Danai Theodoulou

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently evolved as a pandemic disease. Although the respiratory system is predominantly affected, cardiovascular complications have been frequently identified, including acute myocarditis, myocardial infarction, acute heart failure, arrhythmias and venous thromboembolic events. Pericardial disease has been rarely reported. We present a case of acute life-threatening cardiac tamponade caused by a small pericardial effusion in a mechanically ventilated patient with severe COVID-19 associated pneumonia. The patient presented acute circulatory collapse with hemodynamic features of cardiogenic or obstructive shock. Bedside echocardiography permitted prompt diagnosis and life-saving pericardiocentesis. Further investigation revealed no other apparent cause of pericardial effusion except for SARS-CoV-2 infection. Cardiac tamponade may complicate COVID-19 and should be included in the differential diagnosis of acute hemodynamic deterioration in mechanically ventilated COVID-19 patients.

BACKGROUND/AIM: Multiple reports from all over the world link COVID-19 with endothelial/coagulation disorders as well as a dysregulated immune response. This study tested the hypothesis that immunostimulation will be greater in COVID-19 patients than in patients with H1N1 infection or bacterial sepsis. Also, whether an increase in immune stimulation will be accompanied by a more severely affected endothelium/coagulation system was examined. PATIENTS AND METHODS: Twenty-three septic patients, admitted in the Intensive Care Unit (ICU), were enrolled (9 with SARS-CoV-2, 5 with H1N1 pneumonia, 9 with bacterial sepsis). Myeloperoxidase (MPO) activity along with certain endothelial/coagulation factors were assessed on admission (time point 1) and at either improvement or deterioration (time point 2). RESULTS: MPO levels were significantly higher in COVID-19 patients compared to both other groups. Furthermore, in patients with COVID-19, vWF levels did not differ significantly, fVIII levels were lower while ADAMTS-13 activity was higher compared to patients with H1N1 pneumonia and bacterial sepsis (a trend in the latter). CONCLUSION: Increased immunostimulation was noted in COVID-19 patients compared to other septic patients; however, this was not accompanied by greater disturbance of the clotting system and/or more severe endothelial injury.

A strong anti-hepcidin activity has been observed in heparins. Mean hepcidin levels were significantly reduced compared to baseline, following the first day of unfractionated heparin administration in critically patients. Heparin displayed a strong independent negative association with hepcidin. These results may lead to future treatment methods of forms of anaemia characterised by hepcidin excess, common among the critically ill.

<b>Introduction and Aim:</b> Patients with malignant central airway obstruction (mCAO) may need endobronchial intervention for symptoms relief but also to manage atelectasis and consequent respiratory failure. We herein aimed to assess quality of life (QoL) in patients with lung cancer after endobronchial intervention for malignant central airway obstruction. <b>Methods:</b> Over an 18-month period, 29 patients with symptomatic malignant central airway obstruction were enrolled in order to re-establish airway patency. QoL and dyspnea were evaluated by the EORTC -C30 and EORTC -LC13 Questionnaire before the intervention, 1 week after and every following month until first relapse or death. <b>Results:</b> Overall, 44.8% of patients (n=13) had poor performance status (PS ≥3) and 51.7% (n=15) of patients had stage IV disease. QoL improved significantly from the first week up to the 6th month (p&lt;0.05). Global Health Questionnaire improved from 29.6 (Standard deviation=19.2) to 70.8 (SD=30.5) (p&lt;0.05) on week 24. Dyspnea accessed with EORTC-LC13 questionnaire decreased from 73.2 (SD=29.2) to 23.6 (SD=26) (p&lt;0.05) on week 24. Benefits were independent of tumor histology or history of post-obstructive pneumonia. Mean time until first relapse was 21.2 weeks (SD=20.5) (n=6 patients) and time until death was 15.1 weeks (SD=7.9) (n=16 patents). <b>Conclusions:</b> Interventional management of patients with mCAO results in sustained significant improvement of QoL and decrease of shortness of breath and should be considered as an essential component of a multidisciplinary approach.