SARS-CoV 2 Infection (Covid-19) and Cardiovascular Disease in Africa: Health Care and Socio-Economic Implications.

The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones. This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.

Point-of-Care Ultrasound in the Evaluation of COVID-19.

BACKGROUND: The novel coronavirus SARS-CoV-2 has caused a pandemic, overwhelming health care systems around the world. Hospitals around the world, including the United States, have been struggling to adapt to the influx of patients with COVID-19, the illness caused by SARS-CoV2, given limited resources and high demand for medical care. OBJECTIVES: This article seeks to provide emergency physicians with a guide to sonographic findings in COVID-19 and an algorithm by which point-of-care lung ultrasound may assist emergency physicians caring for these patients during the SARS-CoV-2 pandemic. DISCUSSION: The studies currently being published have established a typical set of ultrasound findings in COVID-19. Point-of-care lung ultrasound is rapid and accessible in most emergency departments in the United States, and even in many resource-poor settings. CONCLUSION: Point-of-care ultrasound provides numerous benefits to emergency providers caring for patients with COVID-19, including decreasing resource utilization, assisting in diagnosis, guiding management of the critically ill patient, and aiding in rapid triage of patients under investigations for COVID-19.

Assessment of PaO2/FiO2 for stratification of patients with moderate and severe acute respiratory distress syndrome.

OBJECTIVES: A recent update of the definition of acute respiratory distress syndrome (ARDS) proposed an empirical classification based on ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) at ARDS onset. Since the proposal did not mandate PaO2/FiO2 calculation under standardised ventilator settings (SVS), we hypothesised that a stratification based on baseline PaO2/FiOv would not provide accurate assessment of lung injury severity. DESIGN: A prospective, multicentre, observational study. SETTING: A network of teaching hospitals. PARTICIPANTS: 478 patients with eligible criteria for moderate (100300). PRIMARY AND SECONDARY OUTCOMES: Group severity and hospital mortality. RESULTS: At ARDS onset, 173 patients had a PaO2/FiO2≤100 but only 38.7% met criteria for severe ARDS at 24 h under SVS. When assessed under SVS, 61.3% of patients with severe ARDS were reclassified as moderate, mild and non-ARDS, while lung severity and hospital mortality changed markedly with every PaO2/FiO2 category (p<0.000001). Our model of risk stratification outperformed the stratification using baseline PaO2/FiO2 and non-standardised PaO2/FiO2 at 24 h, when analysed by the predictive receiver operating characteristic (ROC) curve: area under the ROC curve for stratification at baseline was 0.583 (95% CI 0.525 to 0.636), 0.605 (95% CI 0.552 to 0.658) at 24 h without SVS and 0.693 (95% CI 0.645 to 0.742) at 24 h under SVS (p<0.000001). CONCLUSIONS: Our findings support the need for patient assessment under SVS at 24 h after ARDS onset to assess disease severity, and have implications for the diagnosis and management of ARDS patients. TRIAL REGISTRATION NUMBERS: NCT00435110 and NCT00736892.

Body temperature monitoring and SARS fever hotline, Taiwan.

In Taiwan, a temperature-monitoring campaign and hotline for severe acute respiratory syndrome (SARS) fever were implemented in June 2003. Among 1,966 calls, fever was recorded in 19% (n = 378); 18 persons at high risk for SARS were identified. In a cross-sectional telephone survey, 95% (n = 1,060) of households knew about the campaign and 7 households reported fever.

[Assessment of health-related quality of life in cured SARS patients].

OBJECTIVE: To assess the quality of life in cured patients with severe acute respiratory syndrome (SARS). METHODS: One hundred and nineteen SARS outpatients, including 64 men and 55 women, with mean age (34.1 +/- 11.4) years and average days of discharge from hospital (28.0 +/- 12.8) days, were assessed by the St George's respiratory questionnaire (SGRQ), and 72 patients with spirometry test. RESULTS: The patients had a moderately degree physiological impairment and increased SGRQ score. Scores of all four part of SGRQ correlated significantly with diffuse capacity of the lung for carbon monoxide/pre (DLco%). The correlation coefficients between the activation, impaction, total score, and diffuse capacity of the lung for carbon monoxide/alveolar ventilation/pre (DLco/Va%) were resembled (r = 0.47-0.54, P < 0.01). There was a significant relationship between the score of SGRQ and patients age, and gender. The time leaving hospital only had a significant relationship with the symptom score of SGRQ. CONCLUSIONS: SGRQ is a sensitive tool for assessing quality of life in cured SARS patients. The cured SARS patients' quality of life decrease moderately.

[Assessment of pulmonary function in SARS patients during the convalescent period].

OBJECTIVE: To investigate the pulmonary function in severe acute respiratory syndrome (SARS) patients during the convalescent period. METHODS: Followup 89 outpatients of SARS. The follow-up study included interview, physical examination, and pulmonary function test. RESULTS: The interval between hospital discharge and functional assessment was 1.75 +/- 0.53 months (0.5-3.4 months). Mild to moderate abnormalities in pulmonary function were found in 48 patients (53.9%). Diffusion capacity for carbon monoxide (DLco) was impaired in 38 patients (42.7%); in 7 patients (7.9%), lung function was restrictive defect combined DLco impairment; Other patterns of impairment were revealed in 3 patient. Dyspnea during acute phase and CT during the convalescent period were found to have significant influences on DLco and total lung capacity (TLC). CONCLUSIONS: Diffusing capacity impairment as well as restrictive defect persist in convalescence SARS.

SARS: epidemiology, clinical presentation, management, and infection control measures.

Severe acute respiratory syndrome (SARS) is a recently recognized febrile respiratory illness that first appeared in southern China in November 2002, has since spread to several countries, and has resulted in more than 8000 cases and more than 750 deaths. The disease has been etiologically linked to a novel coronavirus that has been named the SARS-associated coronavirus. It appears to be spread primarily by large droplet transmission. There is no specific therapy, and management consists of supportive care. This article summarizes currently available information regarding the epidemiology, clinical features, etiologic agent, and modes of transmission of the disease, as well as infection control measures appropriate to contain SARS.