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Background: The most common cardiac arrhythmia, atrial fibrillation (AF), has been associated in prior research with a worse prognosis, both short-and long-term. Although the thickness of the epicardial fat tissue has been associated with the development of AF in earlier clinical trials, little is known about the association between the development of AF and the thickness of the epicardial adipose tissue (EAFT) in the setting of acute coronary syndrome. So we aimed to investigate the relationship between epicardial fat tissue thickness and new-onset atrial fibrillation (AF) development in patients with acute coronary syndrome during in-hospital follow-up. Methods: This cross-sectional study was carried out in the cardiology department at Zagazig University Hospitals on 100 patients with acute coronary syndrome who were divided into two groups: group (A) patients who didn’t develop new-onset AF and group (B) those who developed new-onset AF. EAFT was measured in all patients. Results: Epicardial adipose fat tissue thickness was statistically significantly higher in ACS patients who developed new-onset AF compared to those who didn’t develop AF. Multivariate logistic regression analysis proved that EFT and troponin peak levels were the independent predictors of new-onset AF. Conclusions: Increased epicardial adipose tissue (EAT) thickness is associated with a higher risk of developing new-onset atrial fibrillation in patients with acute coronary syndrome. [ABSTRACT FROM AUTHOR]

This paper addresses the effects and consequences of police checks in Swiss cities. In our participatory and collaborative research, we focus on the perspectives of those for whom racial profiling is part of everyday life. Using a theoretical perspective of subjectivation, we draw on thirty qualitative interviews with members of racialized minorities. We analyse not only the immediate effects of stop and searches such as feelings of humiliation, powerlessness and self-accusation but also long-term consequences such as the restriction of one's own movement in public spaces, fear of police, social withdrawal and loss of trust in state authorities. Ultimately, we examine the tactics and forms of resistance comprising elements of specific subjectivities that individuals use to deal with racial profiling. [ABSTRACT FROM AUTHOR]

Introduction: The accumulation of tissue‐advanced glycation end products in skin results from complex and consecutive reactions and can be measured by skin autofluorescence (SAF) reader devices. This overview discusses studies evaluating the utilization of SAF in screening renal and cardiac disease. Materials and methods: Literature search was performed using Google Scholar, PubMed, Springer, Ovid, and ScienceDirect. Results: SAF was an independent predictor of progression of chronic kidney disease (CKD) and was elevated in subjects on hemodialysis and peritoneal dialysis. Furthermore, SAF was significantly associated with cardiovascular events, cardiovascular mortality, and all‐cause mortality in CKD patients. Other studies revealed a correlation between SAF and arterial stiffness, vascular damage, and subclinical atherosclerosis. A vegetarian diet was associated with lower SAF levels, whereas malnutrition was correlated with higher levels and increased mortality. Conclusions: SAF measurement may be useful in managing renal and cardiac disease. Future studies are needed to clarify the specific role of SAF in the management of CKD and its noninvasive office utilization to identify comorbidities in inflammatory diseases, such as psoriasis. [ABSTRACT FROM AUTHOR]

Background: Heart failure with reduced ejection fraction (HFrEF) people are exposed to increased risk of death that can be predicted by several factors, one of which is increased vascular stiffness. Sacubitril-valsartan has not been thoroughly investigated in this population to determine its effects on vascular function and structure. Based on the vasodilatory features of sacubitril–valsartan, we expected that fractional area change (AFAC) as well as aortic distensibility (AD), when measured through 2D transthoracic echocardiography (TTE), should enhance with treatment course in HFrEF patients. Objective: This review article aimed to determine whether aortic stiffness can be measured by echocardiography in heart failure patients receiving sacubitril-valsartan medication or not. Methods: Search terms for the study included echocardiography, HFrEF, sacubitril-valsartan, aorta, and entresto in PubMed and Google Scholar. After the writers carefully analysed references from the relevant literature, including all the acknowledged research and reviews, only the most recent or complete studies between February 1995 and July 2021 were included. Since no sources for interpretation could be found, non-English language documents have been ignored. Dissertations, discussions, abstract papers from conferences, and everything else that wasn't a fundamental scientific research had been excluded. Conclusion: The positive benefits of sacubitril–valsartan on AD and AFAC as evaluated by TTE are increasing gradually from baseline to six months. [ABSTRACT FROM AUTHOR]

Background: Coronary artery tortuosity (CorT) is a prevalent angiographic finding commonly associated with aging, hypertension, atherosclerosis and other cardiovascular conditions. It has been suggested that coronary artery tortuosity causes alteration in blood flow and reduction in coronary artery pressure distal to the tortuous segment and can thus lead to ischemia. Objective: This study aimed to find the relationship between monocytes to high density lipoprotein cholesterol ratio (MHR) and isolated coronary artery tortuosity (CorT) without obstructive coronary artery disease (CAD). Patients and Methods: This study is an observational retrospective case control study that was performed in National Heart Institute and Zagazig University Hospital between January 2018 and January 2020 for patients with stable coronary artery disease that underwent coronary angiography. In this study 60 patients with chronic stable angina were enrolled, 30 patients showed Cor-T without obstructive CAD (cases) on coronary angiography, while the other 30 patients showed normal coronaries (Control). Results: The most two predictable factors for the detection of Cor-T are MHR and C-reactive protein (CRP). In Cor-T group there was a significant positive correlation between the number of tortuous vessels and the MHR with P-value <0.001, the more number of tortuous vessels the higher MHR. Conclusions: The relationships between the noninvasive laboratory index MHR and coronary artery tortuosity is significant. These findings consider MHR as an accurate, quantitative, non-invasive, highly available and non-expensive parameter for the prediction and detection of Cor-T and may be useful for risk stratification. [ABSTRACT FROM AUTHOR]

Introduction: C-reactive protein (CRP) has come to prominence in the cardiovascular field with the inflammatory hypothesis of atherosclerosis. Many studies evaluated the role of CRP as a prognostic marker in ST-segment elevation myocardial infarction (STEMI). The aim of our work was to study the relation between admission CRP level and the angiographic severity of coronary artery disease in patients presenting with acute ST elevation myocardial infarction. Patients and Methods: Admission CRP was measured for 100 STEMI patients before primary percutaneous coronary intervention (PCI). Complexity of coronary lesion was assessed using both Syntax score and thrombolysis in myocardial infarction (TIMI) flow. Results: Syntax score was significantly higher in the 3rd CRP tertile (20.24 ± 5.6 and P = 0.000), TIMI 0 flow was the highest in the 3rd tertile (24% and P = 0.001). We found a significant positive correlation between Syntax score and CRP and a significant negative correlation between CRP and TIMI flow (P = 0.001 and 0.005, respectively). Receiver operating characteristic curve constructed to determine the sensitivity of admission CRP to determine intermediate to high risk SYNTAX score showed a level =8.4 mg/dl as 71% sensitive (area under the curve [AUC] =0.65 and a P = 0.02) and an admission CRP of =4.8 mg/dl to be 81% sensitive in determining no or faint antegrade flow (TIMI 0 and 1) (AUC = 0.71. P =0.001). Conclusion: There is a strong positive correlation between admission CRP and the syntax score and TIMI flow in STEMI patients undergoing primary PCI, thus adding CRP to the risk scoring systems used to assess STEMI patients before PPCI can help better risk stratify patients before going into the cath laboratory. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, several cases of AGEP have been reported in patients with COVID-19 infection. Twenty-one cases occurred in patients who received HCQ, three on HCQ monotherapy for the treatment of COVID-19 pneumonia, while the rest received additional medications. It is unclear whether the AGEP was related to COVID-19 infection and/or azithromycin.3 The onset of AGEP following COVID-19 diagnosis/treatment was ranging from 3 days to 3 months. [Extracted from the article]

Background:Dilated cardiomyopathy with impaired systolic function is an entity of different etiologies to be differentiated to guide management and prognosis. This study aimed to assess the efficacy of non-invasive tools as speckle tracking Echocardiography (STE), myocardial perfusion imaging (MPI) in differentiation between ICM and NICM.Patients and methods: Retrospective Cohort study included patients with reduced systolic function then 2D Echocardiography (STE), myocardial perfusion imaging (MPIwere done then patients were divided according to coronary angiographic findings into 2 groups ICM, NICM.Results:Summed stress score (SSS), summed difference score (SDC) were the independent predictor of ICM. ROC curve revealed that the best cut off value for SSS was = 10.2 with sensitivity 78.1%, specificity 71.4%, Positive predictive value (PPV) 84.2%, Negative predictive value (NPV)62.5.6%, and accuracy 75.8%. The best cut off value of SDC was = 3.2 with sensitivity 85.4%, specificity 95.2%, PPV 97.2%, NPV 76.9%, and accuracy 88.7% global longitudinal strains did not differ significantly. However, NICM patients had higher apical and lower basal longitudinal strains compared with those with ICM. The ratio of basal to sum of mid- and apical longitudinal strains could predict NICM with a sensitivity of 82.9% and specificity of 80.9% by receiver operating characteristic curve analysis with cutoff value = 0.41 also apical to summed mid and basal ratio with cut off value = 0.71, sensitivity 70.7%, specificity71.4%, PPV 82.8%, NPV 55.5%, and accuracy 71% can predict. Relative apical sparing and a basal worsening pattern of LV longitudinal strain by 2D STE were observed in patients with NICM but not ICM. The ratio of basal to sum of mid- and apical longitudinal strains could help differentiate NICM from ICM. Conclusion: 2D STE, MPI can be used in differentiation between ICM and NICM. [ABSTRACT FROM AUTHOR]

Background: One of the world's most common health issues is high blood pressure. Hypertension's dangers are well-documented and have been shown in numerous large-scale investigations. Seasonal variation in blood pressure is largely due to changes in the temperature of the surrounding environment. Several studies have found a negative correlation between the temperature outside and blood pressure. No observational study has been done in Egypt so far using either healthy people or patients to examine the effect of weather on blood pressure. Evidence suggests that seasonal fluctuations in ambient temperature have an impact on cardiovascular events and blood pressure levels. Objective: Study the blood pressure levels in the winter and summer to see whether they differ. Conclusion: In both men and women, young and elderly, the seasonal change in BP appears to be a global phenomenon that has been documented in regions with varying climate conditions. [ABSTRACT FROM AUTHOR]

Brown recluse spiders, also known as Loxosceles reclusa, are endemic to the Southwest and Central Midwestern United States. A bite from this spider can cause a range of clinical manifestations, anywhere from a painless papular lesion to life-threatening reactions. We report a possible spider bite presenting as leukostasis initially suspected to be acute leukemia. A 22-year-old female patient presented to the emergency department with confusion and right upper arm pain, redness, and swelling after a suspected spider bite. Initial labs showed WBC count of 103.5x10e3/µL, hemoglobin of 3.3 g/dL, positive Direct Coombs' test, creatinine of 1.8 mg/dL, transaminitis, and lactic acid of 20 mmol/L. Acute leukemia with leukostasis was suspected. She was started emergently on hydroxyurea in conjunction with prophylaxis for tumor lysis syndrome. However, peripheral smear showed left-shifted granulocytosis with lymphocytosis, monocytosis, and no blast cells or evidence of myelodysplasia. Bone marrow aspirate showed mildly hypercellular marrow with myeloid hyperplasia and no myelodysplasia. Flow cytometry analysis confirmed a left-shifted myeloid maturation pattern with 0.3% myeloblasts. BCR-ABL1 and JAK2 testing was negative. Hence, she had no evidence of leukemia but rather had leukostasis from a spider bite. Hydroxyurea was stopped and follow-up labs normalized. Sphingomyelinase D in the brown recluse spider venom is unique to Loxosceles and Sicarius and may be responsible for the unique clinical presentation of loxoscelism. The presentation of hyperleukocytosis complicated by shock with an unclear history poses a diagnostic challenge. In diagnostic uncertainty, consider delaying chemotherapy until a diagnosis can be confirmed to avoid potential harm. [ABSTRACT FROM AUTHOR]

Objectives: We purposed to determine the relationship between left bundle branch block (LBBB) and coronary artery disease (CAD) site, severity, and CAD risk factors. Methods: Eighty patients with LBBB were sorted into two groups based on coronary angiography (CA) findings: Group 1: 56 patients with CAD (stenosis ≥70% in ≥1 epicardial vessel) and Group 2: 24 patients with normal coronaries. Results: Our observations confirm male preponderance of LBBB and affirm hypertension and diabetes as common risk factors for CAD within this subpopulation. Hence, these risk factors can be considered a strong predictor of CAD in LBBB. Cardiac echocardiography data suggest that LBBB and CAD are associated with regional hypokinesia and decreased ejection fraction. The most frequently diseased vessel was left anterior descending (LAD), followed by left circumflex then right coronary artery. Our study CA showed single-vessel disease (SVD) in 37 participants (46.3%), two-vessel disease in 16 subjects (20%), three-vessel disease in 3 subjects (3.8%), and normal vessels in 24 participants (30%). Hence, SVD frequency was high in our study. Conclusion: The risk for left ventricular dysfunction and SVD more commonly LAD artery involvement had increased in the presence of LBBB in electrocardiogram. CA present only in tertiary centers, which considered a major and invasive diagnostic tool for CAD, so selection criteria are required to predict patients with LBBB who are prone to be at risk of CAD and need this invasive procedure, on the other hand, avoid CAD overdiagnosis, unnecessary admissions to hospital, and antianginal drugs consumption. [ABSTRACT FROM AUTHOR]

The optimal fluence for treating hirsutism with the diode laser has not been elucidated. The aim of this study is to evaluate and compare the satisfaction and side effects of patients who have been treated with two diode laser therapy techniques: high-fluence and low-fluence. In this cross-sectional study, the medical records of 182 patients referred to Yazd Laser center were collected. Various side effects of laser therapy were assessed, and the satisfaction rate of the patients was evaluated at three points: after the first session, at the end of the treatment course, and six months after the end of the treatment. The satisfaction level after the first session of the laser treatment was higher with the low-fluence technique (P-value<0.001). The satisfaction level at the end of treatment was the same in the two groups (P-value = 0.394). However, six months after the treatment, satisfaction level was significantly higher with the low-fluence technique (P-value = 0.005). The rate of complications, such as burn and pain, was higher in the high-fluence group, while the number of treatment sessions was lower with the high-fluence technique. The low-fluence method of laser therapy has fewer complications associated with greater patient satisfaction. [ABSTRACT FROM AUTHOR]

This study examined the safety of placing percutaneous endoscopic gastrostomy (PEG) tube in people with liver cirrhosis. The target population was further subdivided into people with ascites (case group) and people without ascites (control). We compare the morbidity and the mortality difference of PEG placement in cirrhotic patients with ascites vs cirrhotic patients without ascites. We then examined multiple factors including sex, race, chronic illness including hypertension, congestive heart failure, and others and their influence on the inpatient mortality of all cirrhotic patients who had PEG placement. A total of 38,175 inpatient PEG tube placements were identified. Only 583 patients out of 38,175 had a history of cirrhosis. One hundred seven had ascites and the rest did not. Mean age of the patients was 61.14 years. Patient demography included (65.2%) male and the rest were female, 359 were white (64.4%), 90 black (14.8%), 84 Hispanic (13.7%), 23 Asians (3.3%), 7 Native Americans (0.4%), and 20 others (3.5%). Complications from PEG procedure in cirrhosis with ascites vs non-ascites included bleeding of 4 (0.8%) vs 2 (1.9%) (P=0.35), surgical site infection 2 (0.4%) vs 1 (0.9%) (P=0.51), and urinary tract infection 105 (22.1%) vs 34 (23.8%) (P=0.34), respectively. There was no colonic injury in either group. The total inpatient mortality was 75 out of the 583. Fifty-six (11.8%) were in the ascites group and 19 (17.8%) in the non-ascites group (P=0.097). Factors including ascites, postsurgical bleeding, and surgical site infection did not have influence on the inpatient mortality and there were no statistical differences between the two groups. [ABSTRACT FROM AUTHOR]

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Background: Angina occurs when there is regional myocardial ischemia caused by inadequate coronary perfusion and is usually but not always induced by increases in myocardial oxygen requirements. Objective: The aim of this work was to study the significance of ST changes in aVR, V5, V1 during exercise ECG for diagnosis of single -or multi-vessel coronary artery disease. Patients and methods: This study had been carried out in the cardiology department, Zagazig University and National Hear Institute during the period from January 2005 to January 2007. This study included 56 patients (40 male +16 female) with chronic stable angina. Results: Comparison was done among groups regarding demographic data, resting ECG data, echocardiographic findings and there were no statistical significant difference among groups. Single vessel disease: LAD: - the ability of the test to detect left anterior descending (LAD) lesion as a single vessel disease has high specificity 87.5%, high +ve predictive value 96%, but low sensitivity 50%. Left circumflex (LCx): the sensitivity of the test to detect LCx lesion as a single vessel disease was 53.4%, specificity 60%, but with low +ve predictive value 44%. RCA: as regard RCA lesion the test has low sensitivity, specificity positive and negative predictive values. Conclusion: The concomitant appearance of exercise-induced ST-segment elevation in lead V1 and in lead aVR with simultaneous ST-segment depression in lead V5, or the isolated appearance of ST-segment elevation in lead V1 mostly detects single-vessel disease and correlates strongly with significant narrowing of the LAD coronary artery as single-vessel disease, or with significant stenosis of the LAD and LCx coronary arteries as double-vessel disease. [ABSTRACT FROM AUTHOR]

In clinical practice, there are a lot of variations in disease manifestations. Diseases are constantly evolving, and one negative test cannot completely rule out a disease. Erythema multiforme (EM) is a common mucocutaneous disease that can be linked to a lot of etiologies, with the most common being herpes simplex virus (HSV) types 1 and 2, Mycoplasma pneumoniae , and the use of various drugs. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new virus, and traditionally it is not the first differential for EM eruptions. We report the case of a 52-year-old female patient with a history of multiple drug use, pneumonia-like symptoms, an initial negative viral panel for SARS-CoV-2, followed by a positive polymerase chain reaction (PCR) test, asymptomatic coronavirus disease 2019 (COVID-19) clinical course, and break-out of typical targetoid lesions of EM. Throughout her hospital stay, the patient maintained her oxygenation levels and improved clinically with steroids and symptomatic treatment. She regained her health and was counseled to quit smoking, alcohol, and opioid usage at the time of discharge from the hospital, and a regular follow-up with her primary care practitioner (PCP) was advised., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Tahir et al.)

Normal saline solution infusion with concurrent removal by ultrafiltration successfully corrected pretreatment metabolic alkalosis when other measures were inadequate for a patient on dialysis., Competing Interests: Author disclosures The authors report no actual or potential conflicts of interest with regard to this article., (Copyright © 2021 Frontline Medical Communications Inc., Parsippany, NJ, USA.)