bluuebunny/crossref_metadata_2025_split huggingface dataset:
SKIN CAPILLARY ALTERATIONS IN PATIENTS WITH ACUTE SARS-COV-2 INFECTION
Authors: De Ciuceis Carolina , Rosei Claudia Agabiti , Brami Valeria , Rossini Claudia , Gaggero Andrea , Fama’ Francesca , Muiesan Maria Lorenza , Rizzoni Damiano 
Published: April 2021

Objective:
Acute SarsCoV2 infection is associated with endothelial dysfunction and endothelitis which might explain systemic microvascular impairment. The presence of endothelial damage can promote vasoconstriction with consequent organ ischemia, inflammation, tissue edema and a procoagulant state resulting in an increase in the incidence of cardio- and cerebrovascular events. Microvascular thrombosis has been demonstrated in post-mortem autopsy of COVID19 patients; however no data are available about skin capillary alterations in these patients.

Design and method:
We evaluated skin microvascular alterations in 14 patients admitted to our hospital with SarsCov2 infection. Basal capillary density was performed by capillaroscopy bedside in the nailfold and in the dorsum of the 4th finger.

Results:
Fourteen patients (9 males, 5 females) were evaluated: average age was 66 ± 1 years, BMI 26 ± 3. Nine patients were hypertensive (64%), 4 diabetic (29%), 3 were dyslipidemic (21%), 3 with cerebrovascular or cardiovascular disease history (21%). Seven patients were treated with ev steroid (50%), 3 with tocilizumab (21%) and 7 were treated with non-invasive ventilation (50%).
During the hospitalisation all patients presented interstitial pneumonia SarsCov2 associated whereas vascular complication (ischaemic stroke or pulmonary embolism) were observed in 3 patients (21%) with SarsCov2 infection. Nine patients showed skin capillary alterations (5 thrombosis, 5 haemorrhage/microbleeding, 4 neoangiogenesis). Interestingly, capillary alterations were present only in patients treated with non-invasive ventilation and/or with cardio- or cerebrovascular complications. These alterations were not detected after 2 month from the discharge.

Conclusions:
This is the first in vivo evidence of skin capillary thrombosis, microhaemorragia and angiogenesis in patients with acute SARS-CoV2 infection which support the presence of endothelial dysfunction and inflammation. Capillary alterations might reflect systemic vascular effects of viral infection.
ROLE OF HYPERTENSION, CARDIOVASCULAR DISEASE AND CARDIOVASCULAR RISK FACTORS ON OUTCOME IN HOSPITALIZED COVID-19 PATIENTS
Authors: Chiarini Giulia , Boari Gianluca E.M. , Bonetti Silvia , Orlandini Federico Braglia , Malerba Paolo , Bianco Gianluca , Faustini Cristina , Rizzoni Damiano 
Published: April 2021

Objective:
Emerging data show that hypertension as well as other cardiovascular risk factors may have a major role on outcome in terms of death on patients with COVID-19. We analysed a population of 258 consecutive patients admitted to General Medicine ward of the Hospital of Montichiari (Brixia, Italy) from 29 February to 30 April 2020.

Design and method:
A group of 258 consecutive patients (173 males and 85 females, aged 71 ± 14) was enrolled. In 168 patients, high-flow oxygen was required (Venturi mask), 20 patients needed orotracheal intubation and 11 were given continuous positive pressure oxygen therapy (CPAP). Patients were treated with the best approach according to available evidence during pandemic period: anti-malaria agents, anti-viral drugs, antibiotics (azithromycin and others), tocilizumab and low molecular weight heparin (LMWH). As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test.

Results:
As shown in the table, a significant raise in mortality was observed in patients older than 65 years (p < 0.001), of male sex (p < 0.001), hypertensives (p < 0.001) as well as in patients with heart disease (picture 1; p < 0.001), COPD (picture 2; p = 0.004), diabetes (p < 0.001) and neoplasms (p = 0.03) compared with patients with no comorbidities or different diseases, both at discharge and at standard follow-up. The number of comorbidities impacted on survival as well.

Conclusions:
Hypertension, heart disease and cardiovascular risk factors play a significant role as a negative prognostic factor in patients affected by SARS-CoV-2 pneumonia. This confirms previous observations (Pol Arch Intern Med 2020;130(4):304–309) and outlines the importance of prevention of contagion in population with cardiovascular risk factors or established cardiovascular disease.
LOW MOLECULAR WEIGHT HEPARIN AT HIGH DOSE IMPACTS ON OUTCOME OF COVID-19 HOSPITALIZED PATIENTS, WHILE STANDARD DOSE DOESN’T
Authors: Bonetti Silvia , Boari Gianluca E.M. , Chiarini Giulia , Faustini Cristina , Bianco Gianluca , Braglia-Orlandini Federico , Malerba Paolo , Rizzoni Damiano 
Published: April 2021

Objective:
COVID-19 is a new disease caused by pandemic SARS-CoV-2, that involves multiple organs and can cause a potentially fatal respiratory distress syndrome. Accumulating evidence point out that an “endothelitis” due to a cytokines storm causes intravascular thrombosis, especially in the lungs, and is related to the poor outcome.
We tested possible relationships between anticoagulant treatment and/or administration of low molecular weight heparin (LMWH) at different doses and outcome in a population of 258 COVID-19 patients admitted from February 28th to April 30th, 2020 to General Medicine ward of the Hospital of Montichiari (Brixia, Italy).

Design and method:
A group of 258 consecutive patients (174 males and 84 females, mean age 71 years +/- 14) was included in the present study. In 168 patients, high-flow oxygen was required (Venturi mask), 6 patients needed orotracheal intubation and 20 were given continuous positive pressure oxygen therapy (CPAP). Patient were treated (unless a pulmonary embolism was detected) with different doses of prophylactic LMWH, according to emerging evidence during pandemic period. As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test.

Results:
LMWH at standard dose (4000 IU once daily) didn’t reduce mortality compared to no treatment (p = ns), while LMWH at a higher dose than usual prophylactic dose (enoxaparin 6000 IU once daily or 4000 IU bid) was associated with better outcome (p < 0.001 vs untreated and treated with standard dose). Significance was confirmed adding patients treated with oral anti-coagulant (OAC)for any reason. None of the patients treated with LMWH at higher doses or OAC died.

Conclusions:
The administration of subcutaneous LMWH at a higher dose than indicated for deep vein thrombosis prophylaxis is associated with a better outcome in patients with SARS-CoV-2 pneumonia, confirming some emerging evidence.
EFFECT OF ONGOING TREATMENT AND DIFFERENT THERAPIES ON PROGNOSIS IN COVID-19 PATIENTS IN AN HOSPITAL SETTING
Authors: Bianco Gianluca , Boari Gianluca E.M. , Bonetti Silvia , Chiarini Giulia , Orlandini Federico Braglia , Faustini Cristina , Malerba Paolo , Rizzoni Damiano 
Published: April 2021

Objective:
Patients affected by novel pandemic SARS-CoV-2 may develop COVID-19 related pneumonia, which is potentially fatal. To date, the role of ongoing treatments for different conditions (such as hypertension) has been clarified in terms of their impact on survival and there is no established specific therapy for the disease, although many molecules are under investigation. Aim of the present study was testing those two issues in a population of 258 consecutive patients admitted from 29 February to 30 April 2020 to General Medicine ward of the Hospital of Montichiari (Brixia).

Design and method:
A group of 258 patients (173 males and 85 females, aged 71 ± 14) was enrolled. Their medical record and ongoing treatment were assessed. Patients were treated according to emerging information with oxygen, anti-malarian agents, anti-viral drugs, different antibiotics (azithromycin and others), tocilizumab and low molecular weight heparin (LMWH) at different doses. As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test

Results:
Ongoing therapy with ACE-inhibitors at the time of admission was associated with a worse prognosis (p = 0.004), while no difference in survival was observed in patients under treatment with ARBs (p = 0.68). Ongoing treatment with statins (p < 0.001), low-dose aspirin (p < 0.001) and steroids (p < 0.001) was associated with a poorer outcome as well
Administration during hospitalization of LMWH (p < 0.001), steroids (p < 0.001), anti-viral drugs (p = 0.002), anti-malarian drugs (p < 0.001) and tocilizumab (p < 0.001), improved prognosis, while antibiotics (azithromycin and other) didn’t have any impact.

Conclusions:
our experience confirms most findings in ongoing trials. Surprisingly, treatment with ACE-inhibitors seems to impact negatively on survival in patients affected by SARS-CoV-2 pneumonia. A possible explanation may be that patients treated with certain drugs are more comorbid and due to this, more fragile.
THE INFLUENCE OF LIRAGLUTIDE ON THE LEVEL OF BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION AGAINST THE BACKGROUND OF OBESITY AND TYPE 2 DIABETES MELLITUS
Authors: Zhuravlyova Larysa , Rogachova Tetyana , Sokolnikova Nelya , Filonenko Maryna 
Published: April 2021

Objective:
To assess the effect of liraglutide (L) on the level of blood pressure (BP) in patients with arterial hypertension (AH) and obesity against the background of type 2 diabetes mellitus (T2DM).

Design and method:
A total of 55 patients with stage II AH and concomitant non-severe T2DM were examined (fasting plasma glucose <12 mmol/L, glycosylated hemoglobin (HbA1c) - 8.75 ± 1.4%, disease duration 6.4 ± 1.8 years, mean age 51.4 ± 2.7, BMI 35.2 ± 2.6 kg/m2, mean BP 165/103 ± 3.4/2.2 mm Hg). Patients were distributed into 2 groups: the comparison group consisted of 22 patients who received metformin 850 mg 2/day, lisinopril 10 mg 1/day and amlodipine 10 mg 1/day. Patients of the main group (L-group, n = 23), received liraglutide 1.8 mg in addition to similar therapy.

Results:
6 months after the initiation of therapy, the following results were obtained: HbA1C in the L group was 6.35 ± 0.5%, and in the comparison group - 7.78 ± 0.45% (p < 0.05). BMI in the L-group was 30.28 ± 1.1 kg/m2, and in the comparison group - 32.5 ± 1.2 kg/m2. Systolic blood pressure (SBP) in the L-group was 132 ± 8.23 mm Hg., and in the comparison group - 143.5 ± 10.15 mm Hg., p < 0.05 of difference between groups. The diastolic blood pressure (DBP) in the L- group was 84.5 ± 3.7 mm Hg, and in the comparison group - 89 ± 5.5 mm Hg, significant differences were not identified.

Conclusions:
A significant decrease in SBP during treatment with liraglutide in patients with hypertension against the background of obesity and type 2 diabetes can be due to both significant loss of body weight and an improvement of metabolic control. The obtained data suggest that liraglutide has a potential to reduce cardiovascular risk in hypertensive patients with obesity and diabetes.
THE ASSOCIATION BETWEEN ARTERIAL STIFFNESS AND CIRCULATING ADIPOKINE IN PATIENTS WITH TYPE 2 DIABETES AND COMORBID OVERWEIGHT OR OBESITY
Authors: Varahabhatla Sai Krishna Ragh , Soloviuk Oleg Olegovich , Soloviuk Olena , Nazarenko Elena 
Published: April 2021

Objective:
Omentin-1 is a circulating adipokine with anti-inflammatory, anti-atherosclerotic, cardioprotective effects. It is hypothesised that reduced levels of omentin-1 is connected with increase in arterial stiffness, thus leading to the rise in acute vascular events. A strong relationship between arterial stiffness and the levels of circulating omentin-1 in patients with diabetes mellitus type 2 (DM-2) and comorbid overweight or obesity was adapted from literature which necessitated for this study.

Design and method:
98 patients with diabetes mellitus type 2 were examined, of which 64 patients (34 women and 30 men) with comorbid overweight or obesity (BMI more than 25), included in the 1st group, 34 patients with normal body weight (19 women and 1 5 men) were in the 2nd group at the Regional Hospital, Zaporizhzhia. As a control, 28 practically healthy individuals were examined, comparable with the 1st and 2nd groups by age and sex. The levels of circulating Omentin-1 was determined by enzyme-linked immunosorbent assay and arterial stiffness was assessed by the pulse wave velocity (PWV) of the elastic and muscular arteries during rheovasography.

Results:
Results: In patients of the 1st group, the level of omentin-1 was 127.5% lower than in the 2nd group, with a longer duration of diabetes, the average values of omentin-1 were lower by 39.2% (p < 0.05) in Group 1 and 25.9% (p < 0.05) in group 2 compared with the control group. PWV in muscular arteries in the 2nd group was 15.7% higher than in the 2nd and 34.3% than in the control; Differences in elastic arteries were 10.6% and 30.5%, respectively. A relationship was established between the level of omentin-1, as well as PWV in the muscular (r = -0.56, p < 0.05) and elastic arteries (r = -0.47, p < 0.05).

Conclusions:
In patients with DM-2 and comorbid overweight or obesity, a decrease in the level of omentin-1 was noted, which was associated with high arterial stiffness leading to an increased cardiovascular mortality risk. Thus, omentin-1 is a potential biomarker and a new combined therapeutic target for metabolic and vascular diseases.
IS THERE A RELATIONSHIP BETWEEN NON-DIPPER PATTERN AND CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS WITH DIABETES?
Authors: Stojanovic Milovan , Deljanin-Ilic Marina , Ilic Stevan , Stojanovic Sanja 
Published: April 2021

Objective:
To determine the influence of diabetes mellitus (DM) on circadian blood pressure rhythm and to investigate is there a relationship between non-dipper pattern (ND) and cardiovascular events (coronary artery disease - CAD, stroke) in patients with DM and arterial hypertension.

Design and method:
184 consecutive hypertensive pts (92 men and 92 women, mean age 63.21 ± 12.62) were divided in two groups: 58 pts with type 2 diabetes mellitus (DM group) and 126 pts without diabetes (no-DM group). In all pts ambulatory blood pressure monitoring (AMBP) were performed. The values obtained by AMBP were compared between groups. ND pattern was defined as the absence of normal nocturnal fall of blood pressure (less than 10% and more than 20% compared to daily values).

Results:
Patients in DM group had higher systolic blood pressure (129.7 ± 17.4 vs 119.9 ± 11.5 mmHg, p = 0.001), higher values of the pulse pressure (58.7 ± 11.9 vs. 49.5 ± 9.0, p < 0.001) and larger burden of high blood pressure during AMBP (51.7% vs 22.2%, p = 0.001) in comparison to pts in no-DM group. Hyperlipidemia (84,5% vs. 70,6%; p < 0,05) and CAD (27,6% vs. 12,7%; p < 0,05) were more common in the DM than in no-DM group. Out of 184 hypertensive pts 129 pts were nod-dippers. There was borderline significant association between the ND pattern and CAD (20.9% vs. 9.1%, p = 0.058) but without significant association with stroke (6,2% vs 1,2%, p = 0.283). Prevalence of ND pattern was higher in DM group but without significant difference compared to no-DM group (75,9% vs 67,5%, ns). In patients with DM there was no significant association between ND pattern and CAD (31,8% vs 14,3%, p = 0,308) compared to dippers. Also, there was no significant association between ND pattern and stroke in pts with DM (6,8% vs 7,1%, ns).

Conclusions:
Our study showed that hypertensive pts with DM have inadequate regulation of blood pressure which results in higher values of systolic and pulse pressure and higher prevalence of non-dipping pattern than in hypertensive pts without DM, but failed to prove that there is a relationship between non-dipping pattern and cardiovascular events in patients with DM.
ARTERIAL STIFFNESS AND ITS CORRELATION WITH LABORATORY PARAMETERS AND INDICATORS OF OBESITY IN DIABETIC HYPERTENSIVE PATIENTS
Authors: Novak Ivana , Milin Sara , Nenadic Dora Bucan , Radic Josipa 
Published: April 2021

Objective:
Arterial stiffness can be assessed by a variety of non-invasive methods. One of the measures of arterial stiffness that has been used in clinic for some time now is pulse wave velocity (PWV). PWV can be measured with “Agedio B900” device which, in addition to measuring arterial pressure, gives information about arterial stiffness and cardiovascular age. The aim of this study was to evaluate correlations of PWV with age, laboratory parameters and indicators of obesity in Dalmatian diabetic hypertensive patients.

Design and method:
106 hypertensive diabetic patients, 66 (62.3 %) men and 40 (37.7%) women, aged 69.5 (range 36-94) years were included. For each patient data about age, gender, body weight and height were collected and BMI (body mass index), WC (waist circumference) and MUAC (mid-upper circumference) were calculated. Also, values of laboratory parameters such as haemoglobin (Hg), urea, creatinine, urate, albuminuria, cholesterol and triglycerides were taken for each patient. The Agedio B900 device was used for the measurement of arterial pressure and PWV calculation. Each study subject was measured with Tanita MC780 Multi Frequency segmental body composition analyser to record whole body and segmental measurements of body composition.

Results:
PWV was significantly higher in patients over 65 years old than those younger than 65. Among the laboratory parameters statistically significant correlation was found only between PWV and Hg (Rho= -0.365, p = 0.02). Among the indicators of obesity, only MUAC showed significant correlation (Rho = -0.316, p = 0.01). However, statistical significance was reached after making adjustments for age, eGFR, urea, creatinine and albuminuria. All of the variables of body composition affected PWV (p < 0.001, R2 = 0.28) but BMI (p < 0.001), fat mass (p < 0.001) and muscle mass (MM) of the trunk (p < 0.001) and skeletal MM to body fat ratio (p < 0.001) stood out.

Conclusions:
PWV was correlated to all the variables of body composition after making adjustments for age and markers of kidney function. Future studies with larger number of participants should evaluate correlation of PWV with the observed parameters in this population of patients.
EFFECTS OF ANGIOTENSIN RECEPTOR BLOCKER AZILSARTAN IN ARTERIAL HYPERTENSION COMBINED WITH TYPE II DIABETES MELLITUS
Authors: Musayev Zaur , Rasulova Gulshan , Dadasheva Antiga 
Published: April 2021

Objective:
Arterial Hypertension (AH) with type II Diabetes Mellitus (DM II) is characterized by diminished myocardial compliance with diastolic dysfunction and impaired left ventricular filling. Angiotenzin receptors blocker (ARB) Azilsartan (Az) is antihypertensive drug in AH combined with DM II for good tolerance and metabolic neutrality. Az in AH patients with DM II is unexplored in view of influence on cardiac systolic and diastolic parameters. The interrelation between long-term Az treatment and basic metabolism lipid, carbohydrate indices alterations in AH coupled with DM II is disputable. The purpose of study was evaluation of ARB Az's antihypertensive, hemodynamic and metabolic actions in AH patients with DM II.

Design and method:
72 diagnosed I-II WHO classification AH patients without coronary artery disease and congestive heart failure signs with DM II were examined (46 male, 26 female, 42–63 aged, mean age 52+/-2,1 years old, body mass index 32+/-1,8 kg/m2, systolic and diastolic blood pressure (SBP,DBP) range 145/90-179,109 mm Hg, mean blood pressure (MBP) 120+/-3,1 mm Hg. Az was administered once daily 40–80 mg in addition to basic management of DM II.

Results:
Az significantly reduced SBP 169+/-5.3 vs 148+/-5.1 mm Hg, diminution -12.4% (p<0.02), DBP 104+/-2.6 mm Hg vs 91+/-2.8 mm Hg, diminution-12.6% (p < 0.02), MBP 120+/-3.1 mm Hg vs 106+/-4.4 mm Hg, diminution 11.7% (p < 0.02). Early diastolic filling flow velocity (Peak E) increased significantly 0.56+/-0.033 vs 0.79+/-0.048 m/sec, augmentation+28.9% (p < 0.02). After 4 weeks SBP, DBP, MBP significantly decreased (p < 0.02), 12-weeks management resulted in BP reduction (p < 0.01). No negative changes of carbohydrate, lipid metabolism indices and GFR observed, moreover 12-weeks Az treatment had a trend to some improvement of blood and urine glucose level, lipids and lipoprotein fractions.

Conclusions:
Az in I-II AH patients with DM II resulted in antihypertensive effect, left ventricular systolic and diastolic performance indices improved. Study didn’t reveal any negative changes of metabolism and GFR. Metabolism indices improvement was marked probably on account of Atherosclerosis prevention actions. Az improves systolic performance and diastolic compliance in AH with DM II, positively affects on metabolism indices. Long-term Az treatment in AH combined with DM II should explored further.
FRAGILITY INDEX OF VARIOUS GLP1 AGONISTS ON CARDIOVASCULAR OUTCOMES IN PLACEBO CONTROLLED TRIALS
Authors: Mourad Jean -Jacques , Voisin Olivier , Le Lorch Erwan , Hubert Sidonie , Menage Elodie , Mahe Anabelle , Borie Marie -Francoise , Azria Philippe , Antakly Yara 
Published: April 2021

Objective:
Several well-designed randomized controlled trials (RCTs) have been conducted to evaluate the cardiovascular and renal effects of Glucagon-Like Peptide receptor agonists (GLP1) in type 2 diabetes. Their results have largely influenced the most recent dedicated therapeutic recommendations. Traditionally, p-values and confidence intervals have been used to denote the statistical significance of RCT results. However, even with a p-value and a confidence interval, the clinician cannot immediately discern how likely the study, if repeated, would yield a different and potentially conflicting result. The Fragility Index (FI) was developed as a novel metric to further assess the quality of statistically significant results and assist with the interpretation and clinical applicability of RCT findings, by providing the absolute number of patients or events from an RCT whose alternate outcome would have resulted in the study no longer being statistically significant. To date, there have been no studies evaluating the statistical fragility of GLP1 agonists RCTs.

Design and method:
We performed a systematic review of GLP1 cardiovascular outcomes trials using the PubMed database and calculate the FI for the specified primary endpoint, non-fatal myocardial infarction, non-fatal stroke, cardiovascular and all-cause death and renal outcomes as defined for each trial. The larger the FI the better (more robust) a trial's data are. A FI index reported as ‘0’ clearly emphasizes the lack of robustness of the data.

Results:
Results: We identified and included 7 trials, that involved 6 different molecules. The results are depicted in the following figure.

Conclusions:
Conclusion: In trials reported to date, the CV and renal benefits of GLP-1 agonists are not consistent across this class of medications. The Fragility Index may help clinicians to identify how easily a particular RCTs statistical significance may be overturned and to choose the molecule with the more robust expected benefit.