The Impact of the COVID-19 Pandemic on Hospitalization Rates due to Prosthetic Valve Thrombosis

Backgrounds: Studies have shown a decline in the admission rates of various diseases during the COVID-19 pandemic. Prosthetic valve thrombosis (PVT) is a rare condition followed by surgical or transcatheter valvular interventions. Considering the lack of data on hospitalization rates due to PVT during the pandemic, this study evaluated the implications of the COVID-19 pandemic on PVT admissions and characteristics in a tertiary referral center. Methods: Data from all the consecutive patients hospitalized due to PVT between February 2020 and February 2021 (the first year of the pandemic) were collected from medical records and compared clinically with the corresponding time before the pandemic (February 2019 through February 2020). Variables of interest included the number of hospitalization, patient and valve characteristics, diagnostic and management strategies, and in-hospital events. Results: Forty patients (32.5% male, age: 54.0 [46.5-62.0 y] comprised the study population. We observed a considerable decline in hospitalization rates during the pandemic, from 31 to 9 patients. Admitted patients were 8 years younger, had a higher proportion of the New York Heart Association functional class III or IV symptoms (44.4% vs 22.6%), were more often treated with fibrinolysis (33.3% vs 22.6%) or surgical approaches (33.3% vs 22.6%), and were discharged 6 days sooner. Conclusion: We described a reduction in PVT hospitalization. Patients presented with a higher proportion of severe dyspnea and had increased treatment with fibrinolysis/surgical approaches. These observations highlight the necessity of the active surveillance of patients with prosthetic valves by caregivers for timely diagnosis and appropriate management during the pandemic

In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a Sex-stratified analysis

AimA considerable proportion of patients admitted with acute coronary syndrome (ACS) have no standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, dyslipidemia, and cigarette smoking). The outcomes of this population following percutaneous coronary intervention (PCI) are debated. Further, sex differences within this population have yet to be established.MethodsThis retrospective cohort study included 7,847 patients with ACS who underwent PCI. The study outcomes were in-hospital mortality, all-cause mortality, and major adverse cardio-cerebrovascular events (MACCE). The association between the absence of SMuRFs (SMuRF-less status) and outcomes among all the patients and each sex was assessed using logistic and Cox proportional hazard regressions.ResultsApproximately 11% of the study population had none of the SMuRFs. During 12.13 [11.99–12.36] months of follow-up, in-hospital mortality (adjusted-odds ratio (OR):1.51, 95%confidence interval (CI): 0.91–2.65, P:0.108), all-cause mortality [adjusted-hazard ratio (HR): 1.01, 95%CI: 0.88–1.46, P: 0.731], and MACCE (adjusted-HR: 0.93, 95%CI:0.81–1.12, P: 0.412) did not differ between patients with and without SMuRFs. Sex-stratified analyses recapitulated similar outcomes between SMuRF+ and SMuRF-less men. In contrast, SMuRF-less women had significantly higher in-hospital (adjusted-OR: 3.28, 95%CI: 1.92–6.21, P < 0.001) and all-cause mortality (adjusted-HR:1.41, 95%CI: 1.02–3.21, P: 0.008) than SMuRF+ women.ConclusionsAlmost one in 10 patients with ACS who underwent PCI had no SMuRFs. The absence of SMuRFs did not confer any benefit in terms of in-hospital mortality, one-year mortality, and MACCE. Even worse, SMuRF-less women paradoxically had an excessive risk of in-hospital and one-year mortality

Moral decision making in healthcare and medical professions during the COVID-19 pandemic

With coronavirus disease 2019 (COVID-19) outbreak, healthcare and medical professions face challenging situations. High number of infected patients, scarce resources, and being vulnerable to the infection are among the reasons that may influence clinicians’ decision making and puts them in a moral situation. Furthermore, they may be carriers of coronavirus, resulting their social interactions to involve moral decision making. The aim of this study was to examine the moral decision making in clinicians during the COVID-19 pandemic and to find its relation to psychological, cognitive, and behavioral correlates. 193 clinicians who worked in hospitals allocated to coronavirus disease patients, participated in our study. We designed an online survey containing 8 dilemmas to test moral decision making in clinicians. Information on clinicians’ behavior, cognition and psychological state during the COVID-19 pandemic, including the degree of respect to social distancing, sources of stress, and dead cases of COVID-19 they confronted with were collected. The relation between these measures and moral decision making was assessed. Based on our results, clinicians’ most important source of stress was the infection of their families. There was a positive correlation between utilitarian responses and clinicians’ stress level, and number of dead cases they confronted with. Moreover, degree of utilitarian behavior was positively correlated to social distancing. Both age and sex contributed to individual differences in respecting social distancing, stress and utilitarian behavior. With increasing stress and encountering more deaths, clinicians tended to decide based on the outcome. Our results have critical implications in implementing policies for healthcare principals

Neuroapoptosis Signaling Pathways in Hippocampus Following Ovariectomy and Its Inhibition by Systemic Estradiol Replacement Therapy

In recent decades, there is a growing concern about neurodegenerative diseases (NDs) resulting from the increasing pattern of population age and life expectancy. Although there is no medical treatment for NDs, certain studies have suggested the neuroprotective role of estradiol (ES) in the brain. Hence hormone replacement therapy would be a promising therapeutic alternative for NDs. The present study was performed to investigate the beneficial effect of ES in the neurogenesis and neuro-apoptosis signaling pathways in the hippocampus following ovariectomy (OVX). Thirty Wistar rats were randomly assigned to 5 groups: 1) control 2) OVX, 3) OVX and ES, 4) Surgical sham, and 5) vehicle shams for ES. Eight weeks after surgery, OVX and ES group received an intramuscular injection of ES (20µg/rat) for 30 days, then hippocampi were obtained from all rats for molecular and histology studies. Nissl staining of the hippocampus for neuronal cell counting and western blot for detecting the expression of caspase-3 and cytochrome-c were performed. Based on our findings using western blot, overexpression of apoptotic proteins in the hippocampal tissue was observed in the OVX group. Furthermore, Nissl staining revealed a significant hippocampal neuronal cell death in the OVX group. In a nutshell, ES could result in the increase of neuron cells and the prevention of apoptosis in the hippocampus

Additional file 1 of Spontaneous coronary artery dissection in patients with prior psychophysical stress: a systematic review of case reports and case series

Supplementary Material 1