Current data indicate the existence of post-acute COVID-19 syndrome frequently expressing as cardiovascular and respiratory health issues. The long-term evolution of these complications is not yet fully known or predictable. Among the most common clinical manifestations of post-acute COVID-19 syndrome are dyspnea, palpitations, and fatigue, in most cases being transient and without underlying any morphological or functional changes. A single-center retrospective observational study was performed on cases that had presented with new-onset cardiac symptoms post-COVID-19 infection. Records of three male patients without pre-existing chronic cardiovascular pathology who had presented for dyspnea, fatigue, and palpitations around four weeks post-COVID-19 acute phase were studied in detail. The three post-COVID-19 cases exhibited arrhythmic complications after completely healing from the acute phase of the infection. Palpitations, along with chest pain, and possible aggravation or appearance of dyspnea, with syncopal episodes, were found to be present. All the three cases were non-vaccinated against COVID-19 infection. Isolated case reports showing arrhythmic complications such as atrial fibrillation and ventricular tachycardia on a small number of patients with these complications indicate the need for arrhythmic evaluation of large groups of patients in the post-acute stage of the COVID-19 syndrome for a better understanding of the phenomenon and implicitly better care of these patients. It would also be useful to evaluate large groups of patients divided into vaccinated/non-vaccinated against COVID-19 categories to determine whether vaccination per se can provide protection in the occurrence of these types of complications.

Background: Ischemic stroke remains the most feared complication of atrial fibrillation (AF), and thromboembolic risk is commonly estimated using clinical scores that may not fully capture the cardiometabolic dimension of cerebrovascular vulnerability. The aim of this research was to assess whether additional parameters can be used, to predict ischemic stroke risk in patients with AF, in order to explore whether TG/HDL-C may complement conventional clinical risk scores for ischemic stroke risk stratification in PAF, and to better characterize a metabolically high-risk phenotype beyond the recommendations provided by the CHA₂DS₂-VA score, which is useful but still far from perfect in predicting AF-associated ischemic stroke risk. Methods: In this retrospective, single-center observational study, we evaluated whether the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDLc), a simple surrogate of atherogenic dyslipidemia and insulin resistance, is associated with ischemic stroke risk in patients with paroxysmal atrial fibrillation (PAF). We screened 1111 consecutive AF admissions between 1 January 2015 and 31 December 2016 and, from these 1111 AF cases, we extracted only the patients with PAF for analysis. Patients were stratified based on TG/HDLc values into two groups, Group 1 (TG/HDLc > 2.5; n = 155) and Group 2 (TG/HDLc < 2.5; n = 194). Statistical analysis was performed with MedCalc v23.4.0 using Chi-square and unpaired/Welch’s t-tests as appropriate, Pearson correlations, Kaplan–Meier analysis with log-rank testing, Cox regression for first ischemic stroke, and multivariable logistic regression to identify independent correlates of TG/HDLc > 2.5. Results: Patients with TG/HDLc > 2.5 had a significantly higher prevalence of ischemic stroke after AF onset compared with those with TG/HDLc < 2.5 (37.4% vs. 21.1%, p = 0.0008), despite similar CHA₂DS₂-VA and HAS-BLED scores, and also exhibited a higher burden of cerebrovascular and neurodegenerative findings, including cortical atrophy and cerebral lacunarism. Ischemic stroke-free survival curves diverged significantly over time (log-rank p = 0.0186), and an elevated TG/HDLc ratio was associated with a 68% higher hazard of first ischemic stroke (HR 1.68; 95% CI 1.09–2.60). In multivariable analysis, type 2 diabetes mellitus (OR 4.53), hyperuricemia (OR 3.83), dyslipidemia (OR 1.94), stroke (OR 1.77), and cortical atrophy (OR 4.48) were independently associated with TG/HDLc > 2.5. Conclusions: These findings suggest that TG/HDLc identifies a metabolically high-risk PAF phenotype associated with greater cerebrovascular burden and reduced ischemic stroke-free survival, providing an inexpensive and broadly available marker that may complement conventional clinical risk scores.

The SARS-CoV-2 virus infection, the most severe pandemic in recent human history, found healthcare systems around the world more or less unprepared. Adjusting to this challenge involved changes in the daily routines of healthcare systems, as well as the patients, once again highlighting the importance of primary care (family physician or general practitioner). In the context of the COVID-19 pandemic, the family doctor in Romania played a crucial role in patient management, rapidly adapting to the changes and challenges imposed by the state of emergency. Their involvement quickly evolved from in-person consultations to online assessments, as they took on responsibilities such as monitoring patients in isolation or quarantine and issuing necessary medical leaves. Moreover, family doctors were directly involved in the COVID-19 vaccination process, facing challenges related to access to scheduling platforms and limited resources of protective equipment. Although they were on the front line of the healthcare response, recognition through incentives or compensations came late and incompletely, and their efforts in combating the pandemic were often overlooked. Designating family doctors’ offices as public utility medical units (regardless of their organisational form) and supporting their activities through increased equipment and medical devices provided by local or central authorities are the keys to fighting for human lives in critical situations. Implementing clear and universal rules regarding the competencies (skills) and duties of family doctors, both in normal life situations and in exceptional circumstances, is of utmost importance. Little is known about the dedicated work and dedication of family physicians to their patients. Few studies have been carried out on the activity of the family doctor and their professional difficulties during the pandemic period. Some studies, on a small number of subjects, tried to evaluate the psychological adaptation of the family doctor to the new epidemiological situation. The aim of this narrative review is to highlight the difficulties to which family doctors had to adapt, comparing the data from the Romanian medical system with those discovered in the medical literature regarding family doctors from all over the world.

Most studies analyzing data from patients who experienced at least one episode of acute COVID-19 infection have attributed the cascade of immediate and late complications to disruption of the inflammatory system and neutrophil activity in particular. Among the various functions of neutrophils is the release of pro-inflammatory mediators, including interleukin-6 (IL-6). Oxidative stress induced by pro-inflammatory mediators secreted by neutrophils leads to vascular endothelial dysfunction. Neutrophil counts and the neutrophil-to-lymphocyte ratio (NLR) are directly associated with COVID-19 patient survival, with higher values correlating with increased mortality. To assess endothelial dysfunction secondary to COVID-19 infection, we conducted a retrospective study involving two patient cohorts, each comprising 99 participants: one group with a history of COVID-19 infection and another without. The study aimed to demonstrate the presence of endothelial dysfunction in patients with moderate COVID-19 infection using flow-mediated dilatation (FMD) of the brachial artery and to evaluate its correlation with key inflammatory markers (erythrocyte sedimentation rate—ESR, fibrinogen, NLR, IL-6). FMD values were significantly reduced (p < 0.0001) in post-COVID-19 patients compared to those without prior infection. ESR (p < 0.0001), fibrinogen (p < 0.0001), C-reactive protein (CRP) (p < 0.0001), leukocyte count (p < 0.0001), and granulocyte count (p < 0.0001) were inversely correlated with FMD values. Among post-COVID-19 patients, all analyzed parameters demonstrated a statistically significant impact on FMD, with ESR showing the strongest effect, accounting for nearly 63% of the dependency. ANOVA testing confirmed an inverse association between NLR quartiles and FMD, as well as between IL-6 levels and FMD. In conclusion, this study highlights the presence of endothelial dysfunction in post-COVID-19 patients, as assessed by FMD, and demonstrates statistically significant inverse correlations between FMD values, IL-6 levels, and the neutrophil-to-lymphocyte ratio.

Background: Persistent inflammation and endothelial dysfunction have been proposed as key mechanisms of post-COVID cardiovascular sequelae and may contribute to atrial fibrillation (AF). We examined whether inflammatory/prothrombotic biomarkers and endothelial function differ between post-COVID patients and controls, and whether baseline inflammation/endothelial dysfunction relates to AF burden at 12 months. Methods: In this single-center, retrospective observational study, 198 outpatients were enrolled: 99 post-COVID patients evaluated 3–6 months after documented SARS-CoV-2 infection (Group 1) and 99 age- and sex-matched controls without prior COVID-19 (Group 2). At baseline (t0), clinical characteristics, inflammatory/prothrombotic biomarkers, brachial artery flow-mediated dilation (FMD), and 24 h Holter ECG were assessed in both groups. Univariable linear regression tested associations between baseline variables and FMD in Group 1. At 12 months (t1), 24 h Holter ECG was repeated in both groups. Quartile analyses were performed according to baseline neutrophil-to-lymphocyte ratio (NLR) to explore AF distribution across inflammatory strata. Results: At baseline, post-COVID patients had higher inflammatory and prothrombotic markers than controls (ESR, CRP, fibrinogen, and D-dimer; all p < 0.0001) and markedly lower FMD (7.72 vs. 13.72; p < 0.0001). In Group 1, FMD was inversely associated with multiple inflammatory/prothrombotic markers (all p < 0.0001), with the strongest association for ESR (R² = 0.6297). Holter-detected AF prevalence at baseline did not differ significantly between groups (25/99 [25.3%] vs. 18/99 [18.2%]). At 12 months, AF prevalence was numerically higher in the post-COVID group (32/99 [32.3%] vs. 21/99 [21.2%]); on two-sided testing, this difference was borderline (p = 0.047) and should be interpreted cautiously. Across increasing baseline NLR quartiles, AF prevalence increased stepwise in both groups (post-COVID: 2/25, 5/25, 10/24, 15/25; controls: 1/25, 3/25, 7/24, 10/25), consistent with the enrichment of AF in higher-inflammatory strata. Conclusions: Post-COVID patients exhibited a persistent inflammatory–prothrombotic profile and pronounced endothelial dysfunction at baseline. At 12 months, AF burden was numerically higher post-COVID, and AF clustered in strata characterized by higher baseline NLR and lower FMD, consistent with an inflammation–endothelial dysfunction axis associated with subsequent AF burden. Prospective studies with standardized rhythm monitoring and comprehensive multivariable adjustment are warranted.

Background: Atrial fibrillation (AF) is a major substrate for ischemic stroke, but cerebrovascular risk is heterogeneous and influenced by AF phenotype, comorbidities, anticoagulant exposure, renal function, and metabolic risk. The triglyceride–glucose index (TyG index) is a simple surrogate marker of insulin resistance calculated from fasting triglycerides and fasting plasma glucose. Whether the TyG index is associated with ischemic stroke burden and recurrent cerebrovascular events in patients with different AF phenotypes remains insufficiently characterized. Objective: This study aimed to evaluate the association between the TyG index and ischemic stroke burden in patients with paroxysmal and permanent AF, with particular focus on recurrent ischemic stroke. Methods: We performed a retrospective observational analysis of patients with AF divided according to AF phenotype: paroxysmal AF and permanent AF. Clinical, biological, therapeutic, and cerebrovascular variables were extracted from an existing real-world clinical database. The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. Triglycerides and fasting plasma glucose were measured during hospitalization; therefore, the analysis was framed as a retrospective cross-sectional association with recorded ischemic stroke burden, not as a prospective prediction study. The main outcome was any ischemic stroke. Secondary outcomes included recurrent ischemic stroke, defined as ≥2 recorded ischemic stroke events, and stroke burden categorized as no stroke, single stroke, or recurrent stroke. Continuous variables were reported as mean ± standard deviation and compared using independent samples t-tests or one-way analysis of variance, as appropriate. Results: After patient-level de-duplication, 1031 unique patients with AF were identified: 310 with paroxysmal AF and 721 with permanent AF. The strict TyG-eligible analytical cohort included 941 patients: 295 with paroxysmal AF and 646 with permanent AF. Permanent AF was associated with a higher ischemic stroke burden than paroxysmal AF. Any ischemic stroke was recorded in 325/646 patients with permanent AF compared with 79/295 patients with paroxysmal AF (50.3% vs. 26.8%, p < 0.001). Recurrent ischemic stroke was also more frequent in permanent AF (7.7% vs. 4.1%, p = 0.035). Among stroke-positive patients, the proportion with recurrent stroke was similar between permanent and paroxysmal AF (15.4% vs. 15.2%, p = 0.966). The TyG index was significantly higher in paroxysmal AF than in permanent AF (8.93 ± 0.69 vs. 8.73 ± 0.61, p < 0.001), but it did not differ significantly across stroke burden categories. In logistic regression, the TyG index was not associated with any ischemic stroke or recurrent ischemic stroke in unadjusted, age/sex-adjusted, AF phenotype-adjusted, or clinically adjusted models. Conclusions: In this real-world retrospective cohort, permanent AF was associated with a substantially higher ischemic stroke burden than paroxysmal AF. However, the TyG index was not independently associated with ischemic stroke occurrence or recurrence. Although patients with paroxysmal AF had a more adverse lipid metabolic profile and higher TyG index values, this did not translate into a higher TyG-related cerebrovascular burden. These findings suggest that the TyG index alone has limited utility as a marker of ischemic stroke burden in heterogeneous AF cohorts and that its prognostic value may depend on cardiometabolic phenotype, adiposity distribution, AF substrate, anticoagulant exposure, and the clinical context in which it is applied.