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Blood pressure control aims to reduce the risk of long-term cardiovascular events. Olmesartan medoxomil is an oral prodrug that belongs to the angiotensin II receptor blockers (ARBs) family and blocks the renin-angiotensin-aldosterone system by antagonizing the angiotensin II (AT) type 1 receptor. 1 Olmesartan-associated enteropathy (OAE), was described for the first time in 2012 by Rubio-Tapia et al. in 22 patients with chronic diarrhea and weight loss treated with olmesartan. Serological screening tests for celiac disease were negative, and there was no response to a gluten-free diet. Endoscopic biopsy showed villous atrophy and mucosal inflammation similar to sprue-like enteropathy. Clinical response was demonstrated in all patients after drug discontinuation. In July 2013 the U.S. Food and Drug Administration issued a postmarketing warning highlighting the importance of this new entity. 2 We present a case of a 76-year-old man with a history of arterial hypertension treated with olmesartan/hydrochlorothiazide 40/12.5mg/daily during 2 years, who presented with 2-month history of weight loss of 15 kg, vomiting and watery diarrhea, up to 4 stools per day, without bleeding, mucus or pus, and afebrile. Stool sample culture found no microbiological isolations. Laboratory tests showed hemoglobin 14 g/dL, white blood cells 9,100/mcL, platelets 259,000/mcL, creatinine 0.7 mg/dL with no electrolyte imbalance, albumin 3.0 g/dL, C-reactive protein 1.5 mg/dL, thyroid-stimulation hormone 0.5 mUI/L and T4-free 1.3 nanogram/dL. Biomarkers were normal. Autoimmune tests with anti-nuclear antibodies and anti-DNA antibodies were negative. Serological tests for celiac disease (CD) were negative. Human leukocyte antigen (HLA) DQ2 typing was positive. Abdominal computed tomography showed a diffuse thickening throughout the entire colon and terminal ileum. Gastroscopy and colonoscopy evinced villous atrophy in duodenum and unspecific recto-colon-ileitis, respectively. Biopsy samples from gastric, ileum and colon showed no malignancy but severe chronic nonspecific inflammatory damage with the presence of lymphocytes, plasma cells and granulocytic infiltration. Helicobacter pylori was not visualized (Figure 1).During hospitalization, watery diarrhea persisted in spite of a gluten-free diet. Parenteral nutrition was required initially due to severe weight loss and oral intolerance. Clinical remission was observed after withdrawal of olmesartan. Control

Mid-regional pro-adrenomedullin (MR-proADM), methemoglobin (MetHb), and carboxyhemoglobin (COHb) levels have been associated with sepsis. In this study, we assessed the role of this potential biomarkers in critically ill COVID-19 patients. Outcomes were mortality and a combined event (mortality, venous or arterial thrombosis, and orotracheal intubation (OTI)) during a 30-day follow-up. A total of 95 consecutive patients were included, 51.6% required OTI, 12.6% patients died, 8.4% developed VTE, and 3.1% developed arterial thrombosis. MetHb and COHb levels were not associated with mortality nor combined event. Higher MR-proADM levels were found in patients with mortality (median of 1.21 [interquartile range-IQR-0.84;2.33] nmol/L vs. 0.76 [IQR 0.60;1.03] nmol/L, p = 0.011) and combined event (median of 0.91 [IQR 0.66;1.39] nmol/L vs. 0.70 [IQR 0.51;0.82] nmol/L, p < 0.001); the positive likelihood ratio (LR+) and negative likelihood ratio (LR−) for mortality were 2.40 and 0.46, respectively. The LR+ and LR− for combined event were 3.16 and 0.63, respectively. MR-proADM ≥1 nmol/L was the optimal cut-off for mortality and combined event prediction. The predictive capacity of MR-proADM showed an area under the ROC curve of 0.73 (95% CI, 0.62–0.81) and 0.72 (95% CI, 0.62–0.81) for mortality and combined event, respectively. In conclusion, elevated on-admission MR-proADM levels were associated with higher risk of 30-day mortality and 30-day poor outcomes in a cohort of critically ill patients with COVID-19.

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