Since its first appearance in December 2019 in the Chinese province of Wuhan, COVID-19 has spread rapidly throughout the world and poses a serious threat to public health. Acute respiratory failure due to widespread lung inflammation progress to acute respiratory distress syndrome (ARDS) with an altered pulmonary and alveolar function that can lead to disability, prolong hospitalizations, and adverse outcomes. While there is no specific treatment for severe acute lung injury (ALI) and ARDS due to the COVID-19 and the management is mostly supportive, it is very important to better understand the pathophysiological processes activated by the inflammatory mediators such as cytokines and metalloproteinases with the aim of their subsequent inhibition in the course of the complex treatment. Herein, we will discuss the pathophysiological mechanisms of ALI/ARDS, with a focus on the pivotal role played by matrix metalloproteinases (MMP) and the kinin-kallikrein system (KKS), and the effects of the possible pharmacological interventions. Aprotinin is a nonspecific protease inhibitor especially of trypsin, chymotrypsin, plasmin, and kallikrein, and it is many years in clinical use. Aprotinin inhibits the release of pro-inflammatory cytokines and involved in the process of glycoprotein homeostasis. Experimental data support that the use of aprotinin to inhibit MMPs and KKS may be a new potential approach to the treatment of ALI / ARDS.

Background: Hyperglycemia in hospitalized patients is found to be associated with increased risk of complications, systemic infections and mortality. Thus, managing and controlling glucose blood levels in these patients are essential. The aim of the present retrospective study was to evaluate the efficacy of standardized electronic insulin orders, using a computerized physician order entry (CPOE), in controlling blood glucose levels, preventing hypoglycemic events and reducing the variability of daily blood glucose levels during hospitalization of patients with diabetes mellitus in internal medicine departments. Methods: Data were obtained from an internal medicine unit that used the standardized electronic insulin orders (Department 7) and compared to data from 6 other internal medicine departments in which the standardized electronic insulin orders was not used (Departments 1-6). The variability of daily changes in blood glucose levels was determined by the standard deviation of the daily changes and respective coefficient of variation. Results: 130,078 point-of-care bedside glucose tests were recorded from 13,577 hyperglycemic patients. The average daily mean blood glucose levels were significantly lower in patients from Department 7 than from Departments 1-6. The rate of patients achieving average daily mean blood glucose levels ≤ 180 mg/dL was higher in Department 7 than Departments 1-6. The percent of patient days with hypoglycemia and the variability of daily changes in blood glucose levels were significantly lower in Department 7 than Departments 1-6. Conclusions: A standardized electronic insulin orders of basal/bolus regimen improves glucose control in hospitalized patients.

It is well known that patients with type 2 diabetes mellitus (T2DM) are at increased risk of cardiovascular (CV) disease. Elevated plasma glucose levels that independently lead to increased cardiovascular risk, combined with associated co-morbidities such as obesity, hypertension, and dyslipidemia, further contribute to the development of CV complications. Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors) are a relatively new class of drugs used for the treatment of diabetes and recently have been widely used in clinical practice. They exert their actions through degradation inhibition of endogenous glucagon-like peptides (GLP-1) and glucose-dependent insulinotropic peptides (GIP), with a resulting increase in glucose mediated insulin secretion and a suppression of glucagon secretion. Since GLP-1 is known to have an impact not only on plasma glucose levels but also to have cardiovascular protective effects there is increased speculation of whether DPP-4 inhibitors will have similar effects. Though many short-term studies have been encouraging, ongoing long-term clinical trials on humans are needed to provide further clarity to the complete safety profiles of these agents in terms of cardiovascular risk, and whether they may exert potential cardiovascular benefit. This review includes available data on the cardiovascular effects of DPP-4 inhibitors as well as their overall safety profile.

Hypertension is the most common disease affecting humans. Statistical surveys indicate that approximately one billion individuals worldwide suffer from this serious condition. The spotlight of the present review is on the cardiac involvement in patients with hypertension and especially on the possibility that treatment of increased blood pressure may abolish the incidence of cardiac arrhythmia and particularly atrial fibrillation. Modern therapeutic approach based on the electrical and structural remodeling process in the hypertensive heart with a consequent administration of ACE inhibitors and AT1 receptor blockers represent new and more efficient option compared to other antihypertensive drugs, such as calcium channel blockers, beta-blockers and thiazide-type diuretics and might be useful in the prevention of atrial fibrillation and incidence of stroke.