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Background and aims COVID 19 pneumonia commonly leads to ARDS. The occurrence of ARDS in COVID 19 patients is thought to occur secondary to an exaggerated immunologic response. In this meta-analysis, we aim to comprehensively study the various levels of immunological parameters in patients with COVID 19. Materials and methods We performed a systematic literature search from PubMed, EuropePMC, SCOPUS, Cochrane Central Database, and medRxiv with the search terms, “COVID-19” and “Interleukin”. The outcome of interest was prognosis in COVID 19 patients. Results We performed meta analysis of 16 studies. Higher counts of CD4 and CD8 with Lower Levels of TNF-a, IL2R, IL6, IL8 were observed on patients with good prognosis compared to patients with poor prognosis; −0.57 (pg/mL) (−1.10, −0.04, p = 0.04), (I2 91%, p, Highlights • Elevated immune response occurs in COVID 19 patients, and this immune response is mediated by various cytokines. • Exaggerated immune response in COVID19 does not seem to be mediated by complements. • Wider gap in IL-6 levels are observed between older age patients with good and poor outcomes. • Lower levels of TNF-a, IL6, IL8, and IL10 were observed in patients with good prognosis.

Introduction: Endothelin receptor antagonists (ERAs) are widely accepted as a specific treatment for pulmonary arterial hypertension. Unfortunately, consensus and recommendations are lacking for the treatment of patients who suffer from pulmonary arterial hypertension and congenital heart disease, including Eisenmenger syndrome. Objective: This meta-analysis aimed to compare the effect of ERA on patients with Eisenmenger syndrome. Methods: Electronic search on PubMed (MEDLINE), EBSCO, EuropePMC, Clinicaltrials.gov, and Google Scholar was done. Studies involving the use of ERAs on Eisenmenger syndrome patients were included. There were 18 studies included. The primary outcome of interest was the 6-min walking test distance before and after exposure to ERA. Results: There were 517 patients with Eisenmenger syndrome. The subjects had Eisenmenger syndrome secondary to congenital heart disorders, with WHO functional Class ranging from Class I–IV. The follow-up ranges from a mean of 4–60 months. Seventeen studies reported a statistically significant difference between pretreatment and the posttreatment result of 6-min walking test distance. Pooled mean difference comparing pre and posttreatment values yielded an increase of 55.24 m (42.15, 68.33) P < 0.001; moderate heterogeneity I2 51% P = 0.008. Pooled mean pulmonary vascular resistance index difference comparing pre and posttreatment values yielded a decrease of 4.76 woods unit (−6.86, −2.66), P < 0.001 favoring posttreatment; low heterogeneity I2 0%, P = 0.82. Pooled mean mean pulmonary arterial pressure difference comparing pre and posttreatment values yielded a decrease of 5.40 mmHg (−7.53, −3.28), P < 0.001 favoring posttreatment, low heterogeneity I2 0%, P = 0.65. Conclusion: Implementation of ERA in Eisenmenger improves 6-min walking distance and pulmonary vascular pressure indices. Earlier administration of ERA might be beneficial, further studies are needed to assess mortality benefit of this agent.

Honey is a nutritious substance produced by bees. Its quality and nutritional value is of great importance for consumers. Keeping this in view physicochemical and minerals determination as quality parameters of fresh floral Pakistani honeys produced by A. mellifera and branded honeys was conducted. The results of fresh honey indicated average means of Color as 48.78 mmPfund, pH 4.9, Total acidity 37.14 meq/kg, Moisture content 18.62%, Electrical conductivity 0.23 mS/cm, Ash content 0.49%, HMF content 30.85 mg/kg, Proline 365.84 mg/kg, Diastase activity 34.39(DN) and Invertase activity was 68.61(IN) comparable to honey standards. Natural honey were rich in k+ (408.46 ppm) and Na+ (405 ppm). Although Ca+ was very low. Whereas, Co, Mn and Ba concentrations exceed the 1 ppm. However, Pb, Cr, and Mo were unnoticeable. Similarly, Color, pH, MC, EC, T. Acidity, HMF, Proline, Ash content, Diastase and Invertase activity of branded honey samples average means found were 42.5 mmPfund, 5.05, 20.5%, 0.18 mS/cm, 15.34 meq/kg, 36.5 mg/kg, 181.6 mg/kg, 1.11%, 7.90(DN) and 36.97(IN) respectively. The findings showed that fresh honey samples were good and of consumable quality as per honey standards than branded honey. Higher HMF content and lower enzymatic activity in branded honey sample than the Codex standards revealed its either long or improper storage. Keywords: Honey analysis, Branded honey, Mineral content, Pakistan

Background Diagnosis‐to‐ablation time (DTAT) has been postulated to be one of the predictors of atrial fibrillation (AF) recurrence, and it is a “modifiable” risk factor unlike that of many electrocardiographic or echocardiographic parameters. This development may change our consideration for ablation. In this systematic review and meta‐analysis, we aim to analyze the latest evidence on the importance of DTAT and whether they predict the AF recurrence after catheter ablation. Methods We performed a comprehensive search on topics that assess diagnosis‐to‐ablation time (DTAT) and AF recurrence from inception up until August 2019 through PubMed, EuropePMC, Cochrane Central Database, and http://ClinicalTrials.gov. Results There was a total of 3548 patients from six studies. Longer DTAT was associated with increased risk for AF recurrence in all studies included. Meta‐analysis of these studies showed that DTAT had a hazard ratio (HR) of 1.19 [1.02, 1.39], P = .03; I 2: 92% for AF recurrence. Upon sensitivity analysis by removing a study, HR became 1.24 [1.16, 1.32], P 3 years had HR 1.73 [1.54, 1.93], P 6 years to, Diagnosis‐to‐ablation time >3 years is associated with the increased risk of atrial fibrillation recurrence after catheter ablation.

Background Several comorbidities have been associated with an increased risk of severity and mortality in coronavirus disease 2019 (COVID-19), including hypertension, diabetes, cerebrovascular disease, chronic kidney disease, and chronic obstructive pulmonary disease. Purpose In this systematic review and meta-analysis, we attempted to investigate the association between heart failure (HF) and poor outcome in patients with COVID-19. Methods We performed a systematic literature search from PubMed, EuropePMC, SCOPUS, Cochrane Central Database, and medRxiv with the search terms, “Heart failure” and “COVID-19”. The outcome of interest was mortality and poor prognosis (defined by incidence of severe COVID-19 infection, admission to ICU, and use of ventilator) in patients with preexisting heart failure with coronavirus disease. Results We identified 204 potential articles from our search, and 22 duplicates were removed. After screening of the titles and abstracts of the remaining 182 articles we identified 92 potentially relevant articles. We excluded 74 studies due to the following reasons: four studies were systematic reviews, two studies were meta-analyses, three articles were literature reviews, and 65 articles did not report on the outcome of interest. Finally, we included the remaining 18 studies in our qualitative synthesis and meta-analysis. There were 21,640 patients from 18 studies. HF was associated with hospitalization in COVID19 HR was 2.37 [1.48, 3.79; p, Highlights • Individuals with preexisting cardiovascular diseases have been shown to have poor outcomes with COVID 19 • Patients with preexisting Heart failure suffer from decreased circulatory and physiological reserves, which renders them to a more severe course of disease • Patients with Heart Failure are at increased risk for poor outcomes such as hospitalization, and death from COVID-19. • Significant difference in mortality between patients with and without HF was observed, those with Heart failure showing higher mortality rates.

Background Basic life support (BLS) performed by general population improves outcomes in cardiorespiratory collapse. This community-based study aims to measure the general population's eagerness in learning BLS, knowledge regarding early recognition, and use an automated external defibrillator. Methods This was a cross-sectional community-based study in Jakarta using questionnaire. Numerous questions asked through a questionnaire in order to evaluate the general population's eagerness and knowledge about basic life support. Results There were 303 respondents in this study. Most respondents stated that knowledge about BLS is important and was eager to learn; however, only 39.6% of respondents have ever done BLS training. 59.4% of respondents have ever looked for information or read about BLS. 63.6% of respondents chose to call an ambulance for the first reaction, while 36,5% of respondents preferred to look for a pulse. Most of the respondents know to check the carotid pulse in the neck. 77.4% of respondents know that chest compression was done on mid-chest. 81.5% of respondents agreed that CPR was preferably done repeatedly in a specific rhythm, but giving one despite the method is better than none. Only 49.5% of respondents wanted to give mouth-to-mouth ventilation. Most respondents thought that they are not allowed to use AED, and only a small proportion had seen AED in public. Conclusion Most of the respondents agreed that BLS is important. Respondents have satisfying knowledge about how to react while encountering an unconscious person. Most respondents have not seen AED and most likely didn't know how to use it.

Background and Aim Conventional epicardial cardiac resynchronization therapy (CRT) can cause fatal arrhythmia associated with increased transmural dispersion of repolarization (TDR). It is unknown whether endocardial biventricular pacing in various locations will decrease TDR and hence the occurrence of fatal arrhythmia. This study aimed to find out the most effective location of endocardial biventricular pacing resulting in the shortest homogenous TDR. Methods A before‐and‐after study on adult chronic heart failure (CHF) patients undergoing endocardial biventricular pacing in several defined locations. The changes in TDR from baseline were compared among various pacing locations. Results Fourteen subjects were included with age ranged 36‐74 years old, of which 10 were males. Location revealed the highest post biventricular pacing TDR (113.4 (SD 13.8) ms) was the outlet septum of right ventricle in combination with lateral wall of left ventricle (RVOTseptum‐LVlateral) while the lowest one (106.1 (SD 11.6) ms) was of the right ventricular apex and posterolateral left ventricle (RVapex‐LVposterolateral). Two CRT locations resulted in the most homogenous TDR, that is the right ventricular apex ‐ left ventricular lateral wall (RVapex‐LVlateral, mean difference −9.43; 95% CI (−19.72;0.87) ms, P = 0.07) and right ventricular apex ‐ left ventricle posterolateral wall (RVapex‐LVposterolateral, mean difference −6.85; 95% CI (−13.93;0.22) ms, P = 0.056). Conclusion Endocardial biventricular pacing on right ventricular apex and left ventricular lateral/posterolateral walls results in the most homogenous TDR.

Recent evidence showed that the characteristics and outcome of those with de novo heart failure (HF) and acutely decompensated chronic heart failure (ADCHF) were different. We aimed to perform a comprehensive search on the clinical characteristics and outcome of patients with de novo HF and ADCHF.We performed a comprehensive search on de novo/new onset acute HF vs ADCHF from inception up until December 2019.There were 38320 patients from 15 studies. De novo HF were younger and, had less prevalent hypertension, diabetes mellitus, ischaemic heart disease, chronic obstructive pulmonary disease, atrial fibrillation, and history of stroke/transient ischaemic attack compared to ADCHF. Five studies showed a lower NT-proBNP in de novo HF patients, while one study showed no difference. Valvular heart disease as aetiology of heart failure was less frequent in de novo HF, and upon sensitivity analysis, hypertensive heart disease was more frequent in de novo HF. As for precipitating factors, ACS (OR 2.42; IRisk factors, aetiology, and precipitating factors of HF in de novo and ADCHF differ. De novo HF also had lower 1-year mortality and 3-month mortality compared to ADCHF.

Background: Prevalence of atrial fibrillation (AF) in patients with congenital heart disease (CHD) is on the rise. Anti-arrhythmic drugs are usually the first line of treatment in CHD, however, it is often ineffective and poorly tolerated. We aimed to perform a systematic review to assess the efficacy and safety of catheter ablation for AF in CHD. Methods: We performed a comprehensive search on catheter ablation for atrial fibrillation in congenital heart disease up until July 2019 through several electronic databases. Results: Ablation of AF in patients with CHD had a modest 12 months AF freedom ranging from 32.8% to 63%, which can be increased by subsequent/repeat ablation. The complexity of CHD appears to have a significant effect on a study but not in others. Catheter ablation in ASD and persistent left superior vena cava had a high success rate. Overall, catheter ablation is safe whichever the type of CHD is. Conclusion: Catheter ablation for AF in CHD had modest efficacy that can be increased by subsequent/repeat ablation and it also has an excellent safety profile. Ablation in complex CHD could also have similar efficacy, however, it is preferably done by experts in a high volume tertiary center. Keywords: Catheter ablation, Atrial fibrillation, Congenital heart disease, Efficacy, Safety

Objective The assessment of quality of life has significant impact in device therapy. This research was aimed to translate and evaluate the validity and reliability of the Indonesian version of the AQUAREL questionnaire. Results We evaluated 32 patients during the cross-cultural adaptation stage and 20 patients during validity and reliability evaluation stages. Indonesian version of AQUAREL showed positive correlation between 6-min walking test and dyspnea domain (r = 0.228; p = 0.048), and showed negative correlation between NT pro-BNP and chest discomfort (r = − 0.231; p = 0.043) and dyspnea domain (r = − 0.268; p = 0.020). The total AQUAREL also showed positive moderate correlation toward total SF-36 (r = 0.543; p = 0.000). The internal consistency was good (Cronbach α = 0.728) and the repeatability between day 1 and day 8 was good, with moderate positive correlation (r = 0.581; p = 0.007). Electronic supplementary material The online version of this article (10.1186/s13104-019-4208-1) contains supplementary material, which is available to authorized users.

Background: Data on the optimal therapeutic international normalized ratio (INR) for non-valvular and valvular atrial fibrillation (AF) in Indonesia is currently unavailable. Therefore, we designed the Indonesian Registry on Atrial Fibrillation (OneAF) registry in order to seek a safe and beneficial range of INR in Indonesian patients with non-valvular and valvular AF. Methods/design: The OneAF registry is a nationwide collaboration of the Indonesian Heart Rhythm Society (InaHRS) enrolling all hospitals with cardiac electrophysiologists in Indonesia. It is a prospective, multicentre, nationwide, observational study aiming to recruit non-valvular and valvular AF patients in Indonesia. The registry was started in January 2020 with a planned 2 years of recruitment. There are 2 respondents for this registry: non-cohort and cohort respondents. Non-cohort registry respondents are AF patients at hospitals who fulfill inclusion and exclusion criteria but did not consent for a 24 month follow up. Whereas patients who consented for a 24 month follow up were included as cohort registry respondents. Key data collected includes basic sociodemographic information, symptoms and signs, medical history, results of physical examination and laboratory test, details of diagnostics and treatment measures and events. Results: Currently, a total of 1568 respondents have been enrolled in the non-cohort registry, including 1065 respondents with non-valvular AF (67.8%) and 503 respondents with valvular AF (32.2%). We believe that the OneAF registry will provide insight into the regional variability of anticoagulant treatment for AF, the implementation of rhythm/rate control approaches, and the clinical outcomes concerning cardiocerebrovascular events. Trial registration: Registered at clinicaltrials.gov (NCT04222868).

Background: There is controversy among physicians regarding the use of dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients treated with coronary artery bypass grafting (CABG). Moreover, the evidence of previous studies about this topic remained inconclusive. This study aimed to perform a meta-analysis concerning the relation between the risk of major bleeding and the use of different DAPT (clopidogrel or ticagrelor) in ACS patients treated with CABG. Methods: A meta-analysis was conducted during March to October 2019. Searches were carried out in Pubmed, Embase, Cochrane, and Web of Science. The predictor covariate in our present study was DAPT (clopidogrel or ticagrelor), and the outcome measure was the risk of major bleeding. Sub-group analysis was also performed, where data were classified into pre- and post-CABG. Furthermore, to determine the correlation and effect estimation, data were analyzed using fixed or random effect model. Results: A total of 13 studies consisting 34,015 patients treated with clopidogrel and 32,661 patients treated with ticagrelor was included in our study. Our pooled calculation revealed that the incidence of major bleeding was not different significantly between clopidogrel and ticagrelor. In pre- and post-CABG sub-groups, our results also found no significant difference in major bleeding incidence between clopidogrel and ticagrelor groups. Conclusions: Our meta-analysis clarifies that clopidogrel, compared to ticagrelor, or vice versa, is not associated with the risk of major bleeding in ACS patients treated with CABG.

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Objective We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. Design Retrospective cohort study. Setting Emergency department of 56 health centres. Participants 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI. Main outcome measure Characteristics of reperfusion therapy. Results The majority of patients with STEMI (81%; N=826) were admitted to six academic percutaneous coronary intervention (PCI) centres. PCI centres received patients predominantly (56%; N=514) from a transfer process. The proportion of patients receiving acute reperfusion therapy was higher than non-reperfused patients (54% vs 46%, p Conclusions In the expanded JAC registry, a higher proportion of patients with STEMI received reperfusion therapy, but 46% still did not. In developing countries, focusing the prehospital care in the network should be a major focus of care to improve the DI-DO time along with improvement of DTD time at PCI centres. Trial registration number NCT02319473.