Spectrum of myocardial involvement in patients with COVID-19 - An echocardiography study.

Introduction: Covid-19 patients can have both regional and global ventricular dysfunction. We aim to study the spectrum of myocardial involvement in Covid-19 patients on echocardiography. Methods: This is a single center, observational study where wall motion abnormality patterns were studied in Covid-19 patients along with global and regional longitudinal strain analysis (GLS). Results: 30 Covid-19 patients were included in the study, with a mean age of 35.3±6.4 years. Echocardiography revealed characteristic wall motion abnormality involving hypokinesia of anterolateral and apical segments, which produced an operculum like appearance in all patients. Strain derived ejection fraction(EF) was lower in 4 chamber as compared to 2 chamber indicating regional myocardial dysfunction. Reduced GLS values in presence of normal EF indicates global systolic function impairment. Endocardial effacement was also noted in these segments along with stretching of interventricular septum. Conclusion: Specific myocardial involvement pattern can be detected on echocardiography, thus helping in diagnosis of Covid myocarditis.

Coronavirus Disease-19 (COVID-19) and Heart Failure: Current Perspective.

COVID-19 has been the biggest pandemic which the world has seen in recent times. The SARS-Cov-2 infection has the potential to cause multi-organ dysfunction. Though the virus predominantly affects the lungs, it can affect the heart in myriad ways. Heart failure (HF) is one such complication caused by the virus, both in patients with and without cardiovascular diseases. Different mechanisms have been proposed for the pathogenesis of HF in COVID-19 ranging from direct viral injury to indirect immune mediated damage. Patients can have different clinical presentations with either acute heart failure or chronic heart failure. Early recognition and prompt management is the need of the hour to prevent any mortality and morbidity. Summary: COVID-19 can affect the heart in many ways. This article describes the mechanisms, clinical presentations and management of heart failure caused by COVID-19 infection.

Improvements in corticosteroid 21-acetoxy-17α-hydroxy-16α-methyl-pregna-1,4,9(11)-triene-3,20-dione synthesis and its use as common intermediate in the synthesis of some impurities related to dexamethasone and mometasone.

There are quite substantial number of impurities related to dexamethasone or mometasone which cannot be made from respective Active Pharmaceutical Ingredients but from common intermediate 21-acetoxy-17α-hydroxy-16α-methyl-pregna-1,4,9(11)-triene-3,20-dione (12). As such, a robust and economical synthesis of this key intermediate is important for delivering a resilient and economically viable supply chain for these impurities. Therefore, it is critical to have a robust and economically viable process to synthesize the intermediate 12 in good yield and quality. We report here an improved synthesis of 12 and eight impurities related to dexamethasone and mometasone from this common intermediate.