 17). 154 (78.6%) were urban residents. Of these, 46 (23.5%) patients died. Only 3 (1.5%) of them were fully vaccinated. Nearly half, 92 (47%) of patients had preexisting comorbidity. The most common comorbidities were diabetes 26 (28.3%), hypertension 23 (25%), and congestive heart failure 18 (19.6%). 33 (71.7%) of dead patients had comorbidity. Factors that were associated with higher odds of mortality were advanced age > = 60 years (AOR 5.3, 95% CI 1.63-17.38), urban residence (AOR 5.2, 95% CI 1.21-22.43), presence of comorbidities (AOR 2.66, 95% CI 1.02-6.99), and severity (AOR 12.93, 95% CI 4.26-39.30).

Conclusions:

COVID-19 patients with chronic non-communicable diseases faced a higher risk of in-hospital mortality. We recommend implementing aggressive preventive strategies including vaccination to combat COVID-19 targeting older adults, urban areas, and patients with chronic diseases comorbidity as a priority.
FACTORS ASSOCIATED WITH DYSGLYCEMIA AND ITS POST-SURGICAL RESOLUTION IN PATIENTS WITH PHEOCHROMOCYTOMAS AND PARAGANGLIOMAS
Authors: Zhao Lin , Zhang Ting , Fan Hua , Liu Yecheng , Zhou Xianliang , Zhu Huadong
Published: June 2023

Objective:

Pheochromocytomas and paragangliomas (PPGLs) are a group of rare neuroendocrine tumors. Dysglycemia has been observed in patients with PPGLs in some small case series. However, few large studies, and none in China, have described the outcomes of dysglycemia after resection, and the factors associated with the development and resolution of dysglycemia in patients with PPGLs.

Design and method:

We retrospectively analyzed the clinical data of consecutive patients with PPGLs admitted between January 2018 and June 2020. Clinical characteristics were compared between patients with and without dysglycemia. Multivariable logistic regression analysis was used to identify independent predictors and the receiver operating characteristic curves was used to evaluate the diagnostic performance of the variables.

Results:

Among 163 patients in this study, 47.9% had preoperative dysglycemia. Patients with dysglycemia were older at diagnosis and have a higher proportion of hypertension. The white blood cell count and 24-hour urinary epinephrine (24hU-E) concentration were higher in patients with dysglycemia. Multivariable logistic regression analysis showed that age [odds ratio (OR), 1.040; 95% confidence interval (CI), 1.011–1.070; p = 0.006], hypertension (OR, 3.318; 95% CI, 1.375 – 8.009; p = 0.008), and 24hU-E concentration (OR, 1.013; 95% CI, 1.005 –1.022; p = 0.016) were independent predictors of preoperative dysglycemia. Taking age, hypertension and 24hU-E into account in the same model, the area under the receiver operating characteristic curve of the model for predicting preoperative dysglycemia was 0.737. The proportion of patients with dysglycemia was significantly decreased after surgery (p < 0.001) and patients with postoperative dysglycemia in remission had larger preoperative tumor diameters (p = 0.005).

Conclusions:

Dysglycemia affects almost half of patients with PPGLs. Age, hypertension, and 24hU-E concentration are predictors of preoperative dysglycemia. Removal of PPGLs can improve dysglycemia in most patients, and the postoperative remission of dysglycemia is associated with the preoperative tumor diameter. These results are of great importance for risk assessment and selection of optimal therapy of dysglycemia in patients with PPGLs.
NET CLINICAL BENEFIT OF DIRECT ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION PATIENTS WITH OR WITHOUT DIABETES MELLITUS: A META-ANALYSIS OF OUTCOME TRIALS
Authors: Drogkaris Sotirios , Thomopoulos Costas , Andrikou Ioannis , Liatakis Ioannis , Tatakis Fotis , Siafi Eirini , Grigoriou Kalliopi , Zammanis Ioannis , Kolokathis Konstantinos , Iliakis Panagiotis , Kariori Maria , Kouremeti Maria , Mantzouranis Manos , Kalos Theodoros , Tsoumpou Ioanna , Leontsinis Ioannis , Chalmoukou Konstantina , Konstantinidis Dimitrios , Tsioufis Konstantinos
Published: June 2023

Objective:

To evaluate the net clinical benefit following direct oral anticoagulants (DOACs) vs. warfarin by diabetes status in patients with non-valvular atrial fibrillation.

Design and method:

We searched 3 electronic databases through end-February 2021 to identify relevant outcome trials in patients with and without diabetes mellitus (DM). All-cause death, non-fatal stroke/systemic embolism, and major bleeding events defined net clinical benefit. In addition, outcome risk ratios and 95% confidence interval (CI), and absolute risk outcome reduction per 1000 treated patients were assessed.

Results:

Four trials of DOACs vs. warfarin compared 22,087 patients with DM to 49,592 patients without DM. CHADS2 and 10-year fatal cardiovascular risk were higher in patients with vs. those without DM (3.7 vs. 2.5 and 28.4% vs. 23.4%, respectively). DOACs were associated with more favorable net clinical benefit compared to warfarin in patients with and without DM (relative risk reduction, 0.85 [95% CI] and 0.87 [95% CI]; absolute risk reduction per 1000 patients treated, 33 [95% CI] and 24 [95% CI}. However, the interaction test was not significant by relative and absolute numbers (P = 0.68 and P = 0.44, respectively).

Conclusions:

The net clinical benefit following DOACs was not different between patients with and without DM over 2.2 years.
ASSOCIATION OF AMBULATORY BLOOD PRESSURE PARAMETERS WITH CAROTID DAMAGE IN PATIENTS WITH TYPE-2 DIABETES/PRE-DIABETES AND HYPERTENSION
Authors: Menti Ariadni , Kollias Anastasios , Kyriakoulis Konstantinos , Ntousopoulos Vasileios , Bountzona Ioanna , Theodosiadi Aikaterini , Stathopoulou Panagiota , Ntineri Angeliki , Stergiou George S.
Published: June 2023

Objective:

This study investigated the association between ambulatory blood pressure (ABP) parameters and carotid damage in patients with type-2 diabetes/pre-diabetes and hypertension.

Design and method:

Adults with hypertension and type-2 diabetes/prediabetes were subjected to (i) 24-hour ABP monitoring (20 min intervals, Microlife WatchBPO3) and (ii) estimation of preclinical carotid damage (ultrasound carotid intima-media thickness [cIMT] and carotid plaque score [CPS]). BP variability was quantified using the standard deviation (SD) and coefficient of variation (CV).

Results:

Seventy individuals were analyzed [age 65.2±9.7 years, 47 men, body mass index (BMI) 31.6±4.8 kg/m2, HbA1c 6.6±0.8%, 86% diabetics, average 24-hour ABP (systolic/diastolic) 123±12/69±7 mmHg, cIMT 0.8±0.2 mm, CPS 5.4±4.7 mm]. There was a significant correlation between 24-hour/daytime systolic ABP and cIMT (r = 0.34/0.34 respectively, p<0.01) and CPS (r = 0.26/0.25 respectively, p<0.05). 24-hour/daytime/nighttime pulse pressure was associated with cIMT (r = 0.39/0.41/0.28 respectively, p<0.05) and CPS (r = 0.26/0.28/0.23, p< = 0.05). No significant association was found between indices of carotid damage and SD or CV of systolic ABP. Stepwise multivariable regression analysis with age, sex, BMI, smoking and daytime pulse pressure as independent variables, revealed that cIMT was determined by the daytime pulse pressure and age (R2 = 0.27), whereas CPS was determined by daytime pulse pressure and smoking (R2 = 0.23).

Conclusions:

These preliminary data suggest that in patients with type-2 diabetes/pre-diabetes and hypertension ambulatory pulse pressure might have a critical role in the development of carotid damage.
RESTRICTED PROTEOLIS AND OXIDIZING MODIFICATION OF PROTEINS IN HEPATOCYATES OF PATIENTS WITH DIABETES AND TUBERCULOSIS
Authors: Semianiv Ihor , Todoriko Liliia , Semianiv Marianna , Sukholitky Yuriy
Published: June 2023

Objective:

The objective of the work is to investigate the oxidative modification of proteins and limited proteolysis in hepatocytes in patients with diabetes and pulmonary tuberculosis.

Design and method:

A prospective pathomorphological study of 60 cases of death of patients who died of various causes, in which in the final clinical and pathologoanatomical diagnosis as the main disease appeared pulmonary tuberculosis. Depending on clinical forms and variants of tuberculosis, the main group was divided into three subgroups.

Results:

An important role in the pathogenesis of the formation of both diabetes mellitus and tuberculosis play an impairment of immune homeostasis, especially in patients with expressive symptoms of exacerbation of the disease and prolonged relapse. Oxidative stress leads to an increase in the production of active forms of oxygen and as a consequence - oxidation modification of proteins (OMB): their aggregation and fragmentation, which is accompanied by irreversible changes in the physical, chemical and biological properties of the protein molecule.

Taking into account the different functional activity of hepatocytes of different zones of the acinus (according to Rappoport) according to their own research, the R / B coefficient (specific coloration on acid and main proteins for Michel Calvo) and average values of relative units of optical density of a specific color on the free amino group of proteins for A. Yasuma and T. Ichikava were determined separately in the hepatocytes of the first, second and third zones and established the linear nature of the increase in the intensity of the oxidative modification of proteins and limited proteolysis from the 1st to the 3rd zone (from peripartal to centrolobular branches of acinus) in patients with resistant forms of tuberculosis.

Conclusions:

Diabetes mellitus in patients with lung tuberculosis leads to increased processes of free radical oxidation of proteins with characteristic effects - increased proteolysis and oxidation of amino groups of proteins – in hepatocytes of the liver.
SEPTAL AND LEFT ATRIAL VOLUME INDEX AS PREDICTORS FOR HFPEF AMONGST TYPE 2 DIABETES MELLITUS PATIENTS
Authors: Radzi Ahmad Bakhtiar Md , Kasim Sazzli Shahlan
Published: June 2023

Objective:

The aim of this study is to determine the prevalence and determination of risk factors of heart failure with preserved ejection fraction (HFpEF) diagnosed based on the consensus recommendation from the Heart Failure Association (HFA) and European Society of Cardiology (ESC) 2019 in type 2 diabetes mellitus (T2DM) patients in Malaysia.

Design and method:

We conducted a cross sectional study on patients with T2DM of more than 18 years old that were under Hospital UiTM follow-up from December 2021 until May 2021 (6 month). The participants were chosen via simple random sampling. Data's on demographic data, comorbid profile, symptoms and clinical examination including vitals sign, chemical profile and proceed with echocardiography and NTproBNP test to diagnosed HFpEF.

Results:

201 diabetic patients were recruited and screened for HFpEF. 40 patients were confirmed with the diagnosis of HFpEF. Mean age was 61 ± 5.4 years. A significant difference in mean septal e’ was found between diabetic patients with HFpEF (5.5 ± 1.5 cm/s) and non-heart failure subjects (7.6 ± 1.0 cm/s)(p<0.001, 95% CI -2.40,-1.49). There was also significant difference in mean left atrial volume index (LAVI) between diabetic patients with HFpEF (35.5 ± 1.5 ml/m2) and non-heart failure subjects (28.6 ± 1.0 ml/m2)(p<0.001, 95% CI -2.50,-1.33). A stepwise increase in cortisol level corresponding to NTproBNP was observed(p<0.061). Basal septal hypertrophy was seen in 30% of HFpEF diabetic patients (p<0.081). Multiple linear regression analysis revealed septal e’ and LAVI as independent predictors of HFpEF in diabetic patients (r2 = 0.249, p<0.001).

Conclusions:

One fifth of diabetic population had HFpEF and specific echocardiography parameters including septal e’ and LAVI were predictors for HFpEF. Emerging early imaging and chemical biomarkers for HFpEF such as basal septal hypertrophy and cortisol should be further studied.
PREDICTIVE FACTORS OF MACROANGIOPATHY IN HYPERTENSIVE DIABETIC PATIENTS WITH VITAMIN D DEFICIENCY
Authors: Cherif Abdelghani Bachir , Bennouar Salam
Published: June 2023

Objective:

Several studies have shown an association between low levels of 25-hydroxyvitamin D and an increased risk of cardiovascular disease. Cardiovascular complications are the most prevalent cause of mortality in patients with type 2 diabetes mellitus and hypertension. The aim of our study was to determine the risk factors related to macroangiopathy among hypertensive diabetic patients with vitamin D deficiency.

Design and method:

Retrospective study, conducted on 1756 type 2 diabetics with hypertension in whom a vitamin D assay was done in the internal medicine department in the area of Blida during the period from April 2020 to November 2022.

Results:

63.1% of patients had high blood pressure at the first examination. In addition, hyperuricemia was present in 39.8% patients, NASH (non-alcoholic fatty liver disease) was also present in 34.6% patients, hypertriglyceridemia in 48.3% patients, hypercholesterolemia in 60.2% patients and mixed dyslipidemia in 46.7% patients. Microalbuminuria, as a cardiovascular risk factor was positive in 39.2% patients. 61 % patients had at least one macrovascular complication. The univariate analysis showed a significant association between macroangiopathy and male gender (p = 0.029), HbA1c > 9.5% (p = 0.008), the cumulative number of cardiovascular risk factors > 5 (p 24 pg / mL (p = 0.007). Multivariate regression analysis showed that cumulative cardiovascular risk factors > 5 (OR = 13.9 [95% CI: 1.4 -137.6], p = 0.024), presence of microangiopathy (OR = 22 [95% CI: 2.2 - 215.4], p = 0.008) and HbA1c > 9.5% (OR = 36.6 [95% CI: 2.6 - 505]; p = 0.007) were predictor factors of macroangiopathy among patients with type 2 diabetes mellitus and Vitamine D deficiency.

Conclusions:

In hypertensive diabetic patients, cardiovascular diseases were the consequence of the additive effects of traditional risk factors with the participation of vitamin D deficiency.
AMBULATORY BLOOD PRESSURE MONITORING BEFORE AND AFTER TREATMENT IN SECONDARY FORMS OF HYPERTENSION
Authors: Stojanovic Milos , Miletic Marija , Gajic Milina Tancic , Ivovic Miomira , Marina Lilja , Ciric Jasmina , Nedeljkovic Biljana Beleslin , Stojkovic Mirjana , Zarkovic Milos , Vujovic Svetlana
Published: June 2023

Objective:

Studies using ambulatory blood pressure (BP) monitoring (ABPM) have reported that in some secondary forms of hypertension the normal nocturnal BP decrease is blunted.

Design and method:

The aim of our study was to compare the nocturnal BP decrease in patients with secondary hypertension before and after treatment. ABPM was performed using the validated Meditech ABPM-06. ABPM readings were obtained at 30-minute intervals for 24-hour in patients with secondary hypertension before and after treatment. The diagnosis of secondary hypertension was based on the history and laboratory data: plasma and urinary electrolytes, renal function, calcium-phosphorus system, the renin-angiotensin-aldosterone system, urinary free cortisol, suppressibility of cortisol after 1 mg dexamethasone, plasma adrenocorticotropic hormone, plasma D4 androstenedione, plasma dehydroepiandrosterone sulphate, plasma 17-alpha hydroxyprogesterone, plasma testosterone, and urinary metanephrine. BP decrease were studied in the following groups: 42 patients with primary aldosteronism (19 men and 23 women; mean age, 44±12 years), 25 patients with adrenal pheochromocytoma (11 men and 14 women; mean age, 42±13 years), and 55 patients with Cushing's syndrome (18 men and 37 women, mean age, 43±13 years).

Results:

Average systolic/diastolic BP decrease was: before 2/1 mmHg and after 8/6 mmHg treatment in patients with primary aldosteronism. Average systolic/diastolic BP decrease was: before 4/5 mmHg and after 9/12 mmHg treatment in patients with adrenal pheochromocytoma. Average systolic/diastolic BP decrease was: before 3/2 mmHg and after 11/9 mmHg treatment in patients with Cushing's syndrome. All differences in systolic/diastolic BP decrease were statistically significant, with a P value <.001

Conclusions:

The results of our study confirm that secondary causes of hypertension lead to a reduced decrease in blood pressure during sleep. After proper treatment reduction in nighttime BP normalizes. A detailed analysis of ABPM can lead us to find the accurate etiology of hypertension.
RISK FACTORS FOR INTRAOPERATIVE AND POSTSURGICAL HYPERTENSIVE CRISIS IN PATIENTS WITH PHEOCHROMOCYTOMAS AND SYMPATHETIC PARAGANGLIOMAS: RESULTS FROM THE PHEO-RISK STUDY
Authors: Araujo-Castro Marta , Sanz Iñigo García , Ojeda Cesár Minguez , Calatayud María , Hanzu Felicia , Vidente Almudena , Carrera Concepción Blanco , Novoa Paz De Miguel , Manjón-Miguelez Laura , Lamas Cristina , Centeno Rogelio García
Published: June 2023

Objective:

To identify presurgical and surgical risk factors for intraoperative and postoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas (PGLs) (PPGLs).

Design and method:

A retrospective multicenter cohort study of patients with PPGLs from 18 tertiary hospitals was performed.

Results:

A total of 296 surgeries performed in 289 patients with PPGLs (276 pheochromocytomas and 13 sympathetic PGL) were included. Laparoscopic PPGL resection was performed in 85.1% (n = 252) of the whole cohort. Alpha presurgical blockade was employed in 93.2% of the cases (n = 276) and beta-adrenergic in 53.4% (n = 158). Phenoxybenzamine was the treatment of choice in 126, doxazosin in 148 and the other 7 were treated with amlodipine and 4 with other antihypertensive drugs. Presurgical intravenous volume expansion was performed in 79% (n = 218) of the cases. In addition, 77.2% (n = 169/219) received oral sodium repletion. Hypertensive crisis occurred in 20.3% (n = 60) of the surgeries: intraoperative crisis in 56 and postoperative crisis in 6 cases. We identified as risk factors of hypertensive crisis (intraoperative and postoperative), a higher presurgical body mass index (BMI) (OR 1.16 per each kg/m2 increase CI 1.01-1.33) and HbA1c levels (OR 3.79 per each unit increase, CI 1.44-9.99), presurgical glucocorticoid therapy (OR 2.9, CI 1.08-7.59), higher presurgical SBP (OR 1.22 per each 10-mmHg increase, CI 1.03-1.45) and absence of oral sodium repletion (OR 2.3, CI 1.11-4.65). Patients with hypertensive crisis had a higher rate of intraoperative bleeding (18.3% vs. 3.4%, P<0.001), intraoperative hemodynamic instability (36.7% vs. 8.5%, P<0.001) and of intraoperative hypotensive episodes (41.7% vs. 11.4%, P<0.001) than those without hypertensive crisis. Hospital stay was longer in patients experienced hypertensive crisis (9.7 vs. 6.8 days, P = 0.007) than those without crisis

Conclusions:

Intraoperative and postoperative hypertensive crisis occurs in up to 20% of the PPGL resections. Patients with higher BMI, HbA1c levels, pretreated with glucocorticoid therapy before surgery, with higher presurgical SBP and who do not receive oral sodium repletion had a higher risk for developing hypertensive crisis during and after PPGL surgery.