Role of the renin–angiotensin–aldosterone and kinin–kallikrein systems in the cardiovascular complications of COVID-19 and long COVID

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the virus responsible for the COVID-19 pandemic. Patients may present as asymptomatic or demonstrate mild to severe and life-threatening symptoms. Although COVID-19 has a respiratory focus, there are major cardiovascular complications (CVCs) associated with infection. The reported CVCs include myocarditis, heart failure, arrhythmias, thromboembolism and blood pressure abnormalities. These occur, in part, because of dysregulation of the Renin–Angiotensin–Aldosterone System (RAAS) and Kinin–Kallikrein System (KKS). A major route by which SARS-CoV-2 gains cellular entry is via the docking of the viral spike (S) protein to the membrane-bound angiotensin converting enzyme 2 (ACE2). The roles of ACE2 within the cardiovascular and immune systems are vital to ensure homeostasis. The key routes for the development of CVCs and the recently described long COVID have been hypothesised as the direct consequences of the viral S protein/ACE2 axis, downregulation of ACE2 and the resulting damage inflicted by the immune response. Here, we review the impact of COVID-19 on the cardiovascular system, the mechanisms by which dysregulation of the RAAS and KKS can occur following virus infection and the future implications for pharmacological therapies

Using the WHO ASSIST to Assess Drug and Alcohol Misuse in the Acute Mental Health Setting to Guide Treatment Interventions

This article reports the prevalence of alcohol and substance use in 695 patients with mental illnesses admitted to an inner city acute mental health unit over a 14 month period. Data were collected from routine screening for alcohol and substance use on admission to the acute mental health unit using the World Health Organisation (WHO) Alcohol Smoking and Substance Involvement Screening Test (ASSIST).The substances most frequently used were tobacco, alcohol and cannabis. Interventions aimed at decreasing the frequency of use and harms associated with use of tobacco, alcohol and cannabis therefore have the greatest potential to improve health outcomes in this population.As drug and alcohol impact significantly on mental health outcomes, assessment of substance use, recognition of addictive behaviours, withdrawal management that includes appropriate pharmacological intervention and supportive counselling that is initiated in the acute mental health setting and continued post discharge are important to the person’s recovery and ongoing quality of life