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Eyfferth T, Koczulla AR, Freytag HW, Krahl G, Ackermann C, Bultmann S, Reimertz R, Dresing K. [The problem of long/post-COVID in expert assessments]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:373-386. [PMID: 37079057 PMCID: PMC10117274 DOI: 10.1007/s00113-023-01297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 04/21/2023]
Abstract
Assessing long/post-COVID syndrome (PCS) following an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a multidisciplinary challenge due to the diverse and complex symptoms. Besides discipline-specific evaluation of infection-related organ damage, the main issue is expert objectivity and causality assessment regarding subjective symptoms. The consequences of long/PCS raise questions of insurance rights in all fields of law. In cases of persistent impairment of performance, determining reduction in earning capacity is crucial for those affected. Recognition as an occupational disease (BK no. 3101) is vital for employees in healthcare and welfare sectors, along with occupational accident recognition and assessing the illness's consequences, including the reduction in earning capacity (MdE) in other sectors or work areas. Therefore, expert assessments of illness consequences and differentiation from previous illnesses or damage disposition are necessary in all areas of law, individually based on corresponding organ manifestations in medical fields and interdisciplinarily for complex late sequelae, for instance, by internists with appropriate qualifications for pulmonary or cardiac manifestations and neurologists, psychiatrists, and neuropsychologists for neurological and psychiatric manifestations, etc.
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Affiliation(s)
- T Eyfferth
- BG Service- und Rehabilitationszentrum, BG Unfallklinik Frankfurt am Main gGmbH, Akademisches Lehrkrankenhaus, Johann-Wolfgang-Goethe Universität Frankfurt Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland.
- Sektion Begutachtung der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Berlin, Deutschland.
| | - A R Koczulla
- Schön Klinik Berchtesgadener Land, Schönau am Königssee, Deutschland
- Professur für Pneumologische Rehabilitation Philipps Universität Marburg, Deutsches Zentrum für Lungenforschung, Marburg, Deutschland
| | - H W Freytag
- Psychotraumatologie (PZDT), BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - G Krahl
- Psychotraumatologie (PZDT), BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Ch Ackermann
- Psychotraumatologie (PZDT), BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - S Bultmann
- Sozialgericht Hamburg, Hamburg, Deutschland
| | - R Reimertz
- BG Service- und Rehabilitationszentrum, BG Unfallklinik Frankfurt am Main gGmbH, Akademisches Lehrkrankenhaus, Johann-Wolfgang-Goethe Universität Frankfurt Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
| | - K Dresing
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
- Sektion Begutachtung der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Berlin, Deutschland
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Abstract
The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.
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Yang Y, Wei Z, Xiong C, Qian H. Direct mechanisms of SARS-CoV-2-induced cardiomyocyte damage: an update. Virol J 2022; 19:108. [PMID: 35752810 PMCID: PMC9233758 DOI: 10.1186/s12985-022-01833-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
Myocardial injury induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is reportedly related to disease severity and mortality, attracting attention to exploring relevant pathogenic mechanisms. Limited by insufficient evidence, myocardial injury caused by direct viral invasion of cardiomyocytes (CMs) is not fully understood. Based on recent studies, endosomal dependence can compensate for S protein priming to mediate SARS-CoV-2 infection of CMs, damage the contractile function of CMs, trigger electrical dysfunction, and tip the balance of the renin-angiotensin-aldosterone system to exert a myocardial injury effect. In this review, we shed light on the direct injury caused by SARS-CoV-2 to provide a comprehensive understanding of the cardiac manifestations of coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Yicheng Yang
- Center for Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular, Beijing, 100037, China
| | - Zhiyao Wei
- Center for Coronary Heart Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular, Beijing, 100037, China
| | - Changming Xiong
- Center for Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular, Beijing, 100037, China.
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Haiyan Qian
- Center for Coronary Heart Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular, Beijing, 100037, China.
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
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Tarantino N, Della Rocca DG, Zou F, Lin A, Natale A, Di Biase L. Prevalence, Outcomes, and Management of Ventricular Arrhythmias in COVID-19 Patients. Card Electrophysiol Clin 2022; 14:11-20. [PMID: 35221078 PMCID: PMC8554003 DOI: 10.1016/j.ccep.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We review the current data on epidemiology, the clinical significance, the pathophysiologic mechanisms, and the treatment of VAs in the setting of COVID-19. VAs prevail in 0.15% to 8% of hospitalized patients, but only sustained and rapid tachyarrhythmias are purportedly associated with a significant increase in mortality. Multiple factors can elicit VAs, which are ultimately deemed to be a marker of severe systemic disease rather than a distinct cardiac condition. Even though the electrophysiologist plays a determinant role in the secondary prevention of VAs, a multidisciplinary approach is indispensable for primary prophylaxis and acute management.
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Affiliation(s)
- Nicola Tarantino
- Montefiore Medical Center, 111 E 210th street, Bronx, NY 10467, USA
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, 3000 N I-35, Suite 720, Austin, TX 78705, USA
| | - Fengwei Zou
- Montefiore Medical Center, 111 E 210th street, Bronx, NY 10467, USA
| | - Aung Lin
- Montefiore Medical Center, 111 E 210th street, Bronx, NY 10467, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, 3000 N I-35, Suite 720, Austin, TX 78705, USA; Scripps Interventional Car, 9834 Genesee Ave, La Jolla, CA 92037, USA; Health Education Campus, 9501 Euclid Ave, Cleveland, OH 44106, USA
| | - Luigi Di Biase
- Montefiore Medical Center, 111 E 210th street, Bronx, NY 10467, USA; Texas Cardiac Arrhythmia Institute at St. David's Medical Center, 3000 N I-35, Suite 720, Austin, TX 78705, USA.
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Nagai T, Horinouchi H, Yoshioka K, Nakagawa Y, Ikari Y. Value of standard echocardiography at the bedside for COVID-19 patients in intensive care units: a Japanese single-center analysis. J Med Ultrason (2001) 2021; 48:595-603. [PMID: 34403024 PMCID: PMC8368052 DOI: 10.1007/s10396-021-01122-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/09/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE In the era of COVID-19, those special settings or indications for which standard transthoracic echocardiography (TTE) can safely produce benefits or advantages over minimized ultrasound imaging procedures need to be identified. Thus, the purpose of this study was to conduct a retrospective analysis with offline comprehensive conventional measurement of bilateral heart function and develop an appropriate prognostic model for in-hospital death. METHODS We performed a retrospective analysis of 37 consecutive patients with COVID-19, confirmed by real-time reverse-transcriptase polymerase chain reaction assay, who had undergone clinically indicated standard two-dimensional echocardiographic studies in intensive care wards. Offline comprehensive measurement was also performed. We further integrated the echocardiographic findings as paired evidence of vital organ involvement (possible respiratory distress assessed using right ventricular functional parameters, possible myocardial injury assessed using increased wall thickness, effusion or asynergy) and circulatory failure (suspected low flow status assessed using stroke volume index, suspected congestion assessed using elevated right or left atrial pressure). We evaluated its value for in-hospital death along with other echocardiographic findings. RESULTS The most common features included a normal-sized left atrium and left ventricle with preserved left ventricular ejection fraction, despite deteriorated left ventricular flow volume. Less frequent findings, such as abnormalities in the right heart and left ventricular abnormalities suggesting myocarditis, were observed. Although the single echocardiographic parameters failed to show predictive values for in-hospital death, integration of the echocardiographic findings suggested predictive value (p = 0.04, odds ratio: 12.28). CONCLUSION Standard TTE at the bedside with offline comprehensive conventional measurement may provide prognostic information that is valuable for the management of patients with COVID-19.
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Affiliation(s)
- Tomoo Nagai
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 259-1193, Japan.
| | - Hitomi Horinouchi
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 259-1193, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 259-1193, Japan
| | - Yoshihide Nakagawa
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 259-1193, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 259-1193, Japan
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Marziliano N, Medoro A, Mignogna D, Saccon G, Folzani S, Reverberi C, Russo C, Intrieri M. Sudden Cardiac Death Caused by a Fatal Association of Hypertrophic Cardiomyopathy ( MYH7, p.Arg719Trp), Heterozygous Familial Hypercholesterolemia ( LDLR, p.Gly343Lys) and SARS-CoV-2 B.1.1.7 Infection. Diagnostics (Basel) 2021; 11:1229. [PMID: 34359312 PMCID: PMC8307649 DOI: 10.3390/diagnostics11071229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 01/31/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) and heterozygous familial hypercholesterolemia (HeFH), two of the most common genetic cardiovascular disorders, can lead to sudden cardiac death. These conditions could be complicated by concomitant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as in the case herein described. A young amateur soccer player died in late October 2020 after a fatal arrhythmia and the autopsy revealed the presence of HCM with diffuse non-obstructive coronary disease. The molecular autopsy revealed a compound condition with a first mutation in the MYH7 gene (p.Arg719Trp) and a second mutation in the LDLR gene (p.Gly343Cys): both have already been described as associated with HCM and HeFH, respectively. In addition, molecular analyses showed the presence of SARS-CoV-2 lineage B.1.1.7 (UK variant with high titer in the myocardium. Co-segregation analysis within the family (n = 19) showed that heterozygous LDLR mutation was maternally inherited, while the heterozygous MYH7 genetic lesion was de novo. All family member carriers of the LDLR mutation (n = 13) had systematic higher LDL plasma concentrations and positive records of cardiac and vascular ischemic events at young age. Considering that HCM mutations are in themselves involved in the predisposition to malignant arrhythmogenicity and HeFH could cause higher risk of cardiac complications in SARS-CoV-2 infection, this case could represent an example of a potential SARS-CoV-2 infection role in triggering or unmasking inherited cardiovascular disease, whose combination might represent the cause of fatal arrhythmia at such a young age. Additionally, it can provide clues in dating the presence of the SARS-CoV-2 lineage B.1.1.7 in Northern Italy in the early phases of the second pandemic wave.
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Affiliation(s)
- Nicola Marziliano
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
- Clinical Pathology Laboratory, ASST Rhodense, Rho, 20017 Milan, Italy
| | - Alessandro Medoro
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
| | - Donatella Mignogna
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
| | - Giovanni Saccon
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
| | - Stefano Folzani
- Poliambulatorio Città di Collecchio, Collecchio, 43044 Parma, Italy; (S.F.); (C.R.)
| | - Claudio Reverberi
- Poliambulatorio Città di Collecchio, Collecchio, 43044 Parma, Italy; (S.F.); (C.R.)
| | - Claudio Russo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
| | - Mariano Intrieri
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
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Maintaining Standards in Colorectal Cancer Surgery During the Global Pandemic: A Cohort Study. World J Surg 2021; 45:655-661. [PMID: 33423099 PMCID: PMC7796814 DOI: 10.1007/s00268-020-05928-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/16/2022]
Abstract
Aim Cancer surgery in the COVID-19 pandemic presents many new challenges. For each patient, the risk of contracting COVID-19 during the perioperative period, with the potential for life-threatening sequelae (1), has to be weighed against the risk of delaying treatment. We assessed the response and short-term outcomes from elective colorectal cancer surgery during the pandemic at our institution. Method We report a prospective cohort study of all elective colorectal surgery cases performed at our Trust during the 11 weeks following the national UK lockdown on 23rd March 2020, compared with the same time period in 2019. Results Eighty-five colorectal operations were performed during the 2020 (COVID) time period, and 179 performed in the 2019 (non-COVID) time period. A significantly higher proportion of cases during the COVID period were cancer-related (66% vs 26%, p < 0.00001). There was no difference in length of hospital stay, complications or readmissions. There were no mortalities in either cohort. Among the cancer patients, there were no differences in TMN staging, R1 resection rate or lymph node yields. No elective patient tested positive for COVID-19 during the perioperative period. Conclusion At the height of the COVID pandemic, we maintained delivery the of high-quality elective colorectal cancer surgery, with no worsening of short-term outcomes and no compromise in the quality of cancer resections. Ongoing monitoring of this cohort is essential. The risks associated with COVID-19 will continue for some time, necessitating adaptive responses to maintain high-quality cancer services.
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