bluuebunny/crossref_metadata_2025_split huggingface dataset:
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN II RECEPTOR BLOCKERS AS A RISK FACTOR FOR PATIENTS HOSPITALIZED WITH COVID-19. IS THAT TRUE?
Authors: Luque Paula , Castilla-Guerra Luis , Ferrary Maria , Sanchez Nieves , Alegre Maria , Carmona Eduardo , Rico Miguel Angel 
Published: June 2022

Objective:
The link with angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is because of the known association between angiotensin-converting enzyme 2 (ACE) and SARS-COV 2. ACE 2 has been shown to be a co-receptor for viral entry for SARS-COV-2 in the respiratory epithelium. It has been a global concern that the use of this drugs may be a risk for patients with COVID-19 infection. It has been published many studies about this subject. Even today there are still controversies regarding to the impact of these drugs.
The aim of this study was to determine the association between the previous use of ACEI/ARB and the prognosis of patients with COVID-19 infection

Design and method:
Single-center, restrospective, cohort study included 608 patients with hypertension diagnosed with COVID-19, who where hospitalized in Macarena`s hospital from Mars to December 2020. Analyses of main outcomes (mortality, need of intensive cares (ICU), and days of mean study) were adjusted by multivariate logistic regression.

Results:
Of a total population of 500,000, 608 patients (0.12%) required admission for COVID-19. A total of 83.7% were hypertensive, specifically 75.9% were under antihypertensive treatment (35.7% with only 1 drug, 29.9% were taking two drugs, 9% with three drugs, and 1.3% with 4 drugs). 26.2% were treated with an ACEI and 24.8% with ARBs. Treatment with ACEI / ARB-II (combined or individually) had no impact on mortality (OR = 1.29; 95% CI, 0.829–2.014; p = 0.257), nor ICU admission (OR = 1, 7; 95% CI, 0.68 - 4.95; p = 0.232), nor on the days of mean stay (OR = 0.98; 95% CI, 0.95–1.04; p = 0.325).

Conclusions:
It is unlikely that previous treatment with ACEI/ARB was associated with an increased mortality risk, neither ICU admission or an increase in days of mean stay. This study supports current guidelines that discourage discontinuation of ACEIS or ARBs in COVID-19 patients.
ARTERIAL HYPERTENSION AND COVID19 IN HOSPITAL MORTALITY
Authors: Vintila Ana Maria , Horumba Mihaela , Miron Paul , Balan Razvan , Catrangiu Maria Beatrice , Negoescu Iris Andreea , Trifan Iuliana , Vintila Vlad Damian , Gurghean Adriana , Ianula Raluca Ciomag , Savulescu-Fiedler Ilinca 
Published: June 2022

Objective:
Our aim was to explore COVID19-related mortality in hypertensive patients as compared to other associated conditions as well as antihypertensive treatment effect.

Design and method:
We performed a retrospective, unicentric study on COVID19 patients admitted to our department between 1st of September and 1st of December 2021. Collected data included medical history, treatment, echocardiographic data and lab test results. SPSS version 23 was used for descriptive and inferential statistics.

Results:
The lot consisted of 139 consecutively enrolled patients. The median age was 68 years (range: 18–91) and 48.9% females. Only 14.9% of patients were fully vaccinated (3.9% partially vaccinated, 81.3% unvaccinated). Associated conditions were: arterial hypertension (64.7%), heart failure (41.7%), T2DM (29.5%), stroke (13.7%) and coronary artery disease (12.2%).
The inhospital mortality rate was 24.5% without differences between hypertensive and non-hypertensive patients (RR: 1.31 | 0.68 - 2.50). However, T2DM, coronary artery disease and stroke had higher relative risk than hypertension, AF and HF for COVID19 death (T2DM: 2.13 | 1.21 - 3.74; CAD: 2.21 |1.20 - 4.06; stroke: 7.11 |4.45 - 11.35).
Hypertensive patients underwent treatment with ACEi/ARB (37.8%), diuretics (32.2%), calcium channel blockers (13.3%) and betablockers (40%) prior to admission. There was a statistical trend showing that fewer hypertensive patients receiving ACEi/ARB prior to admission required ICU management (20.6% vs 39.3%, p = 0.052) with no difference of inhospital mortality (23.5% vs 28.6%, p = 0.394). Hypertensive patients undergoing BB treatment had lower ICU admission rates (16.7% vs 42.6%, p = 0.008).

Conclusions:
Most hospitalised COVID19 patients were not fully vaccinated. Inhospital mortality was higher among patients withT2DM, CAD and history of stroke, but not HTN. Home treatment with ACEi/ARB or BB treatment was associated with lower ICU admission rates.
ELEVATED RESTING HEART RATE AS INDEPENDENT IN-HOSPITAL PROGNOSTIC MARKER IN COVID-19
Authors: Serravalle Gino , Vanoli Jennifer , Dell’Oro Raffaella , Marro Giacomo , Facchetti Rita , Quarti-Trevano Fosca , Spanziani Domenico , Grassi Guido 
Published: June 2022

Objective:
SARS-CoV-2 infection could be complicated by serious autonomic imbalance caused directly by the virus or through secondary release of inflammatory cytokines. Some studies suggested that elevated resting heart rate (HR) and resting tachycardia, being markers of an increased adrenergic cardiac drive, are associated with poor prognosis in COVID-19 syndrome.

Design and method:
We performed a retrospective analysis in an inpatient cohort of 389 subjects diagnosed with SARS-CoV-2 infection to investigate the prognostic relevance of HR in predicting the maximum care intensity needed during hospitalization according to the following four severity outcome classes: I) no need for oxygen support/need for low flow oxygen therapy; II) need for high flow oxygen therapy/continuous positive airway pressure; III) transfer to the Intensive Care Unit; IV) death. HR assessments were recorded on admission and during the first 3 and 7 days of hospitalization.

Results:
For each class increase in maximum care intensity we observed a corresponding significant increase in HR, considering both data collected on admission (average HR value: 90.1 ± 17 beats/minute, p-value trend = 0.0397), and during the first 3 days (p-value trend < 0.0006) or 7 days (p-value trend < 0.0001) of hospitalization. The significant trend was maintained after adjustment for age, sex, comorbidities and fever and in the subpopulation of patients (n = 118) not receiving drugs potentially active on HR both before and during hospitalization. Kaplan-Meier curves for survival based on HR displayed a significant decreased survival in patients with higher HR.

Conclusions:
The assessment of HR during hospitalization provides information on the clinical outcome of patients affected by SARS-CoV-2 infection independently of other confounders. HR as an in-hospital prognostic marker can be obtained both through a first assessment at the admission or mean values over the course of hospitalization with an increase of its accuracy by a 7-days longitudinal evaluation. Further studies might elucidate the association between SARS-CoV-2 infection with multiple autonomic abnormalities.
STAY ALERT ABOUT COAGULATION PARAMETERS - IMPLICATIONS OF THROMBOSIS TREATMENT IN COVID-19
Authors: Sielatycki Piotr , Zbroch Edyta , Markowska Martyna , Zalewska Aleksandra , Bowtruczuk Aleksandra , Warpecowski Jedrzej , Gryciuk Malgorzata 
Published: June 2022

Objective:
The case report presents two patients with COVID-19 history. The first patient, treated with enoxaparin, was diagnosed with pulmonary embolism, and later developed heparin-induced thrombocytopenia. The second patient with history of chronic pulmonary thromboembolism and multiple comorbidities, treated with rivaroxaban and acetylsalicylic acid, reported haemorrhagic events. The objective of this case report is to highlight possible complications of anticoagulant treatment and the role of accurate and rapid response of clinicians in COVID-19 patients.

Design and method:
Case report of two patients with COVID-19 - related thrombotic complications treated respectively with low molecular weight heparin and rivaroxaban. Observation of the treatment process revealed complications in both cases, demanding change of medications within the same group of drugs.

Results:
Development of thrombotic episodes was noticed and treated in time. Both patients developed complications of treatment. Modifications of anticoagulation drugs (low molecular weight heparin replaced with fondaparinux and rivaroxaban with apixaban respectively) were provided with positive outcomes.

Conclusions:
SARS-CoV-2 infection is associated with a high risk of thrombotic events whereas anticoagulant treatment can also lead to various complications. The necessity of watchful observation of coagulation parameters in patients with COVID-19, but also potential complications of any anticoagulant treatment is crucial for the positive long-term outcomes.
COVID-19 IS ASSOCIATED WITH ENDOTHELIAL DYSFUNCTION: A META-ANALYSIS OF OBSERVATIONAL STUDIES
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Stavropoulos Konstantinos , Imprialos Konstantinos , Aidinis Asterios , Sviggou Asimina , Kordalis Vasilios , Pyrpasopoulou Athina , Papadopoulos Christodoulos , Doumas Michael 
Published: June 2022

Objective:
A number of studies have indicated a deleterious effect of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection on endothelial function of enrolled subjects, further impairing during post-infectious stage. Endothelial function might indeed have a prognostic role in coronavirus disease-19 (COVID-19). Herein we sought to determine the effect of SARS-CoV-2 on endothelial function as quantified by flow-mediated dilation (FMD).

Design and method:
We searched the PubMed database from inception till 21st December, 2021, for observational studies assessing the impact of SARS-CoV-2 on endothelial function either in the in-hospital or the outpatient setting. We set as primary efficacy outcome the mean difference in FMD between infected patients and healthy controls.

Results:
We pooled data from 5 observational studies in a total of 541 enrolled subjects. One study enrolled children, while the rest 4 enrolled adults. Overall, COVID-19 induced a significant decrease in FMD by 3.29% (95% CI; -4.57 to -2.01, I2 = 81%) compared to healthy controls.

Conclusions:
Despite being preliminary, these results suggest a significant effect of SARS-CoV-2 on endothelial system, leading to significant endothelial dysfunction. Prognostic implications of that effect have to be determined in prospective studies.
COVID19 INFECTION IN CORONARY ARTERY DISEASE WITH DIABETES AND HYPERTENSION IN VALVULAR SURGERY PATIENTS IN TERTIARY HEART CENTRE
Authors: Jain Rajesh , Hosseini Js , Shoghli Reza 
Published: June 2022

Objective:
The patient was a 59-year-old man who was referred to the hospital due to shortness of breath due to increased activity, accompanied by cough, weakness, and lethargy. The patient also had a history of diabetes, hypertension, hyperlipidemia, and asthma. The patient also underwent cardiac stenting last year. LCX and LAD stenting

Design and method:
He had a continuous pan-systolic murmur on cardiac examination diagnosed with valvular dysfunction.
Severe aortic regurgitation was reported on echo. The patient underwent a CT scan of the lungs and a
PCR test to rule out Covid-19, which was negative. Finally, the patient was diagnosed with severe aortic regurgitation and underwent aortic valve replacement surgery. Echocardiography was performed before the operation, and the diagnosis was confirmed.

Results:
Echocardiography was performed postoperatively, which showed good valve function and no valve leakage. From the 5th day after the operation, the patient developed fever and increased leukocytosis. Suspected of having Covid19 and accordingly underwent PCR test, the test result was positive; the patient underwent a CT scan of the lungs. After that, he was transferred to the corona ICU.
The patient was treated with Remdesivir, and after two weeks, his PCR was negative, and he was almost ready to be discharged.
The patient had completed the entire course of treatment and developed pulmonary fibrosis due to
Covid disease, but suddenly, after two weeks from the onset of the illness, she developed severe shortness of breath, which led to intubation.
We find severe pulmonary fibrosis in the re-CT scan, especially in the left lung, where the entire left lung had fibrosis.
Prednisolone was started at a dose of 50 mg three times a day. The patient was intubated for ten days, then gradually removed from the device. Now the patient is extubated and ready for discharge.

Conclusions:
Risk factors such as Past cardiac surgery and present cardiac intervention with diabetes mellitus increase the risk of developing lung failure in these Covid19 patients.
Elective intubation is better than emergency intubation in patients with comorbidities.
Corticosteroids can be effective in treating pulmonary insufficiency
COVID19 INFECTION AND LIBMAN –SACKS ENDOCARDITIS IN PAST VALVE REPAIRED PATIENT
Authors: Jain Rajesh , Hosseini Sj , Shoghli Reza 
Published: June 2022

Objective:
The patient was a 61-year-old woman who typically underwent mitral valve replacement and tricuspid valve repair in 2011. During these years, she underwent an annual checkup and experienced no particular problems. The potential patient contracted Covid 19 a month ago and underwent conservative treatment.
The patient displayed no specific symptoms, no fever, and her Covid 19 disease was mild. In the accompanying echocardiography, we notice a lump on the atrial surface of the Tricuspid valve that we instantly suspect of local vegetation or heart mass. As a result, we admitted the patient to resume the examination.

Design and method:
Multi-slice (16) spiral thoracic CT scan:
Sternotomy and MVR are seen. Cardiomegaly is evident. Patchy peripheral ground-glass opacities are seen bilaterally, suggesting covid-19 pneumonia; correlation with clinical and paraclinical data is recommended. Degenerative changes are perceived in the thoracic spine. There is no pleural effusion.
Blood cultures and urinary trachea were requested to diagnose endocarditis, and she was also asked to have an esophageal echocardiogram.
The antibiotic Meropenem 500 was started three times a day with vancomycin 1 gram twice a day for prophylaxis.
After these examinations, the mass diagnosis was rejected as the image of vegetation on echocardiography did not found echogenicity similar to cardiac tissue and was denser. Consequently, we diagnosed vegetation. According to the negative culture results, and the patient had no symptoms (chills, heart pain), this patient’s diagnosis of an immunological reaction caused by Covid disease was made.
Libman –sacks endocarditis is a type of sterile nonbacterial thrombotic endocarditis (NBTE) secondary to inflammation.

Results:
In this rare case, the vital point is that immunological reaction after covid can give rise to vegetation on the heart artificial valve and can be typically established with endocarditis.
Covid can cause libman sac endocarditis, then we consider patients with heart disease maybe get limban sac or other forms of immunological reaction after covid virus.

Conclusions:
Concerning the explicit rejection of all the causes, the patient was diagnosed correctly with limb sac endocarditis. She underwent anticoagulant therapy and corticosteroid therapy accordingly and was recovered fully.
SELF-REPORTED CHANGE IN (UN)HEALTHY BEHAVIOURS OF PATIENTS WITH CARDIOVASCULAR DISEASES DURING THE SECOND COVID-19 LOCKDOWN IN NORTHERN GREECE: FOCUS ON DIABETES
Authors: Ioannidis Antonios , Pechlevanis Apostolos , Fragkiskou Afroditi , Asmani Filio 
Published: June 2022

Objective:
The aim of the study was to compare the (un)healthy behaviours of diabetic (DM) and non-diabetic (non-DM) CVDs patients during the second COVID-19 lockdown in Northern Greece.

Design and method:
This is a cross-sectional short questionnaire telephone-based survey conducted in February 2021. Responders with known CVDs were primarily questioned about smoking, diet and physical activity, along essential medical history.

Results:
The response rate was high (62.6%) with the majority of the participants willing to speak for longer time than initially estimated. In total, answers by 374 patients (118 DM and 256 non-DM) were analyzed. There was no difference in term of gender but the DM group was older (mean age 59.3 ± 6.9 old vs 54.8 ± 6.1 years). There were 184 active smokers questioned (DM: 36, 30.5% and non-DM: 148, 57.8%). More non-DM patients increased smoking DM ones. Of note, the majority of the DM patients reported smoking similarly than before the lockdown. Unfortunately, none of the questioned participants attempted to quit smoking. The mean BMI of the non-DM patients was 27.1 ± 4.2 kg/m2(vs. 26.7 ± 3.8 kg/m2before lockdown) corresponding to a mean weight gain of about 1.5 kg. The rise in mean BMI could be explained, partly, by the increased eating as reported by almost half of the non-DM participants (124, 48.4%). There was a smaller increase in mean BMI of the DM sample (from 26.6 ± 3.9 kg/m2to 26.9 ± 4.1 kg/m2) corresponding to a mean weight gain of less than 0.5 kg. The limited weight gain is represented by the majority of the DM patients reported that they didn’t change their eating habits. About 1/5 of the participants answered that they increased exercising in comparison to their pre-lockdown habits (56, 21.9% vs 24, 20.3%, p> 0.05), Contrary to that, more than half of the DM patients had maintained similar levels of physical activity (68, 57.6%).

Conclusions:
The hard lockdown in Greece during the second wave was accompanied with an aggravation of unhealthy choices by patients with CVDs. This observation was less apparent in the patient with diabetes. Further research is warrant to assess the clinical impact of these behaviours.
HOW COVID -19 AFFECTED CARDIOLOGICAL OUTPATIENT CARE IN BULGARIA?
Authors: Gruev Ivan , Tsanova Veska 
Published: June 2022

Objective:
During the last two years Covid 19 has turned into a deadly pandemia, but it also has a devastating effect on noninfectious chronic diseases, particularly on cardiovascular diseases. This situations was described by Prof. Hector Bueno as “sindemia”. SARS Covid-2 - related respiratory syndrome has a direct and strong biological, patophysiological and social interactions with cardiovascular system. Another serious problem is the admission to hospital because, many of cardiologial units and ICU s were transformed into Covid 19 wards. That is why the outpatient treatment of cardiovascular diseases and risk factors became even more important.

Design and method:
According to the regulations of the National Healthcare Fund in Bulgaria, all patients with cardiovascular diseases must have an annual examination by cardiologist. We studied the real –life data from one outpatient cardiological practice in Sofia, Bulgaria. 634 patients had to be checked in 2021. 15 of these patients had died with Covid 19 infection, one with myocardial infarction and one with stroke.

Results:
Only 243 patients attended the annual cardiological examination.172 of them were with worsened control of blood pressure, 48 with new symptoms of heart failure, 16 with newly found atrial fibrillation and 13 with newly diagnosed diabetes mellitus. In just one day the cardiologist met a patient with new decompensated diabetes, patient with new ECG data for myocardial cicatrix, patient with atrial fibrillation and patient with several collapses and ventricular tachycardia on ECG Holter! Many patients had antiaplatelet and anticoagulant treatment prescribed after Covid 19 infection, but also had uncontrolled hypertension and that increases the risk of hemorrhagic stroke

Conclusions:
Covid 19 infection, as an endothelial disease, has a devastating impact on patients with cardiovascular, cerebrovascular, pulmonary and metabolic disorders. The absence of team approach to the therapy leads to very high rate of mortality and long term consequences. The outpatient care of cardiovascular diseases is strongly damaged in Bulgaria. That results in bad control of arterial hypertension, delayed hospitalizations for acute coronary syndromes and heart failure, uncertain control of anticoagulation. It is time to recover healthcare system!
DETERMINANTS OF OUTCOME OF MODERATE TO SEVERE COVID-19 IN A HOSPITAL SETTING: A COMPARISON BETWEEN FIRST AND SECOND/THIRD WAVE IN LOMBARDY
Authors: Boari Gianluca , Leidi Francesca , Accordini Beatrice , Napoli Federico , Ghidelli Chiara , Archenti Giulia , Chiarini Giulia , Malerba Paolo , Scarano Ottavio , Mangili Benedetta , Gorla Giulia , Corbani Andrea , Bonetti Silvia , Braglia-Orlandini Federico , Bianco Gianluca , Faustini Cristina , Ferrari-Toninelli Giulia , Turini Daniele , Guarinoni Vittoria , Saottini Michele , Manzoni Franscesca , Rosei Claudia Agabiti , De Ciuceis Carolina , Rizzoni Damiano 
Published: June 2022

Objective:
Coronavirus disease 2019 (COVID-19) represents a major clinical problem in terms of death and long-term sequelae. We conducted a retrospective cohort study at Montichiari Hospital (Brescia, Italy) to better understand different determinants of outcome in different COVID-19 outbreaks.

Design and method:
A total of 635 patients admitted from local emergency room with a confirmed diagnosis of SARS-CoV-2 infection and a moderate to severe COVID-19 were included in the present study. A group of 260 consecutive patients during SARS-CoV-2 first wave (from February to May 2020) and 375 consecutive patients during SARS-CoV-2 second/third wave (from October 2020 to May 2021) were considered. Demographic data, comorbidities, ongoing treatment and bio-humoral, respiratory and haemodynamic data were recorded and compared.

Results:
Main demographic data (Table 1) were not significantly different in the two considered time-lapses, except a lower prevalence of female sex during first wave. Mortality rate was significantly lower during the latter period (25% vs 11%; p < 0.001). Time from symptoms onset to hospital admission was longer during first wave (7.8 ± 5.6 vs 5.6 ± 4.3 days; p < 0.001) while hospital staying was significantly shorter (11 ± 10 vs 15 ± 12 days; p < 0.001).
Other significant differences were a wider use of corticosteroids and low-molecular weight heparin (LMWH) as well less antibiotic prescription during the second wave (Table 2). Respiratory, bio-humoral and x-Ray score were significantly poorer at the time of admission in first-wave patients (Table 3).
After a multivariate regression analysis, C-reactive protein and procalcitonin values, % fraction of inspired oxygen at admission, days after symptoms onset and duration of hospital staying were the strongest predictors of outcome in both periods.
Concomitant anti-hypertensive treatment (including ACE-inhibitors and ARBs) did not affect outcome.

Conclusions:
Our preliminary data suggest that an earlier diagnosis, a timely hospital admission and a rational use of the therapeutic options allowed to reduce the rate of systemic inflammation response (of which CRP is a hallmark) and granted a better outcome during the second of the two time-lapses considered.