Impact of cardiovascular disease and cardiovascular risk factors in hospitalised COVID-19 patients

BACKGROUND

Hospitalised COVID-19 patients with underlying cardiovascular disease (CVD) and cardiovascular risk factors appear to be at risk of poor outcome. It is unknown if these patients should be considered a vulnerable group in healthcare delivery and healthcare recommendations during the COVID-19 pandemic.

METHODS

A systematic literature search was performed to answer the following question: In which hospitalised patients with proven COVID-19 and with underlying CVD and cardiovascular risk factors should doctors be alert to a poor outcome? Relevant outcome measures were mortality and intensive care unit admission. Medline and Embase databases were searched using relevant search terms until 9 June 2020. After systematic analysis, 8 studies were included.

RESULTS

Based on the literature search, there was insufficient evidence that CVD and cardiovascular risk factors are significant predictors of mortality and poor outcome in hospitalised patients with COVID-19. Due to differences in methodology, the level of evidence of all studies was graded 'very low' according to the Grading Recommendations Assessment, Development and Evaluation methodology. It is expected that in the near future, two multinational and multicentre European registries (CAPACITY-COVID and LEOSS) will offer more insight into outcome in COVID-19 patients.

CONCLUSION

This literature review demonstrated there was insufficient evidence to identify CVD and cardiovascular risk factors as important predictors of poor outcome in hospitalised COVID-19 patients. However, patients with CVD and cardiovascular risk factors remain vulnerable to infectious disease outbreaks. As such, governmental and public health COVID-19 recommendations for vulnerable groups apply to these patients.

Effect of anticoagulant therapy in COVID-19 patients

BACKGROUND

In patients hospitalised with COVID-19, an increased incidence of thromboembolic events, such as pulmonary embolism, deep vein thrombosis and stroke, has been reported. It is unknown whether anticoagulation can prevent these complications and improve outcome.

METHODS

A systematic literature search was performed to answer the question: What is the effect of (prophylactic and therapeutic dose) anticoagulation therapy in COVID-19 patients on cardiovascular and thromboembolic complications and clinical outcome? Relevant outcome measures were mortality (crucial), hospital admission, length of stay, thromboembolic complications (pulmonary embolism, stroke, transient ischaemic attack), need for mechanical ventilation, acute kidney injury and use of renal replacement therapy. Medline and Embase databases were searched with relevant search terms until 17 July 2020. After systematic analysis, eight studies were included. Analysis was stratified for the start of anticoagulation before or during hospital admission.

RESULTS

There was insufficient evidence that therapeutic anticoagulation could improve the outcome in patients hospitalised with COVID-19. None of the studies demonstrated improved mortality, except for one very small Italian study. Furthermore, none of the studies showed a positive effect of anticoagulation on other outcome measures in COVID-19, such as ICU admission, length of hospital stay, thromboembolic complications, need for mechanical ventilation, acute kidney failure or need for renal replacement therapy, except for two studies demonstrating an association between anticoagulation and a lower incidence of pulmonary embolism. However, the level of evidence of all studies varied from 'low' to 'very low', according to the GRADE methodology.

CONCLUSION

Analysis of the literature showed that there was insufficient evidence to answer our objective on the effect of anticoagulation on outcome in COVID-19 patients, especially due to the low scientific quality of the described studies. Randomised controlled studies are needed to answer this question.

How often and to what extent do admitted COVID-19 patients have signs of cardiac injury?

Background

COVID-19 can cause myocardial injury in a significant proportion of patients admitted to the hospital and seems to be associated with worse prognosis. The aim of this review was to study how often and to what extent COVID-19 causes myocardial injury and whether this is an important contributor to outcome with implications for management.

Methods

A literature search was performed in Medline and Embase. Myocardial injury was defined as elevated cardiac troponin (cTn) levels with at least one value > 99th percentile of the upper reference limit. The primary outcome measure was mortality, whereas secondary outcome measures were intensive care unit (ICU) admission and length of hospital stay.

Results

Four studies and one review were included. The presence of myocardial injury varied between 9.6 and 46.3%. Myocardial injury was associated with a higher mortality rate (risk ratio (RR) 5.54, 95% confidence interval (CI) 3.48–8.80) and more ICU admissions (RR 3.78, 95% CI 2.07–6.89). The results regarding length of hospital stay were inconclusive.

Conclusion

Patients with myocardial injury might be classified as high-risk patients, with probably a higher mortality rate and a larger need for ICU admission. cTn levels can be used in risk stratification models and can indicate which patients potentially benefit from early medication administration. We recommend measuring cTn levels in all COVID-19 patients admitted to the hospital or who deteriorate during admission.

Supplementary Information

The online version of this article (10.1007/s12471-021-01571-w) contains supplementary material, which is available to authorized users.

Effects of fingernail length on finger and hand performance

The purpose of this study was to investigate effects of fingernail length on active range of motion (AROM) of the fingers, speed of finger manipulation, number of words typed, and grip strength. Fifteen normal women (mean age, 30 years) performed measurements under four conditions--with no attached fingernails and with fingernails extending 2, 1, and 0.5 cm beyond the tip of the finger. Analyses of variance showed that: 1) with fingernails of all extended lengths, grip strength measured on the first setting of the Jamar hand dynamometer decreased; 2) with fingernails 1 and 2 cm in length, AROM, grip strength on the second dynamometer setting, and finger manipulation decreased; and 3) with fingernails 2 cm in length, typing speed decreased (p < 0.05). Long fingernails limit flexion of the finger joints, particularly the metacarpophalangeal joints. Lack of finger flexion will limit excursion of long flexors and extensors in patients. It is recommended that patients cut their fingernails to a length of 0.5 cm to achieve optimal functional outcomes.

Case reports and case studies: a discussion of theory and methodology in pocket format

Issues of the theory and methodology of case reports and case studies have been presented. Examples of applications of techniques used in the rehabilitation of the upper extremity conclude this report in pocket format on the theory and methodology of case reports and case studies. Case reports and studies enhance our knowledge about practice in ways that are unique to each case, which are not possible when investigations are performed through group comparison. Case inquiries help us share our practice, sharpen our theoretical reasoning, develop our good habits of applying reliable and valid measurements, and above all help us explore and discuss our treatments.

The effect of use of a wrist orthosis during functional activities on surface electromyography of the wrist extensors in normal subjects

Wrist orthoses are advocated for patients with lateral epicondylitis on the assumption that use of the orthosis decreases muscle activity of the wrist extensors during activities. The purpose of this study was to compare the amount of electrical activity, root mean square (RMS) calculated from surface EMG recorded over the wrist extensors, during activities when applying four conditions of wrist orthoses: dorsal; volar; semicircular; and no orthosis. Thirteen normal subjects (mean age 27.7 years) performed three lifting and two gripping tasks, repeated on three consecutive days under four orthotic conditions. Measured were RMS and maximum voluntary grip strength. Repeated measures ANOVA's indicated a significant decrease of RMS using the semicircular design during lifting (p < .0005). Grip strength decreased significantly using all three orthotic designs, but RMS recorded during gripping did not. It was concluded that application of a wrist orthosis reduces electrical activity of the wrist extensors less than anticipated and only during lifting.

Effect of work glove and type of muscle action on grip fatigue

Fatigue plays a major role in limiting work performance. The objectives of this study were: (1) to determine the effect of wearing a work glove on handgrip fatigue; (2) to compare the effect of a sustained grip contraction of concentric versus eccentric nature, named in this study isometric and eccentric; and (3) to determine if there is a relationship between physiological muscle performance and subjective perceptional fatigue during isometric and eccentric gripping. The study had 2 x 2 repeated measures design. The two factors were: (1) glove condition (glove, no glove); and (2) type of contraction (eccentric and isometric). The measurements taken were: (1) time to limit of endurance (Tlim); (2) rate of perceived effort (RPE); (3) mean power frequency (MPF) derived from the electromyogram (EMG); and (4) the fatigue objective-subjective relationship (FOSR, which is the correlation coefficient between RPE and MPF). Twenty-one normal subjects maintained a handgrip of 60% of their maximal effort until exhaustion for each of the four conditions. During each trial EMG values were recorded every 5 s and RPE values were recorded every 10 s. The RPE was recorded as a subjective value selected from a 10-point Borg scale. The results showed that Tlim was greater for the no glove condition (p < 0.0005) and for the eccentric muscle action (p < 0.05). The FOSR was greatest for the glove condition (p < 0.03) and for the isometric muscle action (p < 0.013). The MPF decline showed no significant difference for any condition. These data indicate that glove condition and type of handgrip contraction have an effect on physiological fatigue and subjective perception of fatigue.

Measurement of range of motion of the finger after flexor tendon repair in zone II of the hand

The purpose of this study was to compare classification systems of active range of motion of the finger after flexor tendon surgery in zone II of the hand. Active range of motion of 20 fingers (16 subjects) was classified according to five systems. Agreement between the systems was only fair. Strickland's original system and the Louisville system rated the results most strictly, followed by Strickland's adjusted system. Buck-Gramcko's systems (in centimeters and degrees) rated the results least strictly. Strickland's systems conformed most closely to measurement principles. This article concludes that at this time Strickland's original classification system is preferable for scientific and clinical purposes. However, additional research is needed to evaluate reliability of the measurement, the variability of the scaling factor of 175 degrees, the sensitivity of the measurement, and the validity of the measurement with regard to functional use of the finger and gliding of the repaired tendon.

[Prefabricated tympanic prosthesis]

Total and subtotal perforations of the tympanic membrane cause problems. Adhesions and poor hearing results are the outcome when just the stapes or the footplate remain intact. Reinforcement of the transplant using cartilage and plastic sheeting were not successful in the long run. The tympano-wire prosthesis with its concave form prevents the above mentioned disadvantages. Short interpositioning is to prefer in order to prevent impedance.

Functional repair of the eustachian tube

Endoscopy of the eustachian tube provides a new diagnostic potential for many problems of middle ear disease. The flexible fiberoptic system works from the nasopharynx as well as from the tympanic orifice, depending on the indications. It must be realized, however, that this is just the beginning of a new technique. Eustachian tube surgery plays a special role in connection with the new fiberoptic system. Preservation of the posterior bony canal wall and of the mucosal lining of the eustachian tube are the essentials of this modern approach.