Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications.

PURPOSE: In the pathogenesis of severe COVID-19 complications, derangements of renin-angiotensin-aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases. METHODS: We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors. RESULTS: Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins. CONCLUSIONS: Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group.

Tratamiento conservador en pacientes con síndrome de pinzamiento subacromial e inestabilidad glenohumoral. (Evaluación de resultado funcional con programa de ejercicio) / Conservative treatment in patients with subacromial impingement syndrome and glenohumeral instability. (Evaluation of functional result with a program of exercise)

Se realiza una evaluaciación del resultado del programa de ejercicios de fortalecimiento y elongación en pacientes con dolor crónico de hombro con diagnóstico de síndrome de pinzamiento subacromial (SPS), inestabilidad glenohumeral (IGH) y pacientes postquirúrgico con estas afecciones. Tres grupos fueron conformados: Grupo I (IGM) 30 pacientes, Grupo II (SPS) 25 pacientes y grupo III (Postquirúrgicos) 20 pacientes. Dos fueron buenos resultados en los tres grupos principalmente en los pacientes más jóvenes, con una utilidad importante en recuperación temprana en los pacientes postquirúrgicos. La evaluación del resultado se realizó de acuerdo con los parámetros establecidos por Rowe y col. (función dolor estabilidad y rangos de movimientos)