Polypharmacy Management in a Gender Perspective: At the Heart of the Problem: Analysis of Major Cardiac Diseases, SARS-CoV-2 Affection and Gender Distribution in a Cohort of Patients in Internal Medicine Ward

BACKGROUND

COVID-19 patients with any pre-existing major cardio-vascular disease (CVD) are at the highest risk of viral infection and of developing severe disease. The pathophysiological mechanism is characterized by the viral link to angiotensin-converting enzyme 2 (ACE2) and the involvement of the endothelial system with the release of cytokines and the inflicting of direct damage to the myocardium, the induction of microthrombosis, and the initiation of alterations in oxygen diffusion. The aim of the study is to analyze the clinical course and outcomes in patients (gender-stratified) with pre-existing major CVD.

METHODS

Out of the 1833 (973 M/860 F) patients admitted to the Internal Medicine COVID-19 Unit of "Castelli Hospital", Lazio, Italy, from 1 January 2021 to 31 December 2021, 600 patients (320 M/280 F) with a mean age of 77 (78.6 M/75.1 F) previously had CVD. Demographic characteristics, length of the stay (LOS) and oxygen therapy were evaluated.

RESULTS

All of the CVD COVID-19 patients underwent non-invasive ventilation (NIV). CVD was linked with increased LOS (21 days F/22 M) compared to no CVD (19 days). In total, 32.7% of total patients had major CVD.

CONCLUSIONS

Timely identification and evaluation of patients with pre-existing major CVD are fundamental for adequate treatment based on gender, severity, state of illness and for risk reduction.

Assessment of erythropoiesis activity during hemodialysis therapy by soluble transferrin receptor levels and ferrokinetic measurements

The erythropoietic activity (EA) and degree of erythropoiesis attained by patients undergoing hemodialysis (HD) administered recombinant human erythropoietin (rHuEPO) were studied using ferrokinetic measurements and tests of soluble transferrin receptor (sTfR) levels, assessing which parameter is most useful for measurements in clinical practice. Plasma iron 59 ((59)Fe) clearance (half-life [T(1/2)] (59)Fe), plasma iron turnover (PIT), erythron transferrin uptake (ETU), and erythrocyte (59)Fe incorporation were determined in 23 patients before and at 4 months after administration of rHuEPO. sTfR levels, hematopoietic parameters, and iron metabolism parameters were measured periodically. T(1/2) (59)Fe was shortened (P: = 0.004), PIT and ETU were increased (P: = 0.032 and P: = 0.013, respectively), and the time taken by erythrocytes to incorporate 80% of the (59)Fe administered was reduced from 9.6 to 6.1 days. sTfR levels were increased by 15 days; this increase was significant (P: < 0.05) at 30 days, reaching a maximum of 3.22 mg/dL at day 45. A positive correlation was seen between sTfR levels and hemoglobin (Hb) (P: = 0.001), hematocrit (P: = 0.001), and reticulocytes (P: = 0.038) that was not found between ferrokinetic parameters and those evaluating efficient erythropoiesis (P: = 0.345 between ETU and Hb). In conclusion, EA is increased, shown by ETU and sTfR level. sTfR levels correlate with the parameters that evaluate efficient erythropoiesis, and their measurement does not involve the technical and/or ethical limitations of studies of ferrokinetics, making them the tool of choice in clinical practice for the evaluation of EA in patients undergoing HD administered rHuEPO.