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On January 7 in China, one patient was identified with a new corona virus in throat culture, and World Health Organization called it severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we aimed to summarize overall data for COVID-19 disease related myocarditis and its treatment. In the initial stages, patients developed symptoms of severe acute respiratory infection and afterwards other serious symptoms such as septic shock, metabolic acidosis, coagulation disorders, multiple organ failure problems developed.Complications were mostly associated with pneumonia (91.1%) and acute respiratory distress syndrome. Before the Coronavirus Disease 2019 (COVID-19) infection, the presence of cardiovascular diseases has been found to increase the severity and side effects of primary respiratory syndrome. Since management of COVID-19 related myocarditis is crucial, 114 publications indexed in Pubmed between Dec 10, 2019 and October 16, 2020 were scanned extensively in this review in order to summarize the treatment options of COVID-19 related myocarditis. Analysis of 44.672 COVID-19 cases showed an increased risk of mortality in elderly people (14.8% for patients over 80 years old) and patients with cardiovascular disease (10.5%). Patients with diabetes (7.3%) and hypertension (6%) also demonstrated an increased risk of mortality. The rate of underlying chronic respiratory disease was 6.3%. Arrhythmia was found in 16.7% and acute heart injury existed in 7.2% of 138 hospitalized COVID-19 patients. ACE inhibitors or ARBs should be administered in patients with wall motion abnormality or heart failure with reduced EF. Diuretics should be considered in patients with volume overload and torsemide should be preferred as first option. Non-steroidal antiinflammatory drugs and cardiac glycosides should be avoided. Physical activity should be restricted until the disease resolved. IVIG and interferon therapy are feasible treatment options with reasonable side effect profile.

Background: Obese and hypertensive (HT) patients should restrict salt intake. In excessive salt intake, ouabain-like compounds inhibit Na/K-ATPase (Na+ pump), which increases intracellular Na+ and Ca2+. Ca2+ has a vasotonic effect on arteries and an inotropic effect on the heart and may cause cortical opacities in the lens. To our knowledge, there is still no practical method for salt intake follow-up. This study tested whether salt intake follow-up can be performed with the help of opacity tracking. Methods: In total, 400 HT patients (age 30-69 years) with cortical lens opacities were included in the study. Changes in opacities based on biomicroscopic examination at baseline and after 3 months were recorded digitally with the help of imaging software. Salt intake at 1 and 3 months was evaluated with a 24-hr urine Na assay. Changes in opacities were compared among group 1 (∼50% salt reduction), group 2 (∼10% salt reduction), and group 3 (∼15% salt increase). Results: Age and changes in small opacity diameter (SOD) and large opacity diameter (LOD) were the most important determinants of the 50% salt reduction in the third month. For changes in LOD, the sensitivity was 88.5% [confidence interval (95% CI) 85.2-91.7] and specificity was 95.5% (95% CI 93.1-98.7) for predicting a 50% salt restriction during the 3-month period. For SOD, the values were 85% (95% CI 82.5-87) and 95% (95% CI 92.3-97.5), respectively. Conclusions: Opacity changes are a practical method for predicting a 50% reduction in salt intake over a 3-month period in 30- to 59-year-old HT patients.

Heart, lens, and neuronal cells change significantly with age, and they are older than cells from renewable tissues. Near vision deterioration during aging results from a decrease in accommodation amplitude (AA). Cardiac aging is an independent risk factor for cardiovascular disease. We investigated the association between cardiac aging and AA.The subjects (500 mean 50-year-old subjects, with equal males and females) were divided into two groups according to AA measured with a Raf ruler. Biomicroscopy was used to capture images of the lens nucleus in the unaccommodated and accommodated state. The nucleus diameter change at 1 D accommodation was measured using ImageJ. Cardiac conduction system differences were evaluated using electrocardiography, and cardiac autonomic aging was assessed based on heart rate variability. Myocardial aging was assessed based on diastolic dysfunction.For near distance vision, compared to subjects who could see clearly from 24 to 28 cm, subjects who could see clearly from 29 to 33 cm had a 2.104-fold higher risk of a lateral e' velocity10 cm/s [95%CI: 1.312-3.374], 2.603-fold higher risk of diastolic dysfunction [95%CI: 1.453-4.662], 1.54-fold higher risk of a low/high frequency ratio3.1 [95%CI: 1.085-2.197].As a simple screening test, subjective AA measurement can predict important heart aging parameters, including diastolic dysfunction.NCT04362215.

INTRODUCTION Plasma osmolarity is maintained through various mechanisms. The osmolarity of the aqueous humor around the crystalline lens is correlated with plasma osmolarity. A vacuole can be formed in the lens upon changes in osmolarity. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) are new in the treatment of heart failure. They can cause osmotic diuresis but do not affect plasma osmolarity. OBJECTIVE It is unclear if the presence or absence of lens vacuole changes can monitor diabetic heart failure and SGLT2i treatment efficacy. METHODS Web of Science, PubMed and Scopus databases were searched for relevant articles about osmolarity, diabetes, transient receptor potential vanilloid channel, diabetic heart failure, lens vacuoles up to May 2021. MAIN MESSAGE The effect of SGLT2i on osmosis underlies its benefit to heart failure, but this in turn affects many other mechanisms. Failure to experience osmolarity changes will reduce the negative changes in terms of heart failure affected by osmolarity. A practical observable method is needed. CONCLUSIONS There is a possibility of using lens vacuoles in the follow-up of diabetic heart failure patients.

Aim Current literature lacks a definitive threshold of idiopathic premature ventricular complex (PVC) burden for predicting cardiomyopathy (CMP). The main objective of the present study was to evaluate relationship between the PVC burden and left ventricular ejection fraction (LVEF). Method This multicenter, cross‐sectional study included 341 consecutive patients with more than 1,000 idiopathic PVC in 24 hr of Holter monitoring admitted to the cardiology clinics between January 2019 and May 2019 in the nineteen different centers. The primary outcome was the LVEF measured during the echocardiographic examination. Result Overall, the median age was 50 (38–60) and 139 (49.4%) were female. Percentage of median PVC burden was 9% (IQR: 4%–17.4%). Median LVEF was found 60% (55–65). We used proportional odds logistic regression method to examine the relationship between continuous LVEF and candidate predictors. Increase in PVC burden (%) (regression coefficient (RE) −0.644 and 95% CI −1.063, –0.225, p

Objective: Recent studies have focused on the probable role of oxidative stress in cardiovascular diseases. We aimed to assess the oxidant/antioxidant biomarkers in coronary slow flow (CSF). Methods: The study included 51 subjects with CSF and age and sex matched 32 controls. Detailed anamnesis of the patients in the study was taken and routine physical examinations were performed. Routine biochemical blood tests were analyzed. Total oxidative status (TOS), oxidative stress index (OSI) and lipid hydroxyperoxide (LOOH) levels as oxidant biomarkers; paraoxonase (PON1), ceruloplasmin (CP), free sulphydryl (SH) groups, and total antioxidant capacity (TAS) levels as antioxidant biomarkers were studied. Results: Baseline demographic characteristics of the study population did not differ significantly between groups. TOS, OSI and LOOH concentrations were higher in study group than in control group. However, there was no significant difference detected in levels of TAS, PON1, SH and CP. Multivariate logistic regression analysis revealed that TOS, hsCRP and smoking were indepedent risk factors of CSF. Conclusions: Although there was not any significant difference in antioxidant biomarkers (TAS, PON1, SH and CP) in CSF patients, we detected increased TOS, OSI and LOOH levels which have oxidant properties. These data supported the possible involvement of oxidative stress in pathogenesis of CSF as previous studies reported. doi: https://doi.org/10.12669/pjms.35.3.162 How to cite this:Baysal SS, Koc S. Oxidant-Antioxidant balance in patients with coronary slow flow. Pak J Med Sci. 2019;35(3):786-792. doi: https://doi.org/10.12669/pjms.35.3.162 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Salt is important in the pathogenesis of hypertension (HT). Salt-sensitive hypertension (SSH) accounts for about half of all HT cases. In SSH, sodium/potassium adenosine triphosphatase (NaThe study included 191 SSH and 159 non-SSH, salt-resistant HT (SRH) patients (350 HT patients total), aged 40-80 years. One hundred twenty-four sex- and age-matched patients without a HT diagnosis made up the control group. Daily salt intake of all groups was calculated from 24-hr urinary Na excretion. SSH was diagnosed when the difference in mean arterial blood pressure values obtained during high- and low-Na diets was ≥10%. Non-SSH, SRH was diagnosed when the difference was10%.Two researchers examined the presence of cortical lens opacities biomicroscopically using the diffuse, direct, Scheimpflug, and retroillumination from fundus methods.Total lens opacity was predictive of SSH among all cases (P 0.001), with a sensitivity and specificity of 75.4% [95% confidence interval (CI): 68.6-81.3] and 83.6% (95% CI: 77.0-89.0), respectively. Its positive and negative predictive values were 84.7% (95% CI: 79.4-88.8) and 73.9% (95% CI: 68.6-78.5), respectively.Lens opacities can be used as a finding that can be easily observed in the detection of SSH and excess salt intake.

Background: Glycated hemoglobin (HbA1c) is an index of the average blood glucose level over the preceding 2–3 months. In experimental studies, the lens responded to changes in osmolarity b...

The existence of the retinohypothalamic pathway suggests that light may influence autonomic outflow activity. The objective of this study was to examine the correlation between the estimated iris muscle sympathetic-parasympathetic area (IRIS) ratio and the sympathetic?parasympathetic ratio (Low Frequency (LF)/High Frequency (HF) ratio). The study population consisted of 200 females and 200 males (mean age, 32.4 ± 7.1 y). The IRIS ratio was determined from digital photographs of the iris in a computer setting. The LF/HF ratio was determined from records of heart rate variability obtained using a Holter implementation. The minimum LF/HF ratio was 1.4 and the maximum 5.6 (mean, 3.0 ± 0.8). The minimum IRIS ratio was 1.4 and the maximum 4.9 (mean, 2.7 ± 0.6). A strong positive correlation was determined between the LF/HF and IRIS ratios in the entire population (r=0.825; p

Background: Growing evidence suggests that endothelial dysfunction plays a key role in the pathophysiology of Slow Coronary Flow (SCF). This study investigated the association between endothelial biomarkers endocan and soluble Thrombomodulin (sTM) and SCF. Methods: The study population consisted of 89 subjects (54 patients with SCF and 35 controls). Coronary flow rate was assessed using the Thrombolysis in Myocardial Infarction (TIMI) Frame Count (TFC) method. The serum endocan and sTM levels of all subjects were analysed. Results: Significantly higher endocan levels (1.14 ± 0.22 vs. 0.96 ± 0.32 ng/ml; p=0.009) and sTM levels (657.06 ± 198.18 vs. 592.76 ± 128.45 pg/ml; p=0.119) were observed in the SCF group relative to the control group. A positive correlation was detected between endocan and TFC (r=0.563; p=0.016). Multivariate logistic regression analysis revealed endocan as a predictor of SCF. Conclusions: The endocan level in SCF patients was significantly higher than in controls and the sTM level was also increased, although the difference was not significant. These results suggest that endocan may serve as a biomarker to predict SCF.

WOS: 000374330000069 PubMed: 26008865 Patient: Male, 44 Final Diagnosis: Coronary slow flow Symptoms: Blurring of vision . chest pain Medication: - Clinical Procedure: Medical treatment Specialty: Cardiology Objective: Unusual clinical course Background: Various pathophysiological mechanisms such as microvascular and endothelial dysfunction, small vessel disease, diffuse atherosclerosis, and inflammation have been held responsible in the etiology of coronary slow flow. It is also thought to be a reflection of a systemic slow-flow phenomenon in the coronary arterial tree. Case Reports: A 44-year-old man presented with chest pain causing fatigue, together with blurred vision for the last 2 years, which disappeared after resting. He had used corticosteroid therapy for facial paralysis 1 month ago. Coronary slow flow was detected in all 3 major coronary arteries on coronary angiography. TIMI measurements for the left anterior descending artery, circumflex, and right coronary artery were 64, 72, and 55, respectively. In fundus fluorescein angiography, retinal vascularity was normal, the arm-to-retina circulation time was 21.8 s, and the arteriovenous transit time was 4.3 s. In the early arteriovenous phase, choroidal filling was long, with physiological patchy type. Diltiazem 90 mg/day and acetylsalicylic acid 100 mg/day were given. His chest pain and visual symptoms disappeared after medical treatment. Conclusions: Physicians should be aware that glucocorticoids might cause an increase in the symptoms of coronary slow flow and some circulation problems, which might lead to systematic symptoms.

Coronary slow flow (CSF) may be a reflection of a systemic slow-flow phenomenon in the coronary arterial tree. In this study, the CSF group consisted of 24 men (77.4%) and 7 women (22.5%). An age- and gender-matched normal coronary artery (control) group was composed of 21 men (72.4%) and 8 women (27.5%). Retinal arteriovenous circulation time was measured using fundus fluorescein angiography as a part of the microcirculation and the circulation time between the antecubital vein and the retina as a part of the systemic circulation in patients with CSF and controls with normal coronary arteries. The mean arm-retina circulation time was 19.0 ± 5.7 seconds in the CSF group and 14.1 ± 3.1 seconds in the control group (p

Introduction The incidence of coronary artery anomalies (CAAs) varies from 0.2% to 8.4%. Knowledge of such anatomical variations is important as coronary procedures are regularly performed these days. We aimed to find the coronary dominance pattern, intermediate artery (IMA) frequency and CAA incidence in our clinic, and compare them to those in the literature. Methods The medical reports of 5,548 patients who had undergone coronary angiography (CAG) between 2005 and 2009 were retrospectively investigated. Dominance pattern and presence of IMA and CAA were recorded. CAAs were described using two different classifications: Angelini and Khatami's classification, and a new modified classification that was derived from Angelini and Khatami's classification. Some procedural details and clinical features of the patients with CAA were also investigated. Results Coronary dominance pattern was: 81.6% right coronary artery, 12.2% circumflex artery and 6.2% co-dominant. IMA was present in 613 (11.0%) patients. The incidences of overall anomaly were 2.7% and 1.4%, according to the different classifications. Absent left main coronary artery, which was the most common anomaly in the present study, was found in 51 (0.9%) patients. Incidences of myocardial bridge, coronary arteriovenous fistulae and aneurysms were 1.1%, 0.2% and 0.3%, respectively. Conclusion CAAs are generally asymptomatic, isolated lesions. Some may lead to anginal symptoms, myocardial infarction or sudden death. We found that CAA was associated with increased radiation and contrast exposure in patients who underwent CAG. This risk could be reduced if appropriate catheters were designed and training programmes on ostial cannulation were developed.

A B S T R A C T S phenomenon. In this study, we aimed to study the new biomarker adroin levels as it relates to CSF. Methods: Patients who underwent coronary angiography before and had no significant epicardial coronary disease were included in the study. Patients who had Thrombolysis in Myocardial Infarction frame counts (TFCs) above the normal cutoffs were considered to have CSF and those within normal limits were considered to have normal coronary flow (NCF). The adropin levels and biochemical profiles of all patients were studied and analyzed with coronary flow parameters. Results: There were 58 patients in the CSF group and 50 patients in the NCF group. The mean adropin level was significantly lower in CSF group than in NCF group (3.2 0.71 vs. 4.9 1.51 ng/mL, p < 0.001).There was a significant correlation between the adropin levels and TFC (r1⁄4 0.676, P