Influenza and COVID‐19: What does co‐existence mean?

The COVID‐19 pandemic caused by the novel coronavirus SARS‐CoV‐2 continues to have a major impact on healthcare and social systems throughout the world. As the clinical and epidemiological features of COVID‐19 have many parallels with influenza, it is important to ensure optimal management of both respiratory diseases as we anticipate their continued co‐circulation. In particular, there is a need to ensure that effective surveillance and diagnostic capacities are in place to monitor these and other respiratory viruses, as this will underpin decisions on the appropriate clinical management of the respective diseases. As such, we propose a series of key recommendations for stakeholders, public health authorities, primary care physicians and surveillance bodies that will help mitigate the combined risks of concurrent influenza epidemics and the COVID‐19 pandemic. We advocate the judicious use of influenza vaccines and antivirals, particularly among groups at high risk of complications, with healthcare workers also considered a priority for vaccination. It is likely that the increased use of emerging technologies such as telemedicine and contact tracing will permanently change our approach to managing infectious disease. The use of these technologies, alongside existing pharmaceutical strategies, will ensure that we achieve a holistic approach to the global public health measures needed to deal with the combined threat of influenza and COVID‐19. Ensuring that this approach is optimal will be key as we move from a reactive pandemic response towards preparing for the long‐term management of the remarkable clinical burden associated with these respiratory pathogens.     

Which influenza viruses will emerge following the SARS‐CoV‐2 pandemic?

The world has experienced five pandemics in just over one hundred years, four due to influenza and one due to coronavirus (SARS‐CoV‐2). In each case of pandemic influenza, the pandemic influenza strain has replaced the previous seasonal influenza virus. Notably, throughout the SARS‐CoV‐2 pandemic, there has been a 99% reduction in influenza isolation globally. It is anticipated that influenza will re‐emerge following the SARS‐CoV‐2 pandemic and circulate again. The potential for which influenza viruses will emerge is examined.     

Impact of the “atherosclerotic pabulum” on in‐hospital mortality for SARS‐CoV‐2 infection. Is calcium score able to identify at‐risk patients?

BackgroundAlthough the primary cause of death in COVID‐19 infection is respiratory failure, there is evidence that cardiac manifestations may contribute to overall mortality and can even be the primary cause of death. More importantly, it is recognized that COVID‐19 is associated with a high incidence of thrombotic complications.HypothesisEvaluate if the coronary artery calcium (CAC) score was useful to predict in‐hospital (in‐H) mortality in patients with COVID‐19. Secondary end‐points were needed for mechanical ventilation and intensive care unit admission.MethodsTwo‐hundred eighty‐four patients (63, 25 years, 67% male) with proven severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection who had a noncontrast chest computed tomography were analyzed for CAC score. Clinical and radiological data were retrieved.ResultsPatients with CAC had a higher inflammatory burden at admission (d‐dimer, p = .002; C‐reactive protein, p = .002; procalcitonin, p = .016) and a higher high‐sensitive cardiac troponin I (HScTnI, p = <.001) at admission and at peak. While there was no association with presence of lung consolidation and ground‐glass opacities, patients with CAC had higher incidence of bilateral infiltration (p = .043) and higher in‐H mortality (p = .048). On the other side, peak HScTnI >200 ng/dl was a better determinant of all outcomes in both univariate (p = <.001) and multivariate analysis (p = <.001).ConclusionThe main finding of our research is that CAC was positively related to in‐H mortality, but it did not completely identify all the population at risk of events in the setting of COVID‐19 patients. This raises the possibility that other factors, including the presence of soft, unstable plaques, may have a role in adverse outcomes in SARS‐CoV‐2 infection.     

Syncope with QT‐interval prolongation and T‐wave inversion in anterior and inferior leads: Foreboder of a life‐threatening condition?

Even though patients with pulmonary embolism usually present with respiratory distress and tachycardia, the patient presented with syncope only. Typical ECG changes associated with PE include right axis deviation, right bundle‐branch block, S1Q3T3 pattern, arrhythmia, nonspecific ST‐segment changes, QR pattern in lead V1, Brugada ECG pattern, and T‐wave inversions in the precordial leads. However, his electrocardiogram showed QT‐interval prolongation and simultaneous T‐wave inversions in the inferior and anterior leads. This ECG pattern is crucial for diagnosing PE. The patient underwent computed tomography‐pulmonary angiography, which revealed pulmonary embolism. At the same time, these ECG changes should be differentiated from those of long QT syndrome, myocardial ischemia, Takotsubo cardiomyopathy, post‐pacing T‐wave memory, hypertrophic cardiomyopathy, and subarachnoid hemorrhage.     

Does Systolic Blood Pressure Response to Lifestyle Intervention Indicate Metabolic Risk and Health‐Related Quality‐of‐Life Improvement Over 1 Year?

The purpose of this study was to determine whether responders (minimum 4‐mm Hg reduction of systolic blood pressure [BP]) at 24 weeks) to a 52‐week lifestyle intervention had greater changes in metabolic risk factors and health‐related quality of life than nonresponders. Participants (N=126; age, 57.4 [9.1] years) had waist circumference (WC), resting BP, glycated hemoglobin, lipids, and fitness assessed at baseline and at 12, 24, and 52 months. The 36‐item short‐form survey was administered to assess HRQOL. At baseline, responders had higher mental health scores (P=.04) and systolic and diastolic BPs (P<.001) than nonresponders. Across 52 weeks, responders also had greater improvements in diastolic BP (P<.001), WC (P=.01), and maximal oxygen uptake (P=.04) compared with nonresponders. Participants with clinically important changes in systolic BP at 24 weeks had greater metabolic improvements across 52 weeks, compared with those without clinically important systolic BP changes.     

Out‐of‐Office Blood Pressures—Are They Helpful in Guiding the Treatment of Hypertension Patients?

Following a hypertension symposium in Philadelphia in September 2005, a roundtable was convened to discuss the significance of out-of-office blood pressure. Dr. Marvin Moser of the Yale School of Medicine, New Haven, CT, moderated the panel discussion. Participants included Dr. Raymond Townsend of the University of Pennsylvania School of Medicine, Philadelphia, PA, and Dr. Norman Kaplan of the University of Texas Health Science Center in Dallas, Dallas, TX.     

Combination Therapy With Renin‐Angiotensin‐Aldosterone Receptor Blockers for Hypertension: How Far Have We Come?

In a large number of patients with hypertension, > or =2 antihypertensive agents are required to achieve blood pressure (BP) goals. There is good rationale for initial combination therapy based on clinical trials demonstrating that achievement of BP goals within a reasonably short period of time results in fewer cardiovascular events. One approach to attaining BP goals and improving medication adherence is fixed-dose combination therapy, the use of which dates back to the 1960s. Given some of the advantages of renin-angiotensin-aldosterone system (RAAS) blockers in patients with heart disease, kidney disease, and diabetes, many combinations include either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. In most studies, however, thiazide diuretics were necessary to achieve goal BP. Calcium channel blockers have also been used in combination with angiotensin-converting enzyme inhibitors to lower BP. Studies are now under way to determine the relative benefits of an RAAS blocker/diuretic compared with an RAAS blocker/calcium channel blocker as initial therapy.     

First‐Step Use of Fixed‐Dose Combination Treatment in Stage 2 Hypertensive Patients: Has the Time Come?

A panel discussion was convened on February 14, 2007, to discuss the use of fixed-dose combination therapy for stage 2 hypertensive patients. The panel was moderated by Michael A. Weber, MD, Professor of Medicine, SUNY Downstate College of Medicine, New York, NY. Participants included Luis Ruilope, MD, Chief, Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain, Thomas D. Giles, MD, Professor of Medicine, Tulane University School of Medicine, Metairie, LA, and Joseph L. Izzo, Jr, MD, Professor of Medicine, Department of Medicine, State University of New York at Buffalo, Buffalo, NY.     

Do Obese Individuals With Hypertension Have More Difficult‐to‐Control Blood Pressure and End Organ Damage Than Their Nonobese Counterparts?

The authors assessed whether individuals with elevated body mass index (BMI) and hypertension had more difficult‐to‐control blood pressure (BP) and more evidence of end organ damage using data collected prospectively over 11 years from a secondary care hypertension clinic. A total of 1114 individuals were divided by BMI criteria into normal (n=207), overweight (n=440), and obese (n=467). Mean daytime, nighttime, and 24‐hour systolic BP and diastolic BP were similar in all groups. There was less nocturnal dip in obese compared with overweight groups (P=.025). Individuals with a normal BMI were taking fewer antihypertensive medications than those in the obese group (P=.01). Individuals classified as obese had a higher left ventricular mass index than those with a normal BMI (female, P=.028; male, P<.001); this relationship remained after multivariate linear regression. Obese individuals with hypertension required more medication to achieve similar mean ambulatory BP values, had less nocturnal dip in BP, and had a higher prevalence of left ventricular hypertrophy. As such, obese patients are at potentially increased risk of cardiovascular events.