Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascul...

Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.

/pdf/post-acute-covid-19-syndrome-1bat2sg5js.pdf

Post-acute COVID-19 syndrome.

Although COVID-19 is most well known for causing substantial respiratory pathology, it can also result in several extrapulmonary manifestations. These conditions include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications. Given that ACE2, the entry receptor for the causative coronavirus SARS-CoV-2, is expressed in multiple extrapulmonary tissues, direct viral tissue damage is a plausible mechanism of injury. In addition, endothelial damage and thromboinflammation, dysregulation of immune responses, and maladaptation of ACE2-related pathways might all contribute to these extrapulmonary manifestations of COVID-19. Here we review the extrapulmonary organ-specific pathophysiology, presentations and management considerations for patients with COVID-19 to aid clinicians and scientists in recognizing and monitoring the spectrum of manifestations, and in developing research priorities and therapeutic strategies for all organ systems involved.

/pdf/extrapulmonary-manifestations-of-covid-19-5gbdx3z1ea.pdf

Extrapulmonary manifestations of COVID-19.

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

/pdf/2019-esc-guidelines-for-the-diagnosis-and-management-of-4aacwvv1mo.pdf

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS)

Objective The purpose of the present study was to compare common femoral vein blood flow enhancement during external mechanical compression using the novel, nonpneumatic Recovery Force Health Movement and Compressions (MAC) System (Recovery Force USA, Fishers, Ind), and four currently available intermittent pneumatic compression devices. Methods The MAC device was compared with the Kendall SCD 700 (Cardinal Health, Dublin, Ohio), Arjo Huntleigh Flowtron ACS900 (Arjo, Malmo, Sweden), ActiveCare+S.F.T. (Zimmer Biomet, Warsaw, Ind), and Circul8 (Ortho8, Rocklin, Calif). Doppler ultrasound measurements for each device were directly obtained from the right common femoral vein by a registered vascular technologist. The peak flow velocity and the time taken to reach the peak were calculated. For the MAC system only, the subjects were asked to walk a minimum of 500 steps while wearing the system, which was then checked for slippage. Leg size measurements were obtained using the noncontact Sigvaris Legreader XT5 (Vialis Ortopedia, Turin, Italy). The MAC device is not yet commercially available, and the present study was a prequel to clinical studies of venous thromboembolism prevention. Results We recruited a broad range of 20 subjects who varied in age (mean ± standard deviation [SD], 50.5 ± 16.2 years), body mass index (mean ± SD, 26 ± 5.5 kg/m2), gender (male, 25%; female, 75%), and right calf circumference (mean ± SD, 37.2 ± 5.5 cm). The peak flow velocity compared with the baseline measurements was significantly greater for the Recovery Force Health MAC System for three (Kendall SCD 700, P = .02; ActiveCare+S.F.T., P = .003; Circul8, P  Conclusions The MAC System is a mobile device that remained in place during ambulation and provided more consistent external mechanical compression in the desired range compared with the other three devices included in the present study.

Comparison of a nonpneumatic device to four currently available intermittent pneumatic compression devices on common femoral blood flow dynamics.

The prevalence of thrombosis in lymphoma patients is reportedly high and ranges from 3-10%. Vascular malfunction and inflammatory processes further contribute to the thrombotic activation process in these patients. Andexanet alfa (AA) is an antidote for factor Xa inhibitors and its usage has been reported with thrombotic complications. This study was designed to compare the effect of AA on the thrombin generation (TG) potential. Blood samples from 78 patients with confirmed diagnosis of non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL) and Chronic lymphocytic leukemia (CLL) were collected from the University of Belgrade Clinic, Serbia. Normal human plasma (NHP) was used for referencing purposes. Individual samples were supplemented with AA at 100 ug/ml. TG studies were carried out using a commercially available fluorogenic substrate method. TG parameters such as peak thrombin (PT), lag time (LT) and area under the curve (AUC) were compiled. Cumulatively, lymphoma patients showed an increase in LT compared to NHP which decreases with AA. The PT and AUC levels were decreased compared to NHP and increases with AA. Upon sub-grouping of lymphoma patients, PT levels for all sub-groups were increased with AA. The AUC values increased for HL and NHL and decreased for CLL with AA. Variations in lag time were noted in all 3 sub-groups. Lymphoma represents a heterogenous group of patients where both the hypercoagulable state and inflammatory responses simultaneously occur. Increased thrombin generation in post AA supplemented samples suggest that the use of this agent may potentially be associated with thrombotic complications.

https://journals.sagepub.com/doi/pdf/10.1177/1076029620983466

Thrombin Generation Profile in Various Lymphoma Sub-Groups and Its Augmentation by Andexanet Alfa.

The impact of an electronic medical alert system for patients with cardiac implantable electronic devices and bacteremia


 Introduction:
 Essential Thrombocythemia (ET) is a myeloproliferative neoplasm characterized by an overproduction of platelets in the bone marrow. Patients suffering from this condition are at a higher risk for CV complications. Studies have demonstrated a prothrombotic state in ET patients and a significant mortality rate stemming from thrombotic complications. However, data regarding the risk of hospitalization for CV events in patients with ET are scarce. Therefore, our objective was to identify risk factors for CV outcomes among patients with ET.
 
 
 Methods:
 We performed a retrospective analysis of the National Inpatient Sample (NIS) from 2016 to 2017. Patients included were at least 18 years of age and had an ICD-10 diagnosis of ET. To identify CV outcomes, an ICD-10 code for VTE, Stroke, ACS, or a Major Adverse Limb Event had to be present in the top three discharge diagnoses. We identified common chronic comorbidities and performed binary logistic regression to identify risk factors for hospitalizations due to CV outcomes. Those factors were then validated with the 2018 and 2019 NIS databases.
 
 
 Results:
 We identified a total of 234,225 (weighted) NIS patients with ET. The mean age was 59.72 years (SD = 18.679), and patients were predominantly female (57%). CV outcomes were present in 18,955 cases (8.10%). Significant predictors for CV outcomes among patients with ET included valvular disease (VHD) (odds ratio, 1.33 [95% CI, 1.23-1.43]; P<0.0001), peripheral vascular disease (PVD) (odds ratio, 1.97 [95% CI, 1.87-2.07]; P<0.0001), paralysis (odds ratio, 1.63 [95% CI, 1.54-1.73]; P<0.0001), and hypertension (HTN) (odds ratio, 1.36 [95% CI, 1.32-1.41]; P<0.0001). Upon re-testing with 237,345 (weighted) ET patients from the 2018 and 2019 NIS cohorts, significant risk factors included VHD (odds ratio, 1.99 [95% CI, 1.90-2.08]; P<0.001), PVD (odds ratio, 2.07 [95% CI, 1.98-2.16]; P<0.001), paralysis (odds ratio, 3.35 [95% CI, 3.21-3.49]; P<0.0001), and HTN (odds ratio, 1.68 [95% CI, 1.62-1.74]; P<0.001).
 
 
 Conclusion:
 Among patients with ET in the 2016-2019 NIS cohorts, VHD, PVD, HTN, and paralysis were associated with the greatest risk of CV outcomes. Patients hospitalized with ET may benefit from increased risk management in the setting of these comorbidities.


Abstract 11621: Risk Factors for Cardiovascular (CV) Outcomes in Patients With Essential Thrombocythemia: An Analysis of the National Inpatient Sample (NIS)

Amplified Thrombo-Inflammatory Biomarkers in Pulmonary Embolism with Augmented Responses in Von-Willebrand Factor, Microparticles and Interleukin-6 in Patients with Cancer

Alfonso Tafur

Papers

Comparison of a nonpneumatic device to four currently available intermittent pneumatic compression devices on common femoral blood flow dynamics.

Thrombin Generation Profile in Various Lymphoma Sub-Groups and Its Augmentation by Andexanet Alfa.

The impact of an electronic medical alert system for patients with cardiac implantable electronic devices and bacteremia

Abstract 11621: Risk Factors for Cardiovascular (CV) Outcomes in Patients With Essential Thrombocythemia: An Analysis of the National Inpatient Sample (NIS)

Amplified Thrombo-Inflammatory Biomarkers in Pulmonary Embolism with Augmented Responses in Von-Willebrand Factor, Microparticles and Interleukin-6 in Patients with Cancer