Clinical Complications In Patients Research Articles

Effect of High Magnesium and Astragaloside IV on Vascular Endothelial Cells

Effect of High Magnesium and Astragaloside IV on Vascular Endothelial Cells

Diabetes mellitus patients with increased death rates and clinical complications in patients with CoV-19 pneumonia: A systematic review

Diabetes Mellitus (DM) is a chronic condition that has been associated with Corona virus (CV) sickness and has the potential to cause catastrophic multisystemic consequences. They used a complete meta-analysis and review to examine the connection among DM and a bad prognosis in COVID-19 pneumonia individuals. We searched many online databases for articles assessing the correlation between DM and outcome in COVID-19 pneumonia. This study's principal result was an undesirable interaction of three secondary results: the occurrence of severe cardiovascular disease (CVD), acute respiratory distress syndrome (ARDS), and death. All 17 studies had 6452 participants. After eliminating the duplicates, the number of records remained at 350. After first looking at the titles and abstracts, we discarded 310 articles. After reviewing 43 full-text publications, 13 were ruled ineligible owing to a lack of mortality, interest, or disease progression outcomes, including those for severe ARDS which is disease progression, ARDS, Mortality and COVID-19 severity, were increased in COVID-19 patients with DM.

Integrated metabolomics and proteomics reveal biomarkers associated with hemodialysis in end-stage kidney disease.

Background: We hypothesize that the poor survival outcomes of end-stage kidney disease (ESKD) patients undergoing hemodialysis are associated with a low filtering efficiency and selectivity. The current gold standard criteria using single or several markers show an inability to predict or disclose the treatment effect and disease progression accurately. Methods: We performed an integrated mass spectrometry-based metabolomic and proteomic workflow capable of detecting and quantifying circulating small molecules and proteins in the serum of ESKD patients. Markers linked to cardiovascular disease (CVD) were validated on human induced pluripotent stem cell (iPSC)-derived cardiomyocytes. Results: We identified dozens of elevated molecules in the serum of patients compared with healthy controls. Surprisingly, many metabolites, including lipids, remained at an elevated blood concentration despite dialysis. These molecules and their associated physical interaction networks are correlated with clinical complications in chronic kidney disease. This study confirmed two uremic toxins associated with CVD, a major risk for patients with ESKD. Conclusion: The retained molecules and metabolite-protein interaction network address a knowledge gap of candidate uremic toxins associated with clinical complications in patients undergoing dialysis, providing mechanistic insights and potential drug discovery strategies for ESKD.

IMPACT OF BACTERIAL INFECTIONS IN PERITONEAL DIALYSIS PATIENTS

Bacterial infections can cause significant clinical complications in patients undergoing Peritoneal Dialysis (PD). This study aimed to determine bacterial infection's clinical and psychosocial outcomes in PD patients. A prospective observational study enrolled 150 PD patients through non-probability sequential sampling. Demographic information, duration of PD, previous infections, and laboratory results were collected. Bacterial infections were identified through routine cultures of PD fluids, and antibiotic susceptibility was determined using the disc diffusion method. The average age of PD patients was 52.3 years, with 42% men and 58% women (p<0.05). Staphylococcus aureus infected 22 patients (14.67%), whereas Streptococci infected 18 patients (12%) (p<0.05). Antibiotic susceptibility assays determined that Staphylococcus aureus was 77% sensitive to vancomycin. Seventy-five patients (50%) on PD for more than 19 months encountered infections. Among the infected group, 90 patients (60%) recovered without complications, while 5 (4.2%) died. The study revealed a significant correlation between bacterial infections in PD patients and clinical symptoms, antibiotic resistance patterns, and disease duration. These findings highlight the importance of enhanced patient monitoring and evolving treatment strategies to improve patient outcomes.

Modelling Duchenne muscular dystrophy in vitro with newly generated, blood cell-derived induced pluripotent stem cell line ORIONi003-A

Here, we present newly derived in vitro model for modeling Duchenne muscular dystrophy. Our new cell line was derived by reprogramming of peripheral blood mononuclear cells (isolated from blood from pediatric patient) with Sendai virus encoding Yamanaka factors. Derived iPS cells are capable to differentiate in vitro into three germ layers as verified by immunocytochemistry. When differentiated in special medium, our iPSc formed spontaneously beating cardiomyocytes. As cardiomyopathy is the main clinical complication in patients with Duchenne muscular dystrophy, the cell line bearing the dystrophin gene mutation might be of interest to the research community.

Randomized controlled study to evaluate the safety and clinical impact of percutaneous auricular vagus nerve stimulation in patients with severe COVID-19.

Introduction: A severe course of COVID-19 is characterized by a hyperinflammatory state resulting in acute respiratory distress syndrome or even multi-organ failure along a derailed sympatho-vagal balance. Methods: In this prospective, randomized study, we evaluate the hypothesis that percutaneous minimally invasive auricular vagus nerve stimulation (aVNS) is a safe procedure and might reduce the rate of clinical complications in patients with severe course of COVID-19. In our study, patients with SARS-CoV-2 infection admitted to the intensive care unit with moderate-to-severe acute respiratory distress syndrome, however without invasive ventilation yet, were included and following randomization assigned to a group receiving aVNS four times per 24h for 3h and a group receiving standard of care (SOC). Results: A total of 12 patients were included (six in the aVNS and six in the SOC group). No side effects in aVNS were reported, especially no significant pain at device placement or during stimulation at the stimulation site or significant headache or bleeding after or during device placement or lasting skin irritation. There was no significant difference in the aVNS and SOC groups between the length of stay in the intensive care unit and at the hospital, bradycardia, delirium, or 90-day mortality. In the SOC group, five of six patients required invasive mechanical ventilation during their stay at hospital and 60% of them venovenous extracorporeal membrane oxygenation, compared to three of six patients and 0% in the aVNS group (p = 0.545 and p = 0.061). Discussion: Vagus nerve stimulation in patients with severe COVID-19 is a safe and feasible method. Our data showed a trend to a reduction of progression to the need of invasive ventilation and venovenous extracorporeal membrane oxygenation which encourages further research with larger patient samples.

Sociodemographic and Clinical Characteristics and the Impact of Hydroxyurea on Laboratory Profile and Healthcare Resource Utilization of Adult Patients with Sickle Cell Disease: An Observational and Retrospective Study of 5 Years of Follow-Up in a Reference Center in Brazil

Sickle cell disease (SCD) is a severe inherited and multisystem blood disorder characterized by hemolytic anemia, vasoocclusive crises (VOCs), progressive multiorgan damage, and increased mortality. SCD is the most common inherited disorder worldwide, with well over 300,000 children born with SCD yearly, 75% of whom are born in Africa. Based on the Brazilian neonatal screening program, the annual average of new cases of children diagnosed with SCD was 1,087, with an incidence of 3.78 per 10,000 live births and an estimated number of 60,000 to 100,000 individuals living with SCD in Brazil. Our objectives were to describe the sociodemographic and genotype characteristics and clinical complications of patients with SCD and compare the laboratory profile and the impact of healthcare resource utilization between patients with and without hydroxyurea during five years of observation. Objectives: To describe the sociodemographic and clinical complications, compare the laboratory profile and the impact of healthcare resources utilization between patients with and without hydroxyurea of SCD patients during five years of observation. Method: This was a retrospective cross-sectional descriptive study conducted at one Brazilian reference center on SCD - Santa Casa de Sao Paulo, in Sao Paulo (Southeast region of Brazil) during a 5-year observation period (2016-2020).

Lactate Dehydrogenase/Albumin To-Urea Ratio: A Novel Prognostic Maker for Fatal Clinical Complications in Patients with COVID-19 Infection.

Objective: To investigate lactate dehydrogenase/Albumin to-urea (LAU) ratio as a potential predictor for COVID-19-induced fatal clinical complications in hospitalized patients. Methods: This is a retrospective study involving blood analyses from 1139 hospitalised COVID-19 infection survivors and 349 deceased cases post-COVID-19 infection. Laboratory tests included complete blood picture, inflammatory markers, and routine organ function tests. Results: The non-survivor group showed lower haemoglobin (p < 0.001), platelet (p < 0.0001) and higher mean corpuscular volume, neutrophil count, neutrophil/lymphocytes ratio (NLR), and LAU (p < 0.001, p < 0.0013, p < 0.001, p < 0.0126) than the patients who survived the infection. The non-survivors also exhibited higher markers for infection-related clinical complications, such as international normalized ratio (INR), D-dimer, urea, total bilirubin, alkaline phosphatase (ALK), creatinine, c-reactive protein (CRP), and serum ferritin levels (all p < 0.05). In addition, LAU ratio was positively correlated with infection prognostic parameters including INR (r = 0.171), D-dimer (r = 0.176), serum urea (r = 0.424), total bilirubin (r = 0.107), ALK (r = 0.115), creatinine (r = 0.365), CRP (r = 0.268), ferritin (r = 0.385) and negatively correlated with serum albumin (r = −0.114) (p ≤ 0.05). LAU ratio had an area under receiver operating characteristic of 0.67 compared to 0.60 with NLR. Conclusion: Patients with a high LAU ratio are at increased risk of mortality due to COVID-19 infection. Therefore, early assessment of this parameter, intensive intervention and close monitoring could improve their prognosis.

Efficacy and Safety of Molnupiravir in Mild COVID-19 Patients in India.

Background At the peak of the coronavirus disease 2019 (COVID-19) pandemic, the need for an orally administered agent to prevent the progression ofacute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection became increasingly evident, which was the impetus behind our investigations with molnupiravir. Molnupiravir has been shown to be effective in preventing hospitalizations and/or clinical complications in patients with mild-to-moderate COVID-19. In this study, we evaluate the efficacy and safety of molnupiravir in Indian patients with mild SARS-CoV-2 infection and at least one risk factor for disease progression (CTRI/2021/05/033739). Methodology This was a phase III, multicenter, randomized, open-label, controlled study conducted in Indian adults aged 18-60 years with mild SARS-CoV-2, reverse transcription polymerase chain reaction (RT-PCR)-positive within 48 hours of enrollment in the study, and within five days of first symptom onset. Enrolled patients were randomized to treatment arms in a 1:1 ratio to receive molnupiravir or placebo in addition to the standard of care (SoC) for SARS-CoV-2 infection. The SoC was in compliance with Government of India guidelines that were in force at the time. The primary endpoint was the rate of hospitalization up to day 14. Safety endpoints included incidence of adverse events (AEs). Results Eligible patients were randomized in a 1:1 ratio to receive molnupiravir in addition to SoC treatment (n = 608) or SoC alone (n = 610). In the molnupiravir group, nine (1.48%) patients required hospitalization versus 26 (4.26%) patients in the control group (risk difference = -2.78%; 95% CI = -4.65, -0.90; p = 0.0053). Overall, 45 (3.70%) patients reported 47 AEs during the study, most of which were mild and resolved completely. The molnupiravir group reported 30 AEs compared to 17 AEs in the control group. Headache and nausea were the two most commonly reported AEs. Conclusions The molnupiravir arm showed a lower rate of hospitalization and a shorter time for the improvement of clinical symptoms coupled with early RT-PCR negativity. Molnupiravir was well tolerated, and AEs were mild and rare. The addition of molnupiravir to standard therapy has the potential to prevent the progression of mild COVID-19 disease to the severe form.

Decreased Platelet Specific Receptor Expression of P-Selectin and GPIIb/IIIa Predict Future Non-Surgical Bleeding in Patients after Left Ventricular Assist Device Implantation.

Non-surgical bleeding (NSB) is one of the major clinical complications in patients under continuous-flow left ventricular assist device (LVAD) support. The increased shear stress leads to an altered platelet receptor composition. Whether these changes increase the risk for NSB is unclear. Thus, we compared the platelet receptor composition of patients with (bleeder group, n = 18) and without NSB (non-bleeder group, n = 18) prior to LVAD implantation. Blood samples were obtained prior to LVAD implantation and after bleeding complications in the post-implant period. Platelet receptor expression of GPIbα, GPIIb/IIIa, P-selectin and CD63 as well as intra-platelet oxidative stress levels were quantified by flow cytometry. Bleeders and non-bleeders were comparable regarding clinical characteristics, von Willebrand factor diagnostics and the aggregation capacity before and after LVAD implantation (p > 0.05). LVAD patients in the bleeder group suffered from gastrointestinal bleeding (33%; n = 6), epistaxis (22%; n = 4), hematuria or hematoma (17%; n = 3, respectively) and cerebral bleeding (11%; n = 2). Prior to LVAD implantation, a restricted surface expression of the platelet receptors P-selectin and GPIIb/IIIa was observed in the bleeder group (P-selectin: 7.2 ± 2.6%; GPIIb/IIIa: 26,900 ± 13,608 U) compared to non-bleeders (P-selectin: 12.4 ± 8.1%, p = 0.02; GPIIb/IIIa: 36,259 ± 9914 U; p = 0.02). We hypothesized that the reduced platelet receptor expression of P-selectin and GPIIb/IIIa prior to LVAD implantation may be linked to LVAD-related NSB.

Suppressed serological vitamin A in patients with liver cirrhosis is associated with impaired liver function and clinical detoriation.

BackgroundThe liver is of critical importance for the homeostasis of metabolic and immunomodulatory properties as well as the storage of vitamins, especially vitamin A. In this prospective analysis, the incidence of serological vitamin A deficiency and the association with disease severity as well as clinical complications in patients with liver cirrhosis were investigated.MethodFrom May 2017 to May 2018, 159 patients with primarily alcohol-associated and non-alcoholic steatohepatitis (NASH)-associated preexisting liver cirrhosis were prospectively enrolled and vitamin A status was collected. Clinical complications and infections were followed and recorded over a period of 1-year follow-up. Selected findings were validated in an independent cohort of 44 patients.ResultsAt study inclusion, 77% of patients showed decreased serological vitamin A. Suppressed vitamin A was more common in alcoholic (52 vs. 8%) and NASH-associated liver cirrhosis (16 vs. 9%) than in viral-associated liver cirrhosis. MELD score as well as Child-Pugh score were significantly associated with suppressed vitamin A (P < 0.001). The association between the degree of vitamin A suppression and liver function was confirmed in univariate and multivariate regression analysis. After 1 year of follow-up, 57 patients died and 21 patients received a liver transplant. In addition, low vitamin A levels were more commonly observed in patients with severe ascites (P = 0.001), hepatic encephalopathy (P = 0.002) and hepatorenal syndromes (P = 0.008). In addition, patients with reduced vitamin A showed an increased incidence of infections (P = 0.02), especially respiratory infections (P = 0.04).Conclusion:Suppressed serological Vitamin A is common in patients with liver cirrhosis and is associated with liver function. Clinical complications and infections are more frequent in patients with liver cirrhosis and vitamin A suppression.

Serum matrix metalloproteinase type 9 in patients with coronary heart disease

BACKGROUND: The study sends to quantify type 9 matrix metalloproteinase in serum in patients with coronary heart disease, since this enzyme is able to provoke an immunoinflammatory process leading to destabilization of atherosclerotic plaque, the development of unstable angina and acute coronary syndrome.&#x0D; AIM: Is to conduct a comparative analysis of the quantitative content of MMR-9 in serum in patients with coronary heart disease (CHD) with a different course of angina and atherosclerosis and in relatively healthy individuals.&#x0D; MATERIALS AND METHODS: Blood serum samples of 66 CHD patients were examined. All patients based on clinical examination were divided into 3 groups, depending on the severity of the disease. Quantitative MMR-9 analysis was performed using the Thermo Fisher ELISA kits (BMS2016-2). Determination of the amount of MMR-9 in serum was recorded in the ELX 800 ELISA reader plate. Data processing was carried out using Statistica 6.0 statistical analysis (StatSof, USA). The results were presented as means and mean errors.&#x0D; RESULTS: The obtained results indicate a significant decrease in the concentration of MMR-9 in the serum of patients with an unstable course of the disease compared to the control group (relatively healthy people). This is probably due to the effect on the content and activity of its MMR-9 inhibitor TIMP-1. Further studies will investigate whether MMR-9 can be considered as a marker of destabilization of atherosclerotic plaque and act as an independent predictor of acute clinical complications in patients with cardiovascular pathology.&#x0D; CONCLUSIONS: The study made it possible to establish a significant decrease in the concentration of MMR-9 in the serum of patients with an unstable course of atherosclerosis compared to the control group (relatively healthy people). In addition, in patients with an unstable course of atherosclerosis, a tendency to reduce the concentration of this enzyme compared to persons with stable atherosclerosis was revealed.

The Association of Long-Term Use of Proton Pump Inhibitors and Histamine H2 Receptor Antagonists with Clinical Complications in Patients with Severe Sepsis.

Objective Proton pump inhibitors (PPIs) are commonly used to treat gastric acidity, and their frequent use may trigger various malfunctioning, such as cardiac, renal, and liver function failure. In the current study, we evaluated the association between the excessive use of the PPIs and the clinical complications of intensive care unit (ICU) septic patients. Methods A total of 208188 patients were analyzed from 2016 to 2017 through the China Critical Care Sepsis Trial (CCCST) database. The characteristics of the study group and outcome of events from the PPI- and H2 blocker-using groups were reported. To get unbiased results, the data from the target trials were randomly assigned for PPI and H2 blocker groups. Result The data revealed 43.34 excess deaths (95% confidence intensive (CI) 25.12 to 62.02) per 1000 patients in patients extensively consuming PPI drugs. The sepsis with chronic kidney disease attributed to deaths 21.36; 95% CI (9.34 to 23.23). However, comorbidities, including circulatory diseases (16.34; 95% CI 5.78 to 23.45), nervous system (2.08; 95% CI 1.56 to 6.34), mental disorders (1.87; 95% CI 1.65 to 2.95), genitourinary system (5.23; 95% CI 3.69 to 8.89), and infectious and parasitic disease (4.17; 95% CI 1.44 to 7.49), were also reported. Extensive use of the PPIs and H2 blockers was associated with esophageal adenocarcinoma, Barrett's esophagus, neoplasms, and GI cancers. Conclusion We conclude that the excessive use of PPI in sepsis patients triggers chronic kidney disease which has a higher clinical complication rate among others.

Clinical Outcome and Prognostic Factors of Patients with Perimesencephalic and Nonperimesencephalic Subarachnoid Hemorrhage

To demonstrate the clinical outcome of patients with nonperimesencephalic subarachnoid hemorrhage (npSAH) compared with patients with aneurysmal SAH (aSAH) and perimesencephalic SAH (pSAH) and to evaluate predictive value of various clinical and radiological findings in patients with npSAH. We retrospectively identified patients with SAH who presented at our institution between 2009 and 2018. We analyzed demographic and clinical data and outcomes. Multivariable analysis was performed for outcome parameters. Of 608 patients with confirmed SAH, 78% had aSAH, and 22% had nonaneurysmal SAH. Nonaneurysmal SAH was perimesencephalic in 30% of cases and nonperimesencephalic in 70%. Initial clinical status (Hunt and Hess score) was significantly worse in patients with aSAH compared with patients with nonaneurysmal SAH. Complications such as delayed cerebral ischemia occurred significantly more often in patients with aSAH. Patients with pSAH had a more favorable clinical course than patients with aSAH or npSAH. There was no significant difference in 30-day mortality between aSAH (29%) and npSAH (28%) patients (P= 0.835). Hunt and Hess score emerged as a strong predictor of unfavorable outcome in both aSAH and npSAH in multivariable regression. Patients with npSAH had a similar clinical outcome as patients with aSAH, although there were significantly fewer clinical complications in patients with npSAH. Patients with pSAH demonstrated an overall good clinical course. Our multivariable analysis showed that initial Hunt and Hess score was an important predictor for clinical outcome in aSAH as well as npSAH.

Drug‐Drug Interactions and Disease Status Are Associated With Irinotecan‐Induced Hepatotoxicity: A Cross‐Sectional Study in Shanghai

Irinotecan-induced hepatotoxicity can cause severe clinical complications in patients; however, the underlying mechanism and factors affecting hepatotoxicity have rarely been investigated. In this cross-sectional study, we screened all clinical, demographic, medication, and genetic variables among 126 patients receiving irinotecan and explored potential associations with the incidence and time to onset of irinotecan-induced hepatotoxicity. Approximately 38.9% of the patients suffered from hepatotoxicity after irinotecan administration. The presence of cardiovascular diseases increases the incidence of hepatotoxicity ≈2.9-fold and doubles the hazard of time to hepatotoxicity. Patients with liver metastasis had a >4-fold higher risk of hepatotoxicity and a 3.5-fold increased hazard of time to hepatotoxicity compared to those without liver metastasis. Patients who took cytochrome P450 (CYP) 3A inducers had a 4.4-fold increased incidence of hepatotoxicity, and furthermore, concomitant use of platinum-based antineoplastics revealed 4.2 times the hazard of time to hepatotoxicity compared to those receiving antimetabolites. The cumulative dose of irinotecan (5-9 cycles) increased hepatotoxicity by 8.5 times. However, the genotypes and phenotypes of UGT1A1*28/*6 failed to be predictive factors of hepatotoxicity. The findings of this study suggest that irinotecan-induced hepatotoxicity is not directly associated with genetic variables but is mostly related to concomitant use of CYP3A4 inducers and platinum, as well as the presence of liver metastasis and cardiovascular disease. Thus, close monitoring of liver function is recommended, especially in patients with liver impairment or using CYP3A inducers and platinum antineoplastic drugs, which may be the best way to prevent hepatotoxicity.

Baveno VI criteria as a prognostic factor for clinical complications in patients with compensated cirrhosis.

Combination of liver stiffness measurement and platelets count is a tool to safely rule out varices needing treatment (VNT) in patients with compensated advanced chronic liver disease (cACLD). to evaluate 4-year liver-related complications and survival in low-risk patients according to Baveno VI criteria. we conducted a monocentric retrospective analysis of prospectively collected data of all consecutive patients, with cirrhosis (LSM≥12.5kPa) and without previous complication, evaluated between 2012 and 2015. Liver-related complications and survival were compared between 2 groups of patients: favourable (LSM< 20kPa and platelet count>150.000/mm3) and unfavourable Baveno VI status patients (LSM ≥ 20kPa or platelet count ≤150.000/mm3). 455 patients with cACLD were analysed. Two hundred patients had favourable Baveno VI criteria, 3.6% with VNT. The 4-year probability of being free of acute decompensation was higher in low-risk patients (94.4±1.8% vs. 85.7%±2.6%, p=0.018). Unfavourable Baveno status was independently associated with acute decompensation. The probability of being free of HCC was significantly higher in low-risk patients (94.2±1.8% vs. 87.6±2.4%, p=0.048). Liver-related mortality was not different between the 2 groups (p=0.56). The Baveno VI criteria could predict clinical outcome in cACLD.

The ethical implications of preventing hospital delirium in older adults: A scoping review

Introduction Hospital delirium is a frequent, serious, costly, and underrecognized acute disorder of attention and cognition. Therefore, the prevention of hospital delirium is not only desirable for patients, caregivers, healthcare professionals, and the health system itself, but also a moral duty. Objective To identify and synthetize the main ethical aspects that arise related to the prevention of hospital delirium in patients 65 years and older. Methods A scoping review was carried out in Embase, Medline, and Web of Science (January 2009–January 2022). Articles published in English or Spanish analyzing any pharmacologic, non-pharmacologic, or multicomponent intervention for prevention of delirium in hospitalized patients aged 65 years and over were included. Results Twenty-seven studies were included. Based on the frequency of appearance and the relevance, our findings were organized into three main areas. The first one was related to the principle of nonmaleficence and collected findings about the iatrogenic causes of hospital delirium and the use of restraints systems. The second area analyzed the impact of delirium in patients, families, and healthcare professionals from a relational ethics perspective, and addressed the family presence as a factor to prevent delirium. Finally, the third area is related to the quality of care. Conclusion Prevention of delirium in hospitals is essential to avoid the discomfort and potential clinical complications of patients, as well as the suffering of their relatives, caregivers, and healthcare professionals. Policymakers and healthcare managers are encouraged to make the required efforts to prevent delirium in hospitalized older patients.

Gastrointestinal Bleeding After LVAD Implantation: Is It Predictable?

Purpose Non-surgical bleeding (NSB) is one of the major clinical complications in patients under continuous-flow left ventricular assist device (LVAD) support. Previous studies showed an altered platelet receptor composition in response to increased shear stress and bleeding events in LVAD patients. We investigated if the platelet receptor composition of patients with bleeding complications differs from patients without bleeding complications prior to LVAD implantation. Methods Blood samples were obtained prior to LVAD implantation and at regular follow up-visits after LVAD implantation. The bleeder group consisted of 18 consecutive LVAD patients with postoperative NSB that were matched by age and gender with LVAD patients without NSB (non-bleeder group, n=18). Platelet receptor expression of GPIbα, GPIIb/IIIa, P-selectin and CD63 as well as intra-platelet oxidative stress levels were quantified by flow cytometry. Further we documented clinical characteristics, aggregation capacity and von Willebrand factor (vWF) diagnostic of all patients. Results Bleeders and non-bleeders were comparable regarding their age at study begin, gender, LVAD type, vWF antigen, vWF activity, vWF collagen-binding activity, and the aggregation capacity before and after LVAD implantation (p>0.05). LVAD patients in the bleeder group suffered from gastrointestinal bleeding (44%; n=8), epistaxis (28%; n=5), hematuria (28%; n=5), and from cerebral bleeding (11%; n=2). The analysis of platelet receptor expression showed that the percentage of P-selectin-positive platelets and the relative quantity of GPIIb/IIIa molecules on platelets were decreased in bleeders (GPIIb/IIIa: 26.900 ± 13.608 U; P-selectin: 7.2 ± 2.6%) compared to non-bleeders (GPIIb/IIIa: 36.259 ± 9.914 U; p = 0.024; P-selectin: 12.4 ± 8.1%; p = 0.016) prior to LVAD implantation. Conclusion In this pilot study, we observed a restricted surface expression of the two platelet receptors P-selectin and GPIIb/IIIa prior to LVAD implantation in patients who suffer from NSB during LVAD support. We hypothesized that P-selectin and GPIIb/IIIa may be suitable markers to identify patients at risk for LVAD-related NSB prior to LVAD implantation. Non-surgical bleeding (NSB) is one of the major clinical complications in patients under continuous-flow left ventricular assist device (LVAD) support. Previous studies showed an altered platelet receptor composition in response to increased shear stress and bleeding events in LVAD patients. We investigated if the platelet receptor composition of patients with bleeding complications differs from patients without bleeding complications prior to LVAD implantation. Blood samples were obtained prior to LVAD implantation and at regular follow up-visits after LVAD implantation. The bleeder group consisted of 18 consecutive LVAD patients with postoperative NSB that were matched by age and gender with LVAD patients without NSB (non-bleeder group, n=18). Platelet receptor expression of GPIbα, GPIIb/IIIa, P-selectin and CD63 as well as intra-platelet oxidative stress levels were quantified by flow cytometry. Further we documented clinical characteristics, aggregation capacity and von Willebrand factor (vWF) diagnostic of all patients. Bleeders and non-bleeders were comparable regarding their age at study begin, gender, LVAD type, vWF antigen, vWF activity, vWF collagen-binding activity, and the aggregation capacity before and after LVAD implantation (p>0.05). LVAD patients in the bleeder group suffered from gastrointestinal bleeding (44%; n=8), epistaxis (28%; n=5), hematuria (28%; n=5), and from cerebral bleeding (11%; n=2). The analysis of platelet receptor expression showed that the percentage of P-selectin-positive platelets and the relative quantity of GPIIb/IIIa molecules on platelets were decreased in bleeders (GPIIb/IIIa: 26.900 ± 13.608 U; P-selectin: 7.2 ± 2.6%) compared to non-bleeders (GPIIb/IIIa: 36.259 ± 9.914 U; p = 0.024; P-selectin: 12.4 ± 8.1%; p = 0.016) prior to LVAD implantation. In this pilot study, we observed a restricted surface expression of the two platelet receptors P-selectin and GPIIb/IIIa prior to LVAD implantation in patients who suffer from NSB during LVAD support. We hypothesized that P-selectin and GPIIb/IIIa may be suitable markers to identify patients at risk for LVAD-related NSB prior to LVAD implantation.

An insight into the mechanisms of COVID-19, SARS-CoV2 infection severity concerning β-cell survival and cardiovascular conditions in diabetic patients.

A significantly high percentage of hospitalized COVID-19 patients with diabetes mellitus (DM) had severe conditions and were admitted to ICU. In this review, we have delineated the plausible molecular mechanisms that could explain why there are increased clinical complications in patients with DM that become critically ill when infected with SARS-CoV2. RNA viruses have been classically implicated in manifestation of new onset diabetes. SARS-CoV2 infection through cytokine storm leads to elevated levels of pro-inflammatory cytokines creating an imbalance in the functioning of T helper cells affecting multiple organs. Inflammation and Th1/Th2 cell imbalance along with Th17 have been associated with DM, which can exacerbate SARS-CoV2 infection severity. ACE-2-Ang-(1–7)-Mas axis positively modulates β-cell and cardiac tissue function and survival. However, ACE-2 receptors dock SARS-CoV2, which internalize and deplete ACE-2 and activate Renin-angiotensin system (RAS) pathway. This induces inflammation promoting insulin resistance that has positive effect on RAS pathway, causes β-cell dysfunction, promotes inflammation and increases the risk of cardiovascular complications. Further, hyperglycemic state could upregulate ACE-2 receptors for viral infection thereby increasing the severity of the diabetic condition. SARS-CoV2 infection in diabetic patients with heart conditions are linked to worse outcomes. SARS-CoV2 can directly affect cardiac tissue or inflammatory response during diabetic condition and worsen the underlying heart conditions.

Angioplasty with a stent retriever to treat vasospasm secondary to subarachnoid hemorrhage due to an aneurysm: a multicenter study of safety and efficacy

ObjectiveTo determine the safety and efficacy of angioplasty with a retrievable stent in treating vasospasm secondary to subarachnoid hemorrhage (SAH) due to an aneurysm. MethodsWe retrospectively analyzed prospectively collected data from consecutive patients undergoing endovascular angioplasty with a retrievable stent to treat vasospasm related to SAH due to an aneurysm in four neurointerventional radiology departments between January 2018 and July 2019. We included patients aged >18 years with vasospasm >50% of the internal carotid artery (ICA), anterior cerebral artery (ACA), and / or middle cerebral artery (MCA) secondary to SAH due to an aneurysm treated with endovascular angioplasty with a retrievable stent. The variables used to measure safety were complications of the procedure and clinical complications. The variables used to measure radiological efficacy were improvement in the degree of stenosis after endovascular treatment and improvement or normalization of cerebral circulation time CTT). ResultsWe included 16 angioplasty procedures with retrievable stents in 13 patients, in which 33 arterial segments were treated (10 ICA, 15 MCA, and 8 ACA). We observed no complications of the procedure in any patients and no clinical complications in patients who were not intubated. All but one of the patients who had delayed CTT at the beginning of the procedure showed improvements in CTT. The mean improvement in the degree of stenosis was 18% ± 11.65% in the ICA, 30.67% ± 18.45% in the MCA, and 28.38% ± 15.49% in the ACA. No statistically significant associations were observed between endovascular treatment variables and the degree of improvement in stenosis. ConclusionAngioplasty with a retrievable stent is a safe and efficacious treatment for vasospasm secondary to SAH due to an aneurysm, improving CTT and stenosis.