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The relationship between infectious disease and therapy with immune checkpoint inhibitors remains unknown. We report the case of a 50-year-old woman with metastatic lung adenocarcinoma who responded remarkably well to immunotherapy and underwent upper right lobectomy. Three weeks after hospital discharge, she was readmitted for severe dyspnea due to mainstem bronchus compression by mediastinal mass. Histological analysis of transbronchial needle aspiration revealed A. fumigatus. After six months of voriconazole regimen, her symptoms improved with the regression of bronchial compression. Postoperative progression of pseudo-tumoral mass in patients treated with long-term immunotherapy may be related to opportunistic infectious disease and requires investigation., (Copyright © 2022. Published by Elsevier Masson SAS.)

Unplanned readmissions after lung cancer surgery impair normal postoperative recovery and are associated with increased postoperative mortality. The objective of this review was to compile a detailed and comprehensive dataset on unplanned readmissions after pulmonary resection so as to better understand the associated factors and how they may be attenuated. Based on the identified risk factors, prevention involves improved preoperative preparation of at-risk patients and preoperative discharge planning so as to help prevent unscheduled readmissions, which are predictive of a poorer prognosis., (Published by Elsevier Masson SAS.)

During the COVID-19 pandemic, there was increased interest in the issue of thrombotic complications of acute respiratory infections. Clinical reports and pathological studies have revealed that thrombus formation in COVID-19 may involve the venous and arterial vasculature. As thrombotic complications of infectious respiratory diseases are increasingly considered in the context of COVID-19, the fact that thrombosis in lung diseases of viral and bacterial etiology was described long before the pandemic is overlooked. Pre-pandemic studies show that bacterial and viral respiratory infections are associated with an increased risk of thrombotic complications such as myocardial infarction, ischemic stroke, pulmonary embolism, and other critical illnesses caused by arterial and venous thrombosis. This narrative review article aims to summarize the current evidence regarding thrombotic complications and their pathogenesis in acute lower respiratory tract infections. [ABSTRACT FROM AUTHOR]

Simple Summary: Lung cancer treatment often involves surgical resection. Traditional resection involves a large thoracotomy incision to access the chest cavity. However, thoracotomy has become less common since the introduction of minimally invasive surgery (MIS). Minimally invasive surgery includes video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) and involves small incisions to accomplish the same operation. MIS techniques have improved patient outcomes compared to thoracotomy. Patients recover faster in the hospital, have fewer complications and less pain, and return to baseline function faster. These techniques have now become the standard of care for lung cancer resection. Minimally invasive thoracic surgery has advanced the treatment of lung cancer since its introduction in the 1990s. Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) offer the advantage of smaller incisions without compromising patient outcomes. These techniques have been shown to be safe and effective in standard pulmonary resections (lobectomy and sub-lobar resection) and in complex pulmonary resections (sleeve resection and pneumonectomy). Furthermore, several studies show these techniques enhance patient outcomes from early recovery to improved quality of life (QoL) and excellent oncologic results. The rise of RATS has yielded further operative benefits compared to thoracoscopic surgery. The wristed instruments, neutralization of tremor, dexterity, and magnification allow for more precise and delicate dissection of tissues and vessels. This review summarizes of the advancements in minimally invasive thoracic surgery and the positive impact on patient outcomes. [ABSTRACT FROM AUTHOR]

Coronavirus disease of 2019 (COVID-19) is the respiratory viral infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite being a primary respiratory illness, it is commonly complicated by systemic involvement of the vasculature leading to arterial and venous thrombosis. In this review, we will focus on the association between COVID-19 and thrombosis. We will highlight the pathophysiology of COVID-19 coagulopathy. The clinical manifestations of COVID-19 vasculopathy will be discussed with a focus on venous and arterial thromboembolic events. COVID-19 vasculopathy and disseminated intravascular coagulation (DIC) are distinguished within, as well as areas of controversy, such as "long COVID". Finally, the current professional guidelines on prevention and treatment of thrombosis associated with SARS-CoV-2 infection will be discussed. [ABSTRACT FROM AUTHOR]

Objective: Local Liquid drug (LLD) delivery devices have recently emerged as a novel approach to treat peripheral arterial disease. This systemic review aims to identify and evaluate the clinical utility of the most commonly used delivery devices. Methods: A systemic review was performed using the Medical Subjects Heading terms of "drug delivery," "liquid," "local," and "cardiovascular disease" in PubMed, Google Scholar, and Scopus. Results: Four commonly used delivery devices were identified, including (1) the Bullfrog Micro-Infusion Device, (2) the ClearWay RX Catheter, (3) the Occlusion Perfusion Catheter, and (4) the Targeted Adjustable Pharmaceutical Administration. All have shown to successfully deliver liquid therapeutic into the target lesion and have exhibited favorable safety and efficacy profiles in preclinical and clinical trials. The LLD devices have the ability to treat very long or multiple lesions with a single device, providing a more economical option. The safety profile in LLD clinical studies is also favorable in view of recent concerns regarding adverse events with crystalline-paclitaxel–coated devices. Conclusion: There is clear clinical evidence to support the concept of local liquid delivery to treat occlusive arterial disease. Clinical Impact: The 'leave nothing behind' strategy has been at the forefront of the most recent innovations in the field of interventional cardiology and vascular interventions. Although drug coated balloons have overcome limitations associated with plain old balloon angioplasty and peripheral stents, recent safety concerns and cost considerations have impacted their usage. In this review, various liquid drug delivery devices are presented, showcasing their capabilities and success in both preclinical and clinical settings. These innovative liquid delivery devices, capable of targeted delivery and their ability to be re-used for multiple treatment sites, may provide solutions for current unmet clinical needs. [ABSTRACT FROM AUTHOR]

Chronic wounds can lead to amputations and significant decreases in quality of life. Many commonly used medications are known to cause ulcers or perpetuate chronic wounds. A variety of medication classes can impair wound healing through affecting cells within the skin, metabolism, immune cell function, angiogenesis and coagulation. This review aims to highlight the main types of drugs which negatively impact wound healing. Cancer treatments, non-steroidal anti-inflammatory drugs (NSAIDs), anticoagulants, immunosuppressants, and some antibiotics are all risk factors for cutaneous adverse effects. Identifying drug-induced impaired wound healing is important to counsel patients and their medical practitioners on weighing up the benefits and risks of these medications. [ABSTRACT FROM AUTHOR]

Although COVID-19 primarily affects the respiratory system, it can have various effects on other organs, including the cardiovascular system. COVID-19 can lead to a prothrombotic status, promoting blood clotting, which can potentially affect native vessels and implanted devices. The exact mechanisms through which it leads to increased clotting are not yet fully understood but may involve inflammation, endothelial dysfunction, and a hyperactive immune response. In the present report, we describe a case of acute aortic stent graft thrombosis four days after the resolution of SARS-CoV-2 infection. The patient required emergent explantation of the stent graft after the failure of endovascular bailout procedures. [ABSTRACT FROM AUTHOR]

The implementation of chemoradiation combinations has gained great momentum in clinical practices. However, the full utility of this paradigm is often restricted by the discordant tempos of action of chemotherapy and radiotherapy. Here, a gold nanoparticle-based radiation-responsive nanovesicle system loaded with cisplatin and veliparib, denoted as CV-Au NVs, is developed to augment the concurrent chemoradiation effect in a spatiotemporally controllable manner of drug release. Upon irradiation, the in situ generation of •OH induces the oxidation of polyphenylene sulfide from being hydrophobic to hydrophilic, resulting in the disintegration of the nanovesicles and the rapid release of the entrapped cisplatin and veliparib (the poly ADP-ribose polymerase (PARP) inhibitor). Cisplatin-induced DNA damage and the impairment of the DNA repair mechanism mediated by veliparib synergistically elicit potent pro-apoptotic effects. In vivo studies suggest that one-dose injection of the CV-Au NVs and one-time X-ray irradiation paradigm effectively inhibit tumor growth in the A549 lung cancer model. This study provides new insight into designing nanomedicine platforms in chemoradiation therapy from a vantage point of synergizing both chemotherapy and radiation therapy in a spatiotemporally concurrent manner., (© 2024 Wiley‐VCH GmbH.)

Background: Different studies have identified the prognostic factors of COVID-19 infection. These studies have revealed that COVID-19 infection is more severe in males than in females. The aim of our study was to compare the severity of COVID-19 infection between males and females in terms of clinical, biological, radiological, and evolutionary aspects. Methodology: This is a cross-sectional observational study conducted in patients hospitalized with COVID-19 infection over a 6-month period from 1 August 2021 to 1 February 2022. Results: The comparison of clinical, biological, radiological, and evolutionary severity factors of covid19 infection between the two sexes revealed that this infection was more severe in males. Statistically significant differences were noted for the rate of high dimers (p =0.01) and for lung involvement greater than 25% on chest CT (Computed tomography) (p =0.008). Conclusion: The severity of covid-19 infection in men is due to biological differences between men and women in the renin-angiotensin system, the immune system, genetics, and sex hormones. Further research into the pathophysiological mechanisms behind this finding is needed. [ABSTRACT FROM AUTHOR]

Background: SARS- CoV-2 virus has had dramatic consequences worldwide being able to cause acute respiratory distress syndrome (ARDS), massive thrombosis and pulmonary embolism and, finally, patients' death. In COVID-19 infection, platelets have a procoagulant phenotype that can cause thrombosis in the pulmonary and systemic vascular network. Aspirin is a well-known anti-platelet drug widely used for the prevention of cardiovascular events and systematic reviews suggest a possible benefit of low-dose aspirin (LDA) use in the prevention and treatment of ARDS in patients with COVID-19 infection. However, several studies are available in the literature which do not support any benefits and no association with the patients' outcome. Therefore, currently available data are inconclusive. Materials and patients: Data from the nationwide cohort multicenter study of the Italian Society of Internal Medicine (SIMI) were analyzed. We conducted a propensity score-matched cohort analysis to investigate the impact of chronic assumption of LDA on mortality of adult COVID-19 patients admitted in Internal Medicine Units (IMU). Data from 3044 COVID-19 patients who referred to 41 Italian hospitals between February 3rd to May 8th 2020 were analyzed. A propensity score-matched analysis was conducted using the following variables: age, sex, hypertension, hyperlipidemia diabetes, atrial fibrillation, cerebrovascular disease, COPD, CKD and stratified upon LDA usage, excluding anticoagulant treatment. After matching, 380 patients were included in the final analysis (190 in LDA group and 190 in no-LDA group). Results: 66.2% were male, median age was 77 [70–83]. 34.8% of the population died during the hospitalization. Cardiovascular diseases were not significantly different between the groups. After comparison of LDA and no-LDA subgroups, we didn't record a significant difference in mortality rate (35.7% vs 33.7%) duration of hospital stay and ICU admission. In a logistic regression model, age (OR 1.05; 95% CI 1.01–1.09), FiO2 (OR 1.024; 95% CI 1.03–1.04) and days between symptoms onset and hospitalization (OR 0.93; 95% CI 0.87–0.99) were the only variables independently associated with death. [ABSTRACT FROM AUTHOR]

This work presents an important analysis and comparative study between two organic waste rhodamine B (RhB) and methyl orange (MO) dyes as pollutant models degeneration under sunlight. Hematite (α -Fe2O3) nanorods were synthesized and deposited on glass substrates using an efficient and simple one-step hydrothermal method. The nanorods were characterized by XRD, FESEM, EDX, and UV–Vis equipment. The photodegeneration parameters of α -Fe2O3 films were calculated by modeling the photodegradation of MO and RhB dyes as pollutants under sunlight irradiation for 150 min. Results revealed that the degradation efficiency of α -Fe2O3 films of MO and RhB dyes was 72.7% and 91.9%, respectively. The optimized photocatalyst degraded RhB more efficiently than the MO solution. [ABSTRACT FROM AUTHOR]

Objectives: With the evolution of technology in the field of thoracoscopy, three-dimensional (3D) endoscopic systems with 4 K resolution have recently come into use. This study aimed to determine perioperative outcomes of video-assisted thoracoscopic surgery (VATS) lobectomy performed a year after the 4 K three-dimensional (3D) endoscopic system installation and compare them with those of the high-definition (HD) 3D endoscopic system., Methods: We included patients who underwent complete VATS (cVATS) lobectomy for primary lung cancer using an HD3D endoscopic system (HD3D group, June 2015-September 2021, n = 251) or 4K3D endoscopic system (4K3D group, October 2021-September 2022, n = 47). The perioperative outcomes were compared between the two groups., Results: The operation time was significantly shorter in the 4K3D group (mean, 189.5 min) than in the HD3D group (208.5 min; p = 0.021), and the 4K3D group did not require conversion to thoracotomy or transfusion. The 4K3D group had less blood loss volume (4K3D group: mean, 24.0 mL vs. HD3D group: 43.3 mL; p = 0.105) and shorter chest drainage duration (4K3D group: mean, 2.3 days vs. HD3D group: 3.1 days; p = 0.115) and hospitalization period (4K3D group: mean, 7.9 days vs. HD3D group:10.0 days; p = 0.226) than the HD3D group, with no significant difference. No difference was observed in the incidence of ≥ Grade IIIa complications (p = 0.634)., Conclusion: The 4K3D endoscopic system significantly shortened the duration of cVATS lobectomy. It is useful for lung resection and may replace other endoscopy systems., (© 2024. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

Simple Summary: Lung cancer is a heterogeneous disease, making it a complex and challenging condition to diagnose and treat effectively. However, recent advances have been made in surgery and perioperative management as well as in the emergence of new therapies (targeted therapy and immunotherapy). These novel treatment approaches have fundamentally altered the course of the disease, offering new hope and improved outcomes for patients. While surgery traditionally played a role mainly in the initial phases of lung cancer, its potential benefits are now being considered at various stages of the disease. The objective of this review is to provide a comprehensive description of the latest surgical approaches in lung cancer. We aim to highlight the importance of integrating these modalities within a patient-centered and personalized treatment pathway. Non-small cell lung cancer (NSCLC) is now described as an extremely heterogeneous disease in its clinical presentation, histology, molecular characteristics, and patient conditions. Over the past 20 years, the management of lung cancer has evolved with positive results. Immune checkpoint inhibitors have revolutionized the treatment landscape for NSCLC in both metastatic and locally advanced stages. The identification of molecular alterations in NSCLC has also allowed the development of targeted therapies, which provide better outcomes than chemotherapy in selected patients. However, patients usually develop acquired resistance to these treatments. On the other hand, thoracic surgery has progressed thanks to minimally invasive procedures, pre-habilitation and enhanced recovery after surgery. Moreover, within thoracic surgery, precision surgery considers the patient and his/her disease in their entirety to offer the best oncologic strategy. Surgeons support patients from pre-operative rehabilitation to surgery and beyond. They are involved in post-treatment follow-up and lung cancer recurrence. When conventional therapies are no longer effective, salvage surgery can be performed on selected patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this current investigation is to evaluate the effect of adding different levels of cheeseweed Malva parviflora L. mallow leaves powder (MPLP) on the nutritional and quality characteristics of bread. Design/methodology/approach: Wheat flour was partially replaced with MPLP at 0%, 1%, 2%, 3%, 4% and 5% levels to obtain the wheat– MPLP composite flour. Chemical composition, phenolics, flavonoids and antioxidant activity by 2,2-diphenyl-1-picrylhydrazyl of wheat flour and MPLP were determined. Physicochemical and sensory characteristics of bread enriched with various levels of MPLP were evaluated. Findings: MPLP contains 23.9% of protein, 10.1% of crude fiber and 9.8% of ash, respectively. MPLP had a significantly higher concentration of micronutrients than wheat flour. The content of total phenolics, flavonoids as well as free radical scavenging activity of MPLP were 17.6, 38.2 and 6.0 fold, respectively, higher compared to wheat flour. Protein content in bread samples increased with the addition of the MPLP in a range of 1.2%–6.6%. The increasing replacement of MPLP in the composite flours resulted in progressively higher dietary fiber and ash contents for fortified bread samples. The higher level of MPLP reduced the specific volume of fortified breads. The highest scores for the sensory attributes were noted for bread samples fortified with 2% and 3% of MPLP, whereas the lowest scores for bread samples fortified with 4% and 5% MPLP. Research limitations/implications: Supplementation of wheat bread with different levels of MPLP resulted in significant increases in macro and microelements of fortified breads. Originality/value: Supplementation of wheat bread with different levels of cheeseweed Mallow (Malva parviflora L.) leaves powder resulted in significant increases in macro and microelements of fortified breads. [ABSTRACT FROM AUTHOR]

COVID-19-related thrombosis affects the venous and arterial systems. Data from 156 autopsies of COVID-19 patients were retrospectively analyzed to investigate the pattern of thrombotic complications and factors associated with pulmonary artery thrombosis and thromboembolism. Thrombotic complications were observed in a significant proportion (n = 68, 44%), with pulmonary artery thrombosis the most frequently identified thrombotic event (42, 27%). Multivariate analysis revealed that the length of hospital stay (OR 1.1, p = 0.004), neutrophil infiltration in the alveolar spaces (OR 3.6, p = 0.002), and the absence of hyaline membranes (OR 0.1, p = 0.01) were associated with thrombotic complications. Neutrophil infiltration in the alveolar spaces (OR 8, p < 0.001) and the absence of hyaline membranes (OR 0.1, p = 0.003) were also independent predictors of pulmonary artery thrombosis. The association of pulmonary artery thrombosis with an absence of hyaline membranes suggests it occurs later in the course of COVID-19 infection. As neutrophil infiltration in the alveolar spaces may indicate bacterial infection, our studies suggest the consideration of bacterial infections in these critically ill patients. [ABSTRACT FROM AUTHOR]

Ginseng is a very commonly used natural product in the world, and its two main species are Asian ginseng and American ginseng. Ginseng is an adaptogenic botanical that reportedly protects the body against stress, stabilizes physiological processes, and restores homeostasis. Previously, different animal models and contemporary research methodologies have been used to reveal ginseng's biomedical activities in different body systems and the linked mechanisms of actions. However, human clinical observation data on ginseng effects have attracted more attention from the general public and medical community. In this paper, after an introduction of the phytochemistry of ginseng species, we review positive ginseng clinical studies, mainly conducted in developed countries, performed over the past 20 years. The reported effects of ginseng are presented in several sections, and conditions impacted by ginseng include diabetes; cardiovascular disorders; cognition, memory, and mood; the common cold and flu; cancer fatigue and well-being; quality of life and social functioning, etc. Administration of ginseng demonstrated a good safety record in humans. Although encouraging beneficial effects obtained from clinical data, using the study treatment regimen, the reported ginseng effects in general only ranged from mild to moderate. Nonetheless, these beneficial effects of ginseng could be a valuable add-on therapy for patients receiving standard drug treatments. Additionally, as a dietary supplement, ginseng possesses an important role in maintaining and promoting human health. We believe that the quality of future ginseng trials should be improved, particularly by providing detailed herbal phytochemistry and quality control information. With solid effectiveness data obtained from a well-designed, carefully executed ginseng clinical trial, this meritoriously herbal medicine will be widely used by consumers and patients. [ABSTRACT FROM AUTHOR]

Background: Conventionally, two 4.5 mm cortical screws inserted toward the posterior tibial cortex are usually advocated for the fixation of Fulkerson osteotomy. This finite element analysis aimed to compare the biomechanical behavior of four different screw configurations to fix the Fulkerson osteotomy. Materials and methods: Fulkerson osteotomy was modeled using computerized tomography (CT) data of a patient with patellofemoral instability and fixed with four different screw configurations using two 4.5 mm cortical screws in the axial plane. The configurations were as follows: (1) two screws perpendicular to the osteotomy plane, (2) two screws perpendicular to the posterior cortex of the tibia, (3) the upper screw perpendicular to the osteotomy plane, but the lower screw is perpendicular to the posterior cortex of the tibia, and (4) the reverse position of the screw configuration in the third scenario. Gap formation, sliding, displacement, frictional stress, and deformation of the components were calculated and reported. Results: The osteotomy fragment moved superiorly after loading the models with 1654 N patellar tendon traction force. Since the proximal cut is sloped (bevel-cut osteotomy), the osteotomy fragment slid and rested on the upper tibial surface. Afterward, the upper surface of the osteotomy fragment acted as a fulcrum, and the distal part of the fragment began to separate from the tibia while the screws resisted the displacement. The resultant total displacement was 0.319 mm, 0.307 mm, 0.333 mm, and 0.245 mm from the first scenario to the fourth scenario, respectively. The minimum displacement was detected in the fourth scenario (upper screw perpendicular to the osteotomy plane and lower screw perpendicular to the posterior tibial cortex). Maximum frictional stress and maximum pressure between components on both surfaces were highest in the first scenario (both screws perpendicular to the osteotomy plane). Conclusions: A divergent screw configuration in which the upper screw is inserted perpendicular to the osteotomy plane and the lower screw is inserted perpendicular to the posterior tibial cortex might be a better option for the fixation of Fulkerson osteotomy. Level of evidence Level V, mechanism-based reasoning. [ABSTRACT FROM AUTHOR]

In patients with coronavirus disease 2019 (COVID-19), thromboembolism is a frequently reported complication. However, it is reported that the incidence of arterial occlusion is rare. We experienced a case of 70-year-old male patient who developed a complication of Right common iliac arterial occlusion while treating him for confirmed COVID-19 who did not have any risk factors, such as diabetes or smoking. As in our case, it is necessary to carefully observe whether this complication occurs while treating COVID-19 patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to develop a safe and effective method of inserting one tuberosity screw and to determine whether retro-tubercular (RT)-Open-wedge high tibial osteotomy (OWHTO) with tuberosity screw fixation can be conducted to overcome the problem of osteotomized tubercle and produce favorable outcomes compared to RT-OWHTO without tuberosity screw fixation. Methods: From 2018 to 2020, patients who underwent bi-planar RT-OWHTO were allocated as two groups (RT-OWHTO without tuberosity screw fixation as group I and with screw fixation as group II). Computed tomography (CT) was used to analyze osteotomy configurations such as RT gap and tip distance, and union of the main and second plane osteotomy sites. The RT gap distance was measured as the length of the osteotomy gap. The RT tip distance was measured as the length of the gap at the tip of the tibial tubercle. Post-operative complications were analyzed also. To evaluate the neurovascular (NV) approximity of screw fixation group, the pre-operative magnetic resonance imaging (MRI) images were referenced on the post-operative CT for the assessment of the safe zone. Results: In total, 44 knees in group I and 46 knees in group II were enrolled. The RT gap distance (2.58 ± 0.69 mm vs. 0.57 ± 0.57 mm; p <.001) and RT tip distance (4.31 ± 1.60 mm vs. 1.48 ± 1.42 mm; p <.001) were significantly larger in group I than in group II. The sum of union grade in the second plane osteotomy site (17.93 ± 2.18 points vs. 22.24 ± 2.57 points; p <.001) was statistically different between two groups at three months post operatively. Post-operative tuberosity prominence occurred in five knees only in group I (p = 0.025), although tibial tuberosity fracture developed in seven cases in group II compared with two cases in group I with no statistical significance. NV was safe when the screw was inserted medially. Conclusion: RT-OWTHO with one-screw fixation for the tuberosity was effective in terms of tuberosity prominence and the union of the second plane osteotomy site. However, it also produced another problem, such as tuberosity fracture. In addition, a tuberosity screw was safe when it was inserted in the medial–distal direction. Level of evidence: Cohort study; level III. [ABSTRACT FROM AUTHOR]

Background: Ethylene diamine tetra-acetic acid (EDTA) is a chelating agent used to dissolve calcium deposits but evidence in decalcifying atherosclerotic lesions is limited., Aims: We assessed the feasibility and efficacy of EDTA delivered via porous balloon to target calcified lesions in cadaveric below-the-knee (BTK) arteries., Methods: Using porcine carotid arteries, EDTA concentration was measured in the arterial wall and outside the artery at the 0-, 0.5-, 4-, and 24-h circulation after the injection through a porous balloon. In cadaver BTK samples, the proximal and distal anterior tibial artery (ATA) and distal posterior tibial artery (PTA) were studied. EDTA-2Na/H2O or EDTA-3Na/H2O were administrated using a porous balloon, then circulated for 6 h for EDTA-3Na/H2O and 24 h for EDTA-2Na/H2O and EDTA-3Na/H2O. Micro-CT imaging of the artery segments before and after the circulation and cross-sectional analyses were performed to evaluate calcium burden., Results: In the porcine carotid study, EDTA was delivered through a porous balloon present in the arterial wall and was retained there for 24 h. In BTK arteries, cross-sectional analyses of micro-CT revealed a significant decrease in the calcium area in the distal ATA segment under 24-h circulation with EDTA-2Na/H2O and in the distal ATA segment under 24-h circulation with EDTA-3Na/H2O. The proximal ATA segment under 6-h circulation with EDTA-3Na/H2O showed no significant change in any parameters of calcium CONCLUSION: EDTA-3Na/H2O or EDTA-2Na/H2O with longer circulation times resulted in greater calcium reduction in atherosclerotic lesion. EDTA may have a potential therapeutic option for the treatment of atherosclerotic calcified lesions., (© 2024 Wiley Periodicals LLC.)

Our purpose was to devise a radiomics model using preoperative computed tomography angiography (CTA) images to differentiate new from old emboli of acute lower limb arterial embolism. 57 patients (95 regions of interest; training set: n = 57; internal validation set: n = 38) with femoral popliteal acute lower limb arterial embolism confirmed by pathology and with preoperative CTA images were retrospectively analyzed. We selected the best prediction model according to the model performance tested by area under the curve (AUC) analysis across 1,000 iterations of prediction from three most common machine learning methods: support vector machine, feedforward neural network (FNN), and random forest, through several steps of feature selection. Then, the selected best model was also validated in an external validation dataset (n = 24). The established radiomics signature had good predictive efficacy. FNN exhibited the best model performance on the training and validation groups: its AUC value was 0.960 (95% CI, 0.899–1). The accuracy of this model was 89.5%, and its sensitivity and specificity were 0.938 and 0.864, respectively. The AUC of external validation dataset was 0.793. Our radiomics model based on preoperative CTA images is valuable. The radiomics approach of preoperative CTA to differentiate new emboli from old is feasible. [ABSTRACT FROM AUTHOR]

Introduction: Fenofibrate is an agonist of peroxisome proliferator activated receptor alpha (PPAR-α), that possesses anti-inflammatory, antioxidant, and anti-thrombotic properties. Fenofibrate is effective against a variety of viral infections and different inflammatory disorders. Therefore, the aim of critical review was to overview the potential role of fenofibrate in the pathogenesis of SARS-CoV-2 and related complications. Results: By destabilizing SARS-CoV-2 spike protein and preventing it from binding angiotensin-converting enzyme 2 (ACE2), a receptor for SARS-CoV-2 entry, fenofibrate can reduce SARS-CoV-2 entry in human cells Fenofibrate also suppresses inflammatory signaling pathways, which decreases SARS-CoV-2 infection-related inflammatory alterations. In conclusion, fenofibrate anti-inflammatory, antioxidant, and antithrombotic capabilities may help to minimize the inflammatory and thrombotic consequences associated with SARSCoV-2 infection. Through attenuating the interaction between SARS-CoV-2 and ACE2, fenofibrate can directly reduce the risk of SARS-CoV-2 infection. Conclusions: As a result, fenofibrate could be a potential treatment approach for COVID-19 control. [ABSTRACT FROM AUTHOR]

Purpose: We sought to evaluate the synergistic risk of postoperative thrombosis in patients with a history of COVID-19 who undergo major surgery. Major surgery and SARS-CoV-2 infection are independently associated with an increased risk of thrombosis, but the magnitude of additional risk beyond surgery conferred by a COVID-19 history on the development of perioperative thrombotic events has not been clearly elucidated in the literature., Methods: We conducted a retrospective cohort study among commercially insured adults in the USA from March 2020 to June 2021 using the Optum Labs Data Warehouse (OLDW), a longitudinal, real-world data asset containing deidentified administrative claims and electronic health records. We compared patients with prior COVID-19 who underwent surgery with control individuals who underwent surgery without a COVID-19 history and with control individuals who did not undergo surgery with and without a COVID-19 history. We assessed the interaction of surgery and previous COVID-19 on perioperative thrombotic events (venous thromboembolism and major adverse cardiovascular events) within 90 days using multivariable logistic regression and interaction analysis., Results: Two million and two-hundred thousand eligible patients were identified from the OLDW. Patients in the surgical cohorts were older and more medically complex than nonsurgical population controls. After adjusting for confounders, only surgical exposure-not COVID-19 history-remained associated with perioperative thrombotic events (adjusted odds ratio [aOR], 4.07; 95% confidence interval [CI], 3.81 to 4.36). The multiplicative interaction term (aOR, 1.25; 95% CI, 0.96 to 1.61) and the synergy index (0.76; 95% CI, 0.56 to 1.04) suggest minimal effect modification of prior COVID-19 on surgery with regards to overall thrombotic risk., Conclusions: We found no evidence of synergistic thrombotic risk from previous COVID-19 in patients who underwent selected major surgery relative to the baseline thrombotic risk from surgery alone., (© 2023. The Author(s).)

Neutrophil extracellular traps (NETs) are extracellular webs composed of neutrophil granular and nuclear elements. Because of the potentially dangerous amplification circuit between inflammation and tissue damage, NETs are becoming one of the investigated components in the current Coronavirus Disease 2019 (COVID-19) pandemic. The purpose of this systematic review is to summarize studies on the role of NETs in determining the prognosis of COVID-19 patients. The study used six databases: PubMed, Science Direct, EBSCOHost, Europe PMC, ProQuest, and Scopus. This literature search was implemented until October 31, 2021. The search terms were determined specifically for each databases, generally included the Neutrophil Extracellular Traps, COVID-19, and prognosis. The Newcastle Ottawa Scale (NOS) was then used to assess the risk of bias. Ten studies with a total of 810 participants were chosen based on the attainment of the prerequisite. Two were of high quality, seven were of moderate quality, and the rest were of low quality. The majority of studies compared COVID-19 to healthy control. Thrombosis was observed in three studies, while four studies recorded the need for mechanical ventilation. In COVID-19 patients, the early NETs concentration or the evolving NETs degradations can predict patient mortality. Based on their interactions with inflammatory and organ dysfunction markers, it is concluded that NETs play a significant role in navigating the severity of COVID-19 patients and thus impacting their prognosis. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 19 (COVID-19) is a viral disease caused by SARS-CoV-2. There is an increased incidence of a thromboembolic phenomenon in patients with COVID-19 infection. Pulmonary embolism is the most common thrombotic presentation in COVID-19 patients. Extra-pulmonary thrombosis is an unusual thrombotic complication of COVID-19 disease. Methods: This study was conducted at The Aga Khan University Hospital from June-July'2021. Patients clinical and laboratory findings, treatment, and outcomes were recorded. Results: We report three cases with the diagnosis of COVID-19 pneumonia associated with extra-pulmonary thrombosis from June to July 2021. The mean age of the patients were 66.3 and two of them (66.6%) were male. The diagnosis of COVID-19 was confirmed by real-time reverse transcriptase-polymerase chain reaction analysis in all the three patients. Extra-pulmonary thrombosis was identified in the celiac artery and splenic veins in case 1, left common iliac artery in case 2, and left ventricular apical thrombus in case 3. All the patients were treated with anticoagulation. In total, two patients were discharged home after total recovery, while the third patient died. Conclusion: The take-home message is that COVID-19 infection is a pro-thrombotic condition that can provoke arterial and venous thrombosis. Extra-pulmonary thrombosis is increasingly identified with COVID-19 infection. It is important to remember that the patient might have no potential risk factor for thromboses, as COVID-19 infection per se is a risk to induce thrombosis. [ABSTRACT FROM AUTHOR]

Background Arterial and venous thromboses associated with the coronavirus disease 2019 (COVID-19) have been well described. These events are caused by a hypercoagulable state due to endotheliopathy and infection-driven coagulopathy. There has been an ever-increasing number of documented cases of aortic thrombosis (AoT) in COVID-19 patients. We conducted a systematic review of current scientific literature to identify and consolidate evidence of AoT in COVID-19 patients. Methods A systematic review of literature was conducted between March 15, 2020, and May 1, 2021, on PubMed and Cochrane databases. Additionally, a case from our facility was included. Results A total of 38 studies (12 case series and 26 case reports) and a case from our facility describing AoT in 56 COVID-19 patients were included. Patients were aged 64.8 ± 10.5 years, were predominantly male (75%), and had several comorbidities. AoT was symptomatic in 82,14% of patients; however, when D dimers were reported, they were significantly elevated even in otherwise asymptomatic patients. Most patients had no previous history of aortic disease. Thrombosis was described in all parts of the aorta, with several cases reporting multiple locations. The median reported time until development of AoT was 10 days. Peripheral thrombosis occurred in 73.21% of cases, most commonly causing lower limb ischemia. Mortality rate was 30.4%. Conclusions AoT can occur with no clinical symptoms or as a primary symptom in otherwise asymptomatic COVID-19 patients. D dimers are a highly sensitive diagnostic tool. Diagnosis of this condition prior to development of complications could be instrumental in saving many lives. [ABSTRACT FROM AUTHOR]

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the recent global pandemic, with increasing number of cases reported globally. Our understanding of this novel respiratory virus deepens, it is increasingly clear that its effects extend beyond that of the respiratory system and can be extended to the almost all organ systems. SARS-CoV-2 causes lung inflammation which progresses to cytokine storm in the most severe cases. The lungs of patients with COVID-19 show extensive alveolar and interstitial inflammation. COVID-19 causes a spectrum of complications, with frequent involvement of the hemostatic system and there is a high incidence of venous thromboembolism in hospitalized COVID-19 patients, particularly those with severe illness. There is evidence of current body knowledge that COVID-19 induced by microvascular angiopathy can lead to a wide range of tissue pathology and clinical complications, such as Kawasaki disease, Buerger's syndrome and other systemic inflammatory disorders. Thromboangiitis obliterans (TAO) or Buerger's disease is a segmental occlusive inflammatory condition of arteries and veins, characterized by thrombosis and recanalization of the affected vessels. Limb infection at diagnosis was associated with a 4-fold higher risk of amputation. Smoking cessation was strongly associated with a lower rate of vascular events and amputation. TAO appears more likely to be a systemic disorder rather than a localized vasculopathy. Therefore, treatment protocols based on systemic treatment of TAO patients may be more helpful than localized treatment, such as bypass surgery and endovascular procedures. We present a case of a 53-years-old male with positive SARS-CoV-2 PCR test. Furter examination showed that patient had pneumonia, moreover, based on the duplex scan results the diagnosis of thromboangiitis obliterans (TAO) or Buerger's disease was confirmed. This disease itself is associated with a high risk of thrombosis and alongside with COVID-19 can cause unpredictable outcome. Patient underwent the day-round observation, received the appropriate treatment and was successfully discharged from the hospital on the day 11. [ABSTRACT FROM AUTHOR]

Background: Our objective was to evaluate the location of popliteal artery (PA) in osteotomy planes during high tibial osteotomy (HTO) and to determine a safer angle for screw drilling to the tibial tuberosity during distal tuberosity osteotomy (DTO). Methods: Twenty knees in 20 patients who underwent contrast-enhanced computed tomography for cardiovascular diseases were examined. Osteotomy planes for open-wedge HTO (OWHTO) and hybrid closed-wedge HTO (hybrid CWHTO) were created using three-dimensional bone models. The distance from the posterior cortex of the tibia to the PA (dPC-PA) in the osteotomy planes was measured in the virtual osteotomy planes. The dangerous point (Point D1) was defined as the point 17.5 mm away from PA, setting the working length of the bone saw as 35 mm. The distance between the most medial point of the tibial cortex (Point M) and Point D1 in OWHTO and the most lateral point (Point L) and Point D1 in hybrid CWHTO were examined (dM-D1 and dL-D1, respectively). The location of Point D1 to the osteotomy line (%D1) was expressed as percentage, setting the start and end of the osteotomy line as 0% and 100%, respectively. To determine the safe angle for screw drilling in DTO, the angle between the line tangential to the medial cortex of the tibia and that passing through the center of the tibial tuberosity and PA were measured. Results: In OWHTO and hybrid CWHTO, the mean dPC-PA was 10.6 mm (6.9–16.5 mm) and 10.2 mm (7.3–15.4 mm), respectively. The mean dM-D1 in OWHTO was 25.9 mm (24.6–27.2 mm) and dL-D1 in hybrid CWHTO was 5.1 mm (2.9–7.4 mm). The mean %D1 was 47.6 ± 3.7% in OWHTO and 9.3 ± 4.1% in hybrid CWHTO, respectively. The minimal angle between the two lines in DTO was 35.2°. Conclusion: PAs could run within 10 mm from the posterior cortex in the osteotomy planes of HTO. Therefore, proper posterior protection is necessary when cutting posterior cortex. An angle of less than 35° against the medial cortex line would be safe for screw fixation to avoid vascular injury in DTO. [ABSTRACT FROM AUTHOR]

Coronavirus disease-2019 (COVID-19) has become associated with prothrombotic state that could lead to severe arterial thrombotic complications. In the case of severe COVID-19 infection, hepatic dysfunction has been observed in more than 50% of patients. In this article, we present a case of aortic thrombosis associated with COVID-19 infection and methylenetetrahydrofolate reductase gene polymorphism (C677T) treated with rivaroxaban resulting in acute liver failure with fatal outcome. [ABSTRACT FROM AUTHOR]

Background: Hemorrhagic complications in patients with coronavirus 19 disease (COVID‐19) are infrequent but associated with a prognosis. This study aimed to elucidate the risk factors for bleeding complications in patients with COVID‐19 using rotational thromboelastometry (ROTEM) parameters and blood tests performed at admission. Methods: In total, 31 patients with severe COVID‐19 treated intensively at Saga University Hospital were included in this study. Patients were divided into two groups according to the presence or absence of hemorrhagic complications. Results from the blood tests performed at admission and during hospitalization, and ROTEM values acquired upon admission, were compared between the two groups. Results: There were significant differences in ROTEM values upon admission between the bleeding and non‐bleeding groups. Receiver operating curve analysis showed that the area under the curve for prothrombin time international normalized ratio (PT‐INR) and extrinsically‐activated test with tissue factor (EXTEM) amplitude at 10 min (A10) were 0.82 (0.52–0.92) and 0.81 (0.58–0.93), respectively. Logistic regression analysis with PT‐INR and EXTEM A10 as factors calculated an odds ratio of 1.94 (1.04–3.62) and EXTEM A10 0.86 (0.71–1.05) for bleeding complications occurrence. Conclusion: ROTEM may be a sensitive predictor for bleeding complications in patients with COVID‐19. [ABSTRACT FROM AUTHOR]

Objective: In this study, we investigated the efficacy and safety of remdesivir and tocilizumab combination therapy against dexamethasone for the management of severe COVID-19 patients. Methods: This was a multicenter study. Cases were randomly chosen and divided into two groups using an odd–even ratio of 1:1 applied to the hospital registration number. Group A received remdesivir [5 mg/kg (<40 kg) or 200 mg (>40 kg) on day 1 and then 2.5 mg/kg (<40 kg) or 100 mg (>40 kg) daily] + tocilizumab [8 mg/kg up to 800 mg highest 12 h apart], and group B was the control and received dexamethasone 6 mg/day. In addition, a broad-spectrum antibiotic and other essential treatments were received by all patients. To evaluate the mortality risk, the sequential organ failure assessment (SOFA) score was calculated on day-1. Treatment outcomes were measured as time to clinical improvement; mortality rate; duration of ICU stay; total period of hospitalization; the rate of (Supplementary Material) oxygen use; time to clinical failure; National Early Warning Score-2 (NEWS), and the percentage of lung recovery on CT of chest on discharge. Clinical trial registration ID: NCT04678739. Results: Remdesivir-Tocilizumab group had a lower mortality rate (25.49%) than the control (30.77%). The time to clinical improvement (Group A-9.41; B-14.21 days), NEWS-2 on discharge (Group A-0.89; B-1.2), duration of ICU stay (Group A-7.68; B-10.58), and duration of hospitalization (Group A-9.91; B-14.68) were less in the treatment group. Group A had a better percentage of lung recovery on chest CT than the control (Group A-22.13; B-11.74). All these differences were statistically significant (p = <0.05) in a t -test. However, no significant survival benefit was found among the study groups in Kaplan–Meier survival analysis, p = 0.739. Conclusion: The remdesivir–tocilizumab combination had preferable outcomes compared to the dexamethasone therapy for the treatment of severe COVID-19 concerning mortality rate and clinical and pulmonary improvement, although it did not demonstrate a significant survival benefit. Clinical Trial Registration: https://clinicaltrials.gov, NCT04678739. [ABSTRACT FROM AUTHOR]

Introduction: Patients undergoing maintenance hemodialysis have unique risk factors that render them prone to ischemia. To what extent coronavirus infectious disease 2019 (COVID‐19) increases this risk is unknown. Methods: This retrospective cohort study included incident patients undergoing maintenance hemodialysis from one city in Turkey. A comparison was made between those who developed COVID‐19 and those who did not for clinical variables. Independent predictors of acute ischemic complications in the total cohort were assessed using the logistic regression analysis. Findings By the start of the pandemic in Turkey, 33 of 154 (21.4%) patients developed COVID‐19. During the 15 months of median follow‐up after the start of the pandemic, 16 (10.4%) patients developed acute ischemic complications. These included acute myocardial infarction (n = 10), acute ischemic stroke (n = 4), acute peripheral artery thrombosis (n = 1), and pulmonary thromboembolism (n = 1). Overall, acute ischemic events occurred more commonly in those who experienced COVID‐19 (24.2% vs. 6.6%, p = 0.007). Ischemia‐free survival was significantly shorter in the COVID‐19 group (p = 0.001). In the eight patients with COVID‐19, ischemic complications emerged at a median 185 (range 21–306) days after the diagnosis of COVID‐19. While age, dialysis vintage, and experience of COVID‐19 were found as factors significantly associated with the development of acute ischemic events in univariate analysis, the association between COVID‐19 and acute ischemia remained significant in the multivariate regression model (odds ratio 3.99, 95% CI [1.3, 12.13], p = 0.016). During the pandemic, 23 (14.9%) patients died. Overall survival was significantly shorter among those who developed acute ischemic event (p < 0.001). The hazard ratio of acute ischemic event for death was 6.76 (95% CI [2.92, 15.66], p < 0.001). Discussion A considerable number of patients undergoing maintenance hemodialysis developed acute ischemic complications weeks to months after the resolution of COVID‐19. Hemodialysis patients appear to require specific interventions in order to prevent subsequent acute ischemic events after the resolution of COVID‐19. [ABSTRACT FROM AUTHOR]

Malva parviflora L., Little mallow, has been traditionally used as an alternative food source. It acts as a medicinal herb containing a potential source of mucilage thus herein; we aimed to assess the toxicity, anti-inflammatory, antitussive and gastro-protective actions of M. parviflora mucilage extracted from its leaves (MLM) and fruit (MFM). Toxicity studies were investigated by in vitro hemolytic assay whereas acute anti-inflammatory and antitussive activities were assessed by carrageenan-induced paw edema and sulphur dioxide induced cough model in rats, respectively. Gastro-protective effects were studied using ethanol induced acute and chronic gastric ulcer rat models. Their metabolic profiles were determined using gas chromatography. The results revealed that MLM and MFM were non-toxic towards human erythrocytes and their lethal doses were found to be greater than 5 g/kg. Pretreatment with MLM (500 mg/kg) and MFM (500 mg/kg) significantly reduced the carrageenan-induced paw thickness (p < 0.001). Maximum edema inhibition (%) was observed at 4 h in diclofenac sodium (39.31%) followed by MLM (27.35%) and MFM (15.68%). Animals pretreated with MLM (500 mg/kg) significantly lower the cough frequency in SO2 gas induced cough models in contrast to control. Moreover, MLM at doses of 250 and 500 mg/kg reduced the ethanol induced gastric mucosal injuries in acute gastric ulcer models presenting ulcer inhibition of 23.04 and 38.74%, respectively. The chronic gastric ulcer model MFM (500 mg/kg) demonstrated a remarkable gastro-protective effect showing 63.52% ulcer inhibition and results were closely related to standard drug sucralfate. In both models, MLM and MFM decreased gastric juice volume and total acidity in addition to an increased gastric juice pH and gastric mucous content justifying an anti-secretary role of this mucilage that was further confirmed by histopathological examination. Meanwhile, GC analyses of the mucilage revealed their richness with natural as well as acidic monosaccharides. It is concluded that MLM and MFM can be used therapeutically for the management of inflammation, cough and gastric ulcer. [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a high transmissible infectious disease that primarily impacts the respiratory system and leads to death as it worsens. Ever since the World Health Organization declared the disease as a global pandemic, the pathophysiology, clinical manifestations, and disease prognosis has been discussed in various literature. In addition to impaired respiratory health, the symptoms also indicated the involvement of the cardiovascular and neurological system after SARS-CoV-2 infection. Despite the pulmonary, cardiovascular, and neurological complications, many reports also revealed the prevalence of vestibulocochlear symptoms like dizziness, vertigo, vestibular neuritis, sudden sensorineural hearing loss, and tinnitus. Though many clinical reports and scientific reviews reported the vestibular and cochlear impairments associated with coronavirus disease 2019 (COVID-19) infection, the underlying pathological mechanisms are still unclear and unexplored. In this review, we discussed the published clinical reports, research articles, and literature reviews related to vestibulocochlear manifestations following SARS-CoV-2 infections. We also summarized the current knowledge about the prevalence, epidemiological and clinical features, and potential pathological mechanisms related to vestibular and cochlear manifestations resulting from COVID-19 infections. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is a highly prothrombotic viral infection that primarily manifests as an acute respiratory syndrome. However, critically ill COVID-19 patients will often develop venous thromboembolism with associated increases in morbidity and mortality. The cause for this prothrombotic state is unclear but is likely related to platelet hyperactivation. In this review, we summarize the current evidence surrounding COVID-19 thrombosis and platelet hyperactivation. We highlight the fact that several studies have identified a soluble factor in COVID-19 patient plasma that is capable of altering platelet phenotype in vitro. Furthermore, this soluble factor appears to be an immune complex, which may be composed of COVID-19 Spike protein and related antibodies. We suggest that these Spike-specific immune complexes contribute to COVID-19 platelet activation and thrombosis in a manner similar to heparin-induced thrombocytopenia. Understanding this underlying pathobiology will be critical for advancement of future research and therapeutic options. [ABSTRACT FROM AUTHOR]

Summary: The coronavirus disease 2019 (Covid‐19) pandemic has had devastating effects on public health worldwide, but the deployment of vaccines for Covid‐19 protection has helped control the spread of SARS Coronavirus 2 (SARS‐CoV‐2) infection where they are available. The common side effects reported following Covid‐19 vaccination were mostly self‐restricted local reactions that resolved quickly. Nevertheless, rare vaccine‐induced immune thrombotic thrombocytopenia (VITT) cases have been reported in some people being vaccinated against Covid‐19. This review summarizes the thromboembolic events after Covid‐19 vaccination and discusses its molecular mechanism, incidence rate, clinical manifestations and differential diagnosis. Then, a step‐by‐step algorithm for diagnosing such events, along with a management plan, are presented. In conclusion, considering the likeliness of acquiring severe SARS‐CoV‐2 infection and its subsequent morbidity and mortality, the benefits of vaccination outweigh its risks. Hence, if not already initiated, all governments should begin an effective and fast public vaccination plan to overcome this pandemic. [ABSTRACT FROM AUTHOR]

The global effects of the COVID-19 pandemic make it of the utmost importance to comprehend its mechanisms and define strategies for the most effective approach possible. The SARS-CoV-2 virus can be responsible for the induction of a hypercoagulable state, which can trigger vascular phenomena of venous etiology, specifically deep venous thrombosis or pulmonary embolism. Arterial thrombotic events associated with COVID-19 have also been described in the medical literature, although less frequently. In this paper the authors report the case of a 66-year-old man who was diagnosed with an Acute Aortic Syndrome, specifically an intramural thrombus on the aortic arch, while he was still infected with the virus. Anticoagulation with low weight molecular heparin was initiated and the patient was admitted at the Internal Medicine ward for a conservative therapeutic approach. The thrombus remained stable on a serial imaging evaluation; therefore, the patient was discharged with oral anticoagulation with subsequent followup in the outpatient clinic. This case describes a rare and potentially serious complication of COVID-19, which highlights how broad its clinical spectrum can be, affecting systems other than the pulmonary. [ABSTRACT FROM AUTHOR]

Summary: In 145 previously healthy non‐critically ill young adults, coronavirus disease 2019 (COVID‐19)‐related symptoms, risk factors for thrombosis, coagulation and inflammatory parameters were compared, with 29 patients reporting unusual thrombotic events (UTEs) and 116 not having thrombotic events. The inflammatory indices, coagulation and prothrombotic platelet phenotype (PTPP) were significantly higher in patients with UTEs versus those without. Patients with UTEs were categorised according to detection of thrombophilic genes (TGs), coagulation and inflammatory markers to the non‐TG and TG subcohort. A total of 38 UTEs were identified, which included splanchnic vein thrombosis (SVT; 11), stroke (six), cerebral vein thrombosis (five), thrombotic microangiopathy (four), limb ischaemia and inferior vena cava thrombosis (three each), ST‐segment elevation myocardial infarction (two), superior vena cava thrombosis (two), upper limb deep venous thrombosis and retinal vein thrombosis, one each. We found a 55% prevalence of TGs mainly heterozygous coagulation factor II, thrombin (FII)‐G20210A, Janus kinase 2 (JAK2)‐V617F, protein‐S, and antithrombin III deficiency with a high (76·9%) prevalence of venous UTEs, multiple vessels thrombosis, and recurrence rate among the TG versus non‐TG subcohort. The presence of JAK2‐V617F, and FII‐G20210A mutations was linked with SVT. Thrombosis in the non‐TG subcohort was associated with more haemorrhagic problems, thrombosis progression and a significantly higher level of inflammatory markers, PTPP, mean platelet volume, von Willebrand factor, and factor VIII, which remained high for up to 6 months, as well as elevated D‐dimer. Acquired and inherited thrombophilia with endotheliopathy appeared to be a relevant mechanism to explain the occurrence of UTEs that are not correlated to COVID‐19 severity. [ABSTRACT FROM AUTHOR]

The importance of Zn for human health becomes obvious during Zn deficiency. Even mild insufficiencies of Zn cause alterations in haematopoiesis and immune functions, resulting in a proinflammatory phenotype and a disturbed redox metabolism. Although immune system malfunction has the most obvious effect, the functions of several tissue cell types are disturbed if Zn supply is limiting. Adhesion molecules and tight junction proteins decrease, while cell death increases, generating barrier dysfunction and possibly organ failure. Taken together, Zn deficiency both weakens the resistance of the human body towards pathogens and at the same time increases the danger of an overactive immune response that may cause tissue damage. The case numbers of Corona Virus Disease 19 (COVID-19) are still increasing, which is causing enormous problems for health systems and economies. There is an urgent need to reduce both the number of severe cases and the resulting deaths. While therapeutic options are still under investigation, and first vaccines have been approved, cost-effective ways to reduce the likelihood of or even prevent infection, and the transition from mild symptoms to more serious detrimental disease, are highly desirable. Nutritional supplementation might be an effective option to achieve these aims. In this review, we discuss known Zn deficiency effects in the context of an infection with Severe Acute Respiratory Syndrome-Coronavirus-2 and its currently known pathogenic mechanisms and elaborate on how severe pre-existing Zn deficiency may pre-dispose patients to a severe progression of COVID-19. First published clinical data on the association of Zn homoeostasis with COVID-19 and registered studies in progress are listed. [ABSTRACT FROM AUTHOR]