Search

IMPORTANCE: Post−COVID-19 condition (PCC) is a complex heterogeneous disorder that has affected the lives of millions of people globally. Identification of potential risk factors to better understand who is at risk of developing PCC is important because it would allow for early and appropriate clinical support. OBJECTIVE: To evaluate the demographic characteristics and comorbidities that have been found to be associated with an increased risk of developing PCC. DATA SOURCES: Medline and Embase databases were systematically searched from inception to December 5, 2022. STUDY SELECTION: The meta-analysis included all published studies that investigated the risk factors and/or predictors of PCC in adult (≥18 years) patients. DATA EXTRACTION AND SYNTHESIS: Odds ratios (ORs) for each risk factor were pooled from the selected studies. For each potential risk factor, the random-effects model was used to compare the risk of developing PCC between individuals with and without the risk factor. Data analyses were performed from December 5, 2022, to February 10, 2023. MAIN OUTCOMES AND MEASURES: The risk factors for PCC included patient age; sex; body mass index, calculated as weight in kilograms divided by height in meters squared; smoking status; comorbidities, including anxiety and/or depression, asthma, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, immunosuppression, and ischemic heart disease; previous hospitalization or ICU (intensive care unit) admission with COVID-19; and previous vaccination against COVID-19. RESULTS: The initial search yielded 5334 records of which 255 articles underwent full-text evaluation, which identified 41 articles and a total of 860 783 patients that were included. The findings of the meta-analysis showed that female sex (OR, 1.56; 95% CI, 1.41-1.73), age (OR, 1.21; 95% CI, 1.11-1.33), high BMI (OR, 1.15; 95% CI, 1.08-1.23), and smoking (OR, 1.10; 95% CI, 1.07-1.13) were associated with an increased risk of developing PCC. In addition, the presence of comorbidities and previous hospitalization or ICU admission were found to be associated with high risk of PCC (OR, 2.48; 95% CI, 1.97-3.13 and OR, 2.37; 95% CI, 2.18-2.56, respectively). Patients who had been vaccinated against COVID-19 with 2 doses had a significantly lower risk of developing PCC compared with patients who were not vaccinated (OR, 0.57; 95% CI, 0.43-0.76). CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis demonstrated that certain demographic characteristics (eg, age and sex), comorbidities, and severe COVID-19 were associated with an increased risk of PCC, whereas vaccination had a protective role against developing PCC sequelae. These findings may enable a better understanding of who may develop PCC and provide additional evidence for the benefits of vaccination. TRIAL REGISTRATION: PROSPERO Identifier: CRD42022381002

Objective The aim of this study was to evaluate the incidence of venous stenosis and occlusion (VSO) in patients referred for transvenous lead extraction (TLE) with regard to the indications for this treatment and to analyse the influence of VSO on efficacy, complications and technical challenges of TLE procedures.Methods The material consists of 133 consecutive TLE procedure records. The contrast venography examination of the ipsilateral access vein was performed prior to the operation. The whole study population was divided into two subgroups, based on the presence (subgroup I) or absence (subgroup II) of VSO.Results Phlebography was performed in 133 patients with age ranging from 25.7 to 86.1 years, 44 female (33.1%). The VSO was confirmed in 48 (36.1%) patients – subgroup I. Most of the patients were referred to TLE due to non-infectious reasons (100 pts—75.2%). The absence of VSO was observed substantially more frequently in patients with diabetes (P = 0.02). Procedural success rate reached 93.3% in subgroup I and 98.8% in subgroup II (P = 0.1). There was no significant difference in the use of advanced tools and alternative access sites.Conclusion The presence of VSO can be expected in one third of patients referred for lead extraction. There is no association between indication for TLE (infected or noninfected lead extraction) and the incidence of VSO. Diabetes proved to have a protective effect on venous patency in the previously mentioned group. VSO does not influence the effectiveness, safety, and the use of additional tools during TLE procedures.

IntroductionTransvenous lead extraction (TLE) is a recognized method of treatment in the case of permanent stimulation complication.ObjectivesThe objective of this study was to analyse the indications and presentation of the early experience of TLE procedures in a group of patients with old pacing systems.Patients and methodsPatients with a relevant history of stimulation (at least 12 months in case of a pacemaker) qualified for the research. Indications, effectiveness and complications of TLE procedures were analysed.ResultsTwo hundred patients at the age of 66.4 (19.1-86.2 years) were enrolled and 278 leads with dwell time 76.2 months (2.1-327.4) were removed. The indications for TLE were: lead-dependent infective endocarditis in 13 cases (6.5%), pocket infection in 29 cases (14.5%), lead damage in 120 cases (60.0%), and upgrade of device system in 38 cases (19.0%). Manual traction was used to remove 66 active fixation leads (23.7%). A femoral approach was required to extract 4 leads (1.4%). Two hundred and eight leads (74.8%) were extracted using the mechanical (Cook) system and subclavian approach. Laser technique, and an electrosurgical sheath were not used. Complete procedural success was achieved in 96% of cases and overall clinical success was 98.5%. Complication rate was 5.5% (11 patients): minor and major complication rate was 3.0% (6 patients) and 2.5% (5 cases), respectively. Low body mass index (BMI) was associated with a higher rate of complications.ConclusionsThe dominant indication to TLE procedures was lead dysfunction. Transvenous lead extraction has a high success rate and a low complication rate. Low BMI increased the complication rate.

Tourism is an important sector of the economy, which is responsible for the development of many regions, which generates millions of jobs and allows to operate several businesses. However, it must be remembered that the motives of the trips are strongly differentiated, which translates into the existence of many types of tourism and diversification of tourism products. As a consequence, it becomes necessary to conduct permanent monitoring of attitudes, motives and consumers behaviors in order to adapt the offer to their preferences. In the article, the author, presenting the specificity of tourism shows the results of the study dedicated to selected tourist behaviors of Polish, Ukrainian and Austrian students. Even, if the limitations of the study will be accepted, it provides evidence for positive verification of the hypothesis that the significant differences between these groups exist.

IMPORTANCE: The chronic receipt of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) has been assumed to exacerbate complications associated with COVID-19 and produce worse clinical outcomes. OBJECTIVE: To conduct an updated and comprehensive systematic review and meta-analysis comparing mortality and severe adverse events (AEs) associated with receipt vs nonreceipt of ACEIs or ARBs among patients with COVID-19. DATA SOURCES: PubMed and Embase databases were systematically searched from December 31, 2019, until September 1, 2020. STUDY SELECTION: The meta-analysis included any study design, with the exception of narrative reviews or opinion-based articles, in which COVID-19 was diagnosed through laboratory or radiological test results and in which clinical outcomes (unadjusted or adjusted) associated with COVID-19 were assessed among adult patients (=18 years) receiving ACEIs or ARBs. DATA EXTRACTION AND SYNTHESIS: Three authors independently extracted data on mortality and severe AEs associated with COVID-19. Severe AEs were defined as intensive care unit admission or the need for assisted ventilation. For each outcome, a random-effects model was used to compare the odds ratio (OR) between patients receiving ACEIs or ARBs vs those not receiving ACEIs or ARBs. MAIN OUTCOMES AND MEASURES: Unadjusted and adjusted ORs for mortality and severe AEs associated with COVID-19. RESULTS: A total of 1788 records from the PubMed and Embase databases were identified; after removal of duplicates, 1664 records were screened, and 71 articles underwent full-text evaluation. Clinical data were pooled from 52 eligible studies (40 cohort studies, 6 case series, 4 case-control studies, 1 randomized clinical trial, and 1 cross-sectional study) enrolling 101?949 total patients, of whom 26 545 (26.0%) were receiving ACEIs or ARBs. When adjusted for covariates, significant reductions in the risk of death (adjusted OR [aOR], 0.57; 95% CI, 0.43-0.76; P?<?.001) and severe AEs (aOR, 0.68; 95% CI, 0.53-0.88; P?<?.001) were found. Unadjusted and adjusted analyses of a subgroup of patients with hypertension indicated decreases in the risk of death (unadjusted OR, 0.66 [95% CI, 0.49-0.91]; P?=?.01; aOR, 0.51 [95% CI, 0.32-0.84]; P?=?.008) and severe AEs (unadjusted OR, 0.70 [95% CI, 0.54-0.91]; P?=?.007; aOR, 0.55 [95% CI, 0.36-0.85]; P?=?.007). CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, receipt of ACEIs or ARBs was not associated with a higher risk of multivariable-adjusted mortality and severe AEs among patients with COVID-19 who had either hypertension or multiple comorbidities, supporting the recommendations of medical societies. On the contrary, ACEIs and ARBs may be associated with protective benefits, particularly among patients with hypertension. Future randomized clinical trials are warranted to establish causality.

Introduction:We reviwed our instituitional data to look for gender-specific outcomes after mitral valve surgery and its impact on survival.Methods:We performed a retrospective analysis of consecutive patients who underwent conventional and mini-mitral surgery between January 2000 and August 2018. Patients with concomitant CABG were excluded. Survival data was obtained from Office for National Statistics on 16.04.19. The baseline, procedural and reoperation data was recorded in a prospective registry. End-points were all-cause mortality and the first mitral valve re-operation. The population was divided into 4 groups based on sex and surgical access.Results:Of 956 patients, 448 (47%) were female. Mini-mitral surgery was performed in 327 (34%) and conventional in 629 (66%) patients. At the time of surgery, women had higher EuroSCORE, NYHA class and were older than men. In patients undergoing mini-mitral surgery, despite higher EuroSCORE and age in women, their hazard of re-operation and survival rate were not statistically significantly different compared with men. By contrast, in the conventional mitral surgery women were at significantly higher risk of death but lower risk of re-operation compared with men.Conclusions:We found that women are referred for mitral surgery at an older age with more symptoms and have a higher EuroSCORE. Long term survival appears to match the higher risk profile as women have worse survival than men following mitral valve surgery. A minimally invasive approach improved in-hospital outcomes such as post-operative lenght of hospital stay in women but did not show a trend towards better long term survival compared to a sternotomy approach.