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In patients with severe pneumonia due to COVID-19, the deregulation of oxidative stress is present. Nuclear erythroid factor 2 (NRF2) is regulated by KEAP1, and NRF2 regulates the expression of genes such as

Graphical abstract, The type 2 coronavirus causes severe acute respiratory syndrome (SARS-CoV-2) and produces pneumonia with pulmonary alveolar collapse. In some cases it also causes sepsis and septic shock. There is no specific treatment for coronavirus disease 2019 (COVID-19). Vitamin C (Vit C), Vitamin E (Vit E), N-acetylcysteine (NAC) and Melatonin (MT) increase the intracellular content of GSH, kidnap free radicals and protect DNA, proteins in the cytosol and lipids in cell membranes. Pentoxifylline (Px) has anti-inflammatory activities. Here we evaluate the effect of Vit C, Vit E, NAC, and MT plus Px in COVID-19 patients with moderate and severe pneumonia. 110 patients of either sex were included. They were divided into five groups with 22 patients each. Group 1 received Vit C+Px, group 2 Vit E+Px, group 3 NAC+Px, group 4 MT+Px, and group 5 only Px. Oxidative stress (OS) markers such as lipid peroxidation (LPO) levels, total antioxidant capacity (TAC) and nitrites (NO2-) were evaluated in plasma. The antioxidant therapy improved the survival scores including the Sequential Organ Failure Assessment (SOFA), the Acute Physiology and chronic Health Evaluation II (Apache II), the Simplified Acute Physiology Score II (SAPS II), the Critical Illness Risk Score, Launched during COVID-19 crisis (COVIDGRAM) and the Glasgow Coma Scale (GCS). We found that LPO was elevated (p≤0.04) and TAC (p≤0.03), NO2- (p≤0.04) and inflammation markers such as interleukin-6 (IL-6, p≤0.01) C reactive protein (CRP, p≤0.01) and procalcitonin (PCT, p≤0.05) were diminished in COVID-19 patients upon admission to the hospital. The different antioxidants reversed this alteration at the end of the treatment. The treatment with antioxidant supplements such as Vit C, E, NAC, and MT plus Px could decelerate the aggressive and lethal development of COVID-19. Antioxidant therapy can be effective in this pandemia since it improves the survival scores including SOFA, Apache II, SAPS II, COVIDGRAM, GCS by lowering the LPO, IL-6, CRP, PCT and increasing systemic TAC and NO2-.

Purpose High-flow nasal cannula (HFNC) therapy in patients with hypoxemic respiratory failure due to COVID-19 is poorly understood and remains controversial. Methods We designed a prospective observational study of a large cohort of patients with COVID-19-related hypoxaemic respiratory failure at the Temporary COVID-19 Hospital in Mexico City. The primary outcome was the success rate of HFNC to prevent the progression to invasive mechanical ventilation (IMV). We also evaluated the risk factors associated with HFNC success or failure. Results This study included 378 patients who were admitted to the Temporary COVID-19 Hospital with a confirmed diagnosis of COVID-19 and hypoxemic respiratory failure. HFNC therapy effectively prevented IMV in 71.4% of patients (n = 270; 95% confidence interval [CI] 66.6–75.8%). Factors that were significantly different between patients who were only treated with HFNC therapy and those who progressed to IMV included age, the presence of hypertension, and the Charlson comorbidity index. Predictors of therapy failure included the CALL score at admission (adjusted hazard ratio [HR] 1.27; 95% CI 1.09–1.47; p p = 0.02), and no prior treatment with steroids (adjusted HR 0.34; 95% CI 0.19–0.62; p

Introduction:In response to the evolution of the coronavirus disease 2019 (COVID-19) pandemic, the admission protocol for the temporary COVID-19 hospital in Mexico City has been updated to hospitalize patients preemptively with an oxygen saturation (SpO2) of >90%.Methods:This prospective, observational, single-center study compared the progression and outcomes of patients who were preemptively hospitalized versus those who were hospitalized based on an SpO2⩽90%. We recorded patient demographics, clinical characteristics, COVID-19 symptoms, and oxygen requirement at admission. We calculated the risk of disease progression and the benefit of preemptive hospitalization, stratified by CALL Score: age, lymphocyte count, and lactate dehydrogenase (Results:Preemptive hospitalization significantly reduced the requirement for oxygen therapy (odds ratio 0.45, 95% confidence interval 0.31–0.66), admission to the intensive care unit (ICU) (0.37, 0.23–0.60), requirement for invasive mechanical ventilation (IMV) (0.40, 0.25–0.64), and mortality (0.22, 0.10–0.50). Stratification by CALL score at admission showed that the benefit of preemptive hospitalization remained significant for patients requiring oxygen therapy (0.51, 0.31–0.83), admission to the ICU (0.48, 0.27–0.86), and IMV (0.51, 0.28–0.92). Mortality risk remained significantly reduced (0.19, 0.07–0.48).Conclusion:Preemptive hospitalization reduced the rate of disease progression and may be beneficial for improving COVID-19 patient outcomes.

Background: SARS-CoV-2 infection produces pneumonia with pulmonary alveolar collapse and in some cases sepsis and septic shock. There is no specific treatment for COVID-19. Vitamin C (Vit C), Vitamin E (Vit E), N-acetylcysteine (NAC) and Melatonin (MT) increase the intracellular content of GSH, kidnap free radicals and protect DNA, proteins in the cytosol and lipids of cell membranes. Pentoxifylline (Px) has anti-inflammatory activities. Methods: Here we evaluate the effect of Vit C, Vit E, NAC, and MT plus Px in COVID-19 patients with moderate and severe pneumonia. 110 patients of either sex were included. They were divided into five groups with 22 patients each. Group 1 received Vit C+Px, group 2 Vit E+Px, group 3 NAC+Px, group 4 MT+Px, and group 5 only Px. Oxidative stress markers as Lipid peroxidation levels, evaluation of total antioxidant capacity and nitrites were evaluate by spectrophotometry, and by ELISA assay IL-6 levels. Results: The antioxidant therapy improved the survival scores including SOFA, Apache II, SAPS II, COVIDGRAM and GCS. OS markers in plasma such as LPO (p≤0.04) and TAC (p≤0.03) decreased in COVID-19 patients administered with antioxidants. There was an increase of IL-6 (p≤0.01) and decreases of CRP (p≤0.01) and PCT (p≤0.05) in COVID-19 patients when entering the hospital and the different antioxidants reversed this alteration at the end of the hospital stay. Conclusions: This study confirms the presence of OS in COVID-19 patients. The results suggest that the treatment with antioxidant supplements such as Vit C, E, NAC, and MT plus Px could contribute to the deceleration of the aggressive and lethal development COVID-19. There is evidence that antioxidants in moderate doses decrease inflammation and control of OS; therefore, their use as an adjuvant therapy to improve prognosis is confirmed. The antioxidant therapy can be effective in this pandemia since it improves all of the survival scores including SOFA, Apache II, SAPS II, COVIDGRAM, GCS by lowering the LPO, IL-6, CRP, PCT and increasing systemic TAC.

Background Overweight and obesity (O/O) generate lipotoxicity of the cardiac fiber and increase the incidence and progression of aortic valve stenosis. The low cardiac output syndrome (LCOS) is a timing complication after to aortic valve replacement (AVR) surgery. Objective The objective of the study was to investigate if body mass index (BMI) kg/m2 is a risk factor associated with LCOS and mortality in the post-operative period of AVR. Methods A historic cohort study was designed, including patients with severe aortic stenosis (SAS), who were subjected to AVR. Results 152 patients were included, 45 (29.6%), with normal weight (NW), 60 were overweight (39.5%), and 47 obese (30.9%). The prevalence of systemic hypertension (HT) was higher in O/O (p < 0.0001). Incidence of LCOS was 44.7%, being more frequent in the O/O groups compared to the NW group, 43.3%, 68.1%, and 22.2%, respectively, (p < 0.05 in overweight and p < 0.0001 in the obese). Assessing the presence or absence of LCOS associated with BMI as a numerical variable, we found that women, HT, BMI, left ventricular mass, and valve size, were associated with LCOS (p < 0.02, p < 0.02, p < 0.001, p < 0.032, and p < 0.045, respectively). Mortality was higher in patients who had LCOS (p < 0.02). Multivariate model showed that BMI was an independent risk factor for LCOS (odds ratio [OR] 1.21 [95% CI 1.08-1.35], p < 0.001). Conclusion BMI is a risk factor associated to LCOS in the post-operative period of AVR in patients with SAS.

Ebstein's anomaly (EA) is a myopathy of the right ventricle that causes a variable spectrum of tricuspid valve delamination failure with diverse clinical and anatomical presentation. We reviewed our data of EA to establish an association between clinical and echocardiographic findings with mortality.We divided patients in infants, Children/adolescents (Ch/A), and adults, according to age of presentation. Clinical and echocardiographic parameters were compared among groups. Multivariate analysis was performed for mortality. Survival analysis was plotted using Kaplan Meier curves.Cyanosis, severe forms of AE and heart failure were more frequent among infants, arrhythmias in Ch/A and stroke among adults. Surgery was performed in 71 patients; infants had higher mortality and early complications. We found that the predicted mortality at 40 years of age in the three groups was significantly different (log rank test, p0.0001): Infants: 38%, Ch/A 16 and 4% in adults. Multivariate model in surgical group showed that progressive drop of right ventricular fractional shortening (RVFS) predicts a higher mortality risk. In the non-surgical group, low RVFS and cyanosis were significantly associated with mortality.EA in infants is linked to higher morbidity and mortality, while arrhythmias predominate in Ch/A and stroke in adults. In general, stroke is frequent in patients with EA, some prevention alternative must be implemented. Right ventricular dysfunction is very important in EA and is associated with high mortality. It must be subject of discussion the planning of the type of surgery or even in the decision of to preclude surgical treatment.

The I/D insertion/deletion polymorphism of the angiotensin-converting enzyme has been related to hypertension. This polymorphism also seems to have gender related implications. Angiotensin II contributes to the production and release of oxygen reactive species that react with nitric oxide, inactivating its effects.To establish whether the ACE I/D polymorphism correlates with nitric oxide plasma metabolites in healthy men and women.Among 896 subjects between 18 and 30 years of age range, 138 fulfilled inclusion criteria. The polymorphism was identified by polymerase chain reaction, and blood nitric oxide metabolites were analyzed following the method described by Bryan.Both systolic and diastolic arterial pressures were higher in men than in women (107/67 vs. 101/65 mm Hg, p0.001). In terms of the ACE gene, there were differences in the concentration of nitric oxide metabolites in men with the I/D and D/D genotypes when compared to carriers of the I/I genotype (33.55 and 29.23 vs. 53.74 pmol/ml; p=0.05), while there were no significant differences in women when compared by genotype. Men with the D/D genotype had higher systolic blood pressure than I/D carriers (111 vs. 104 mm Hg, p0.05). We observed no arterial blood pressure differences in women when grouped by ACE genotype.The ACE D/D genotype was associated with nitric oxide metabolite levels and systolic blood pressure in clinically healthy men while it had no effect in women.

Aims Ischaemic mitral regurgitation (IMR) is consequence of left ventricular (LV) remodelling after myocardial infarction. In some cases, the mitral valve enlarges to compensate for LV remodelling and tenting, improving its coaptation; a process termed 'plasticity'. We sought to identify clinical and echocardiographic factors associated with plasticity in patients with chronic inferior myocardial infarction (CII). Methods and results This study included 91 revascularized CII patients and 46 controls. Plasticity and IMR severity were evaluated by 2D transthoracic echocardiography. Compared with controls, CII patients were older (59 vs. 25 years) and mostly men (80% vs. 46%), both P

BACKGROUND In Ebstein's anomaly (EA) current surgical criteria may not translate into better long-term survival. The aim of this study was therefore to determine if surgical treatment for EA increases survival, and to analyze factors associated with mortality.Methods and Results:A retrospective study was carried out involving 103 patients with surgical indication using current criteria, comparing operated (n=49; 47.5%) and non-operated patients (n=54; 52.4%); the severity of disease was similar in all cases. Overall follow-up was 12 years (range, 1-49 years). There were no differences in mortality: in the surgical and non-surgical groups, survival at 10 years was 92.8% vs. 90.7%; 20 years, 85.7% vs. 81.0%; and 30 years, 78.5% vs. 72.2%, respectively. On multivariate analysis right ventricular fractional shortening (RVFS) was associated with mortality in both groups. Decreasing RVFS was associated with worse survival according to severity: when RVFS was

BACKGROUND Severe aortic stenosis (AS), leads to pathological left ventricular remodeling that may worsen with concomitant overweight and obesity (OW/O). METHODS We aimed to prospectively analyze the impact of OW/O on ventricular remodeling in severe AS, by evaluating the percentage of intraendomyocardial fibrosis (PIEF) and the percentage of infiltrating intraendocardial lipid vacuoles (PIELV) and its relationship to global longitudinal strain (GLS) in patients with OW/O. RESULTS 44 patients with severe AS were included, 13 non-obese (29%) and 31 OW/O (71%), all of them with left ventricular ejection fraction ≥ 55%. GLS was evaluated with 2D speckle tracking. During valve replacement, an endocardial biopsy was obtained, where PIEF and PIELV were analyzed. Patients with higher PIEF and PIELV had greater body mass index (p < 0.0001) and worse GLS (p < 0.0053). A GLS cut-off point < -14% had a sensitivity of 75%, and a specificity of 92.8% to detect important PIEF (AUC: 0.928, 95% confidence interval: 0.798-1.00). On multivariate analysis, OW/O and PIELV were independently associated to the PIEF, and OW/O and PIEF were independently associated to GLS. A high correlation between the amount of PIELV and PIEF were found. CONCLUSION Patients with severe AS and OW/O have greater PIEF and PIELV, suggesting more pathological remodeling. GLS is useful to detect subclinical myocardial injury and is potentially useful for endomyocardial fibrosis detection. The presence of higher PIELF may be a trigger factor for the development of intraendomyocardial fibrosis.

Aortic valve replacement in patients with severe aortic stenosis may be complicated by complete atrioventricular block (CAVB), requiring a permanent pacemaker (PPM) implantation. Predicting this complication could help to plan the surgical.Determine whether electrocardiography and echocardiography are useful methods for predicting the need for PPM.A retrospective, observational and transversal study was performed. An echocardiography based semi-quantitative classification was implemented to graduate the extent of calcification of the aortic valve.We included 95 patients; 10 of them required PPM implantation (10.52%). In the pre-surgical basal electrocardiogram we observed that 90% of patients that required PPM had conduction abnormalities as opposed to only 24.7% in the other group, p = 0.001. A 1st and 2nd degree AV block (AVB 1 and 2) was identified in 8 patients that subsequently needed PPM (80%) vs. 5 patients (5.9%), in the group that did not required it, p = 0.001.OR 41.7, IC 95% 6.5-68. We found a grade 3 calcification extent in 80% of patients who required PPM implant compared with only 17.6% of patients in the other group, p = 0.04, OR 4.8, IC 95% 0.76-29. The AVB 1 and 2 were the single predictor in multivariate analysis but the calcification 3 + AVB 1 and 2, increased sensibility.In patients with aortic stenosis in whom aortic valve replacement was performed, identifying AVB 1 and 2 on the basal electrocardiogram is a useful tool in order to identify requirement of PPM. The grade 3 of calcification extent increased the sensibility of this prediction.

In our hospital, the patients that need an elective cardiac surgery are admitted through the admission department on the basis of a waiting list. Since 1999, a fast track to hospitalization program has existed in the National Institute of Cardiology Ignacio Chavez for patients with low surgical risk. Later, in 2004, this program was extended to patients to moderate risk, based on rules accepted worldwide, and our own experience.1) To compare two ways of admission that are used currently: fast track to hospitalization, against admission department waiting list. We compared major events: death or events that increased the hospital stay by more than 14 days (infections, alterations of rhythm and conduction, reoperations and others), 2) To compare the days of hospitalization and money spent by the hospital.We conformed 2 groups of 347 patients. The admission department waiting list group was admitted before doing their preoperative studies, which is the customary form for hospitalization by our admissions department, while the group of fast track to hospitalization was obligated to have their laboratory exams complete and any other diseases resolved or controlled previously. The monetary cost per patient for the hospital was calculated based on the patient's socioeconomic classification.Student t test was conduncted on independent samples and numerical variables, and Chi square for categorical variables. We considered a p0.05 to be statistically significant.In average in both groups, 75% underwent valve operation and 25% underwent congenital heart disease repair, 49% were women, age 47 15 years. The comparison between the groups fast track to hospitalization and admission department waiting list group were: Mortality: 4.3% vs. 5.8% (p=0.38). Major events that needed a hospital stay of more than 14 days: 73 vs. 97 cases respectively (p = 0.032). Infections: 22 vs. 29 (p = 0.14). Mediastinitis: 2 vs. 9 respectively (p = 0.033). In-hospital stay: were 11 days vs. 20 days (p = 0.0001), the biggest difference was found in the pre-surgical time: 2 vs. 9 days respectively (p = 0.0001).The postoperative morbidity in general was lower in fast track to hospitalization group, and the mediastinitis showed a decrease with statistical significance. The time interval between hospital admission an operation in fast track to hospitalization group was significantly shorter. We believe that the decrease in the exposure time to nosocomial pathogens present in the hospital environment was directly related to the low number of mediastinitis. Finally, the decrease in time of hospital stay represented a 32% monetary savings for the hospital.

The Barlow's syndrome is a disease characterized by the presence of mitral valve prolapse and a wide range of signs and symptoms. We know that its manifestations has a great variety existing cases with little clinical expression as those seen frequently in daily practice or the other side opposite completely in which, the syndrome is so complex getting to the patient to present many symptoms secondary to hemodynamics alterations that reduce by much its quality of life and even modify its prognosis.The case that we present is a female patient of 25 years old with Barlow's syndrome and functional class II-III of NewYork Heart Association as a result of the alterations in the contractility function of the heart that finally caused her death.

Dilated cardiomyopathy is a myocardial disease, characterized by biventricular expansion. Renin-angiotensin-aldosterone system (RAAS) is closely related with the progress of this pathology. Has been shown that angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism influences as much in the plasmatic concentration as in activity of ACE. In addition, ACE IID polymorphism has been associated with remodeling phenomena and an increased risk to develop several cardiovascular diseases. On virtue of the influence of ACE gene polymorphism on RAAS, we studied the correlation between ACE I/D polymorphism with morphologic and functional clinical alterations in ischemic or idiopathic dilated cardiomyopathy in one attempt to establish its utility as prognosis factor.We studied 30 patients of The National Institute of Cardiology. Ventricular function was evaluated by transthoracic echocardiography. ACE genotype was determined by polymerase chain reaction (PCR). Results for left ventricle shown: Tei Index was increased in patients with II genotype (0.84 vs. 0.48) when were compared to patients with DD genotype p0.01. Eccentricity Index was lesser in the group with II genotype (0.64), than in the group DD (0.86) p0.01. Ventricular mass was increased in DD patients when was compared with II group (174 g vs. 133 g) Isovolumetric contraction time was shorter in group DD than in II (45 mseg vs. 139 mseg) p0.05. These findings denote better preservation of left ventricular function in patients with DD genotype. In opposition, right ventricle shown an increased Tei Index in the group with DD genotype (1.01) when was compared with II genotype (0.55), p0.05. Pulmonary artery systolic pressure tended to be higher in DD genotype group without reach statistic significance.In our group of study, patients with DD genotype shown better left ventricular function in ischemic or idiopathic dilated cardiomyopathy. On the opposite right ventricular function were more deteriorated in patients with ACE DD genotype.