Background: Need for catecholamines is frequent in COVID-19 patients, but the main echocardiographic patterns are unknown. The objective was to report the main echo patterns in critically-ill COVID-19 patients. Methods: Observational and descriptive study in consecutive COVID-19 patients admitted to the ICU between March 12 and May 8, 2020. Systematic critical care echocardiography (CCE) was performed and retrospectively analyzed off-line. Echo values are reported in the overall population and in patients who required catecholamine infusion during the first 2 days following admission (D1-2) or afterwards until day 7 (D3-7). Results: Of the 79 patients (78% male; median age 63 [56-71]; body mass index 29 [26-30]) included, 90% had at least 1 comorbidity. PaO2/FiO2 at admission was 85 [67-162] mmHg. 53% of patients were mechanically ventilated. ICU length of stay was 9 [5-16] days and mortality 34%. 134 echocardiographic studies were performed during the first week in 65 patients. Pulmonary artery acceleration time was decreased (77 [65-97] ms), suggesting pulmonary hypertension. All 39 patients (49%) who required catecholamine infusion underwent CCE and 25.6% had left ventricular (LV) systolic dysfunction, 28.2% acute cor pulmonale (ACP), 7.7% hypovolemia, and 38.5% vasoplegia. Modification of echo patterns was observed at D3-7, with less LV systolic dysfunction and more ACP, which was the most frequent pattern. Computed tomography pulmonary angiography in 6 patients with ACP indicated intrapulmonary thrombus in 4. Conclusion: Different echocardiographic patterns were observed during the first week following ICU admission in COVID-19 patients. ACP was frequent and often related to thrombus in the pulmonary circulation.
Cardiac alterations may be defined as changes that lead to abnormal cardiac function. They include decrease in preload, increase in afterload, and depressed cardiac contractility. Cardiac dysfunction differs from cardiac failure: cardiac performance is altered, but this does not necessarily mean that the cardiovascular system is failing. Several tools are available to detect cardiac alterations. Some may continuously assess cardiac performance by mainly or exclusively measuring cardiac output, but no information is given about the mechanisms underlying the cardiac output decrease. Doppler echocardiography allows noncontinuous cardiac monitoring, but it is perfectly adapted to evaluation of cardiac performance. It directly visualizes cardiac contractility and assesses cardiac preload. Only when there is an imbalance between oxygen demand and oxygen transport is correction of cardiac alterations required. But the truth is that no study supports the use of one treatment rather than another. Changes in respiratory settings or in respiratory mechanics induce changes in cardiac function and must then be considered in the strategy.
Background and Aims: Influenza (flu) is a respiratory infection in mammals and birds. It is caused by an RNA virus in the family Orthomyxoviridae. The virus is divided into three main types. Influenza virus type A is found in a wide variety of bird and mammal species and can undergo major shifts in immunological properties. Hemagglutinin (HA) is an important influenza virus surface antigen that is highly topical in influenza research. In the present study, the gene encoding HA1 protein which includes Hemagglutinin globular head from influenza virus A/Tehran/18/2010 (H1N1) was cloned into a eukaryotic expression plasmid (pCDNA3) and its expression was evaluated in eukaryotic cells. Materials and Methods: HA1 gene was incised from pFastBacTHc-HA1 by digestion, purified and subcloned into eukaryotic expression vector (pCDNA3). After verification of the cloning fidelity, the recombinant plasmid was transfected into COS-7 and BHK-21 cells, and its expression was detected by RT-PCR. Results: Restriction endonuclease digestion analysis, colony PCR and DNA sequencing indicated that the recombinant plasmid pCDNA3-HA1 had been constructed successfully. After transfection into eukaryotic cells, the presence of mRNA transcripts was verified by reverse transcriptase-polymerase chain reaction (RT-PCR).
Conclusion:This study is a demonstrated success in the construction of eukaryotic expression plasmid for HA1 thus providing a basis for further probing into mechanism of virus infection and exploring DNA vaccine.
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