Acute Coronary Syndrome Admissions and Mortality Rate During COVID-19 Pandemic in Gaza

Background: What is the nature and duration of changes to admissions for different types of acute coronary syndrome (ACS), among patients during coronavirus disease 2019 (COVID-19) pandemic in Gaza? Methods: The investigators analyzed data on hospital admissions in Gaza for types of ACS from August 25-2020, to October 1, 2020, that were recorded in the Alshifa Hospital Cardiology Department Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI) and non-STEACS and we calculate the diagnostic and percutaneous coronary intervention (PCI) rate. Results: Hospital admissions for ACS declined from rate of 99 admissions to 40 admission in 2020in this time, a reduction of 60%. During the period of declining admissions, there were reductions in the number of admissions for all types of ACS, including both STEMI and NON-STEACS, but relative and absolute reductions were larger for NSTEMI, (from 73 patients in 2019 to 26 patients in 2020) with a percent reduction of 64% In parallel, reductions were recorded in the STEMI ( from 26 patients in 2019 to 14 patients in 2020) percent reduction 46 %, the mortality rate for STEMI patient was 4% in 2019 and 21% in 2020, for non-STEMI patient was 0% in 2019 and 4% in 2020. The diagnostic coronary angiography decrease from 130 to 31 cases (76%) and PCI decrease from 35 to 18 cases (49%) during this period Conclusions: We found that significant reduction in the number of patients with ACS who were admitted to the hospital during the pandemic, but increase in mortality rate by 17% in STEMI and 4% in NON-STEACS in Gaza strip

Arsenic Poisoning: The Risk, Clinical Features and Treatment

Environmental exposure to arsenic, is a major concern in many industrialized countries. Although metals occur naturally in the environment but human activities cause more metals releases and have altered the natural cycling of the elements. These exposures occurs mostly from diet (water and food consumption), inhalation from air and metals related occupational exposure like leaded gasoline, industrial processes such as smelting of lead and its combustion, pottery, boat building, mining industry, exhaust fumes of vehicles, metal based painting, metal containing pipes, battery recycling, grids, arm industry, pigments, printing of books, etc Exposure to arsenic may affect nutrient metabolism and can cause a variety of health effects in human. Cancer, immunotoxicity, hepatotoxicicty, neurotoxicity, nephrotoxicity, brain damage, lungs damage, gastrointestinal distress and haematological alterations are the most frequently documented health implication associated with arsenic intoxication. Consequently, this this paper provide a deep understanding of arsenic, their sources, routes of exposure, the mechanisms of occasioning their toxicity, health implications in human and to identify substances that contribute to overcome their hazardous effects in human.

SGLT-2-Inhibitors in Heart Failure

Heart failure is a frequent and highly debilitating pathology. Angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers, β‐ blockers, mineralocorticoid receptor antagonists, and valsartan/sacubitril have been shown to reduce mortality in chronic heart failure with reduced ejection fraction. Recently, glifozines (SGLT‐2 inhibitors) have become another effective therapeutic option for heart failure with reduced ejection fraction, in patients with and without diabetes mellitus. The review presents the effects of SGLT‐2 inhibitors on the cardiovascular system and heart failure.

Theoretical Considerations on Possibilities to Develop Adaptable Centrifugal Pumps as Total Artificial Heart for Individual Body Sizes

Thanks to the modern imaging techniques used in medical technology, it is now possible to scan a patient's chest without any problems. This should definitely be taken into account when designing a modern total artificial heart. With today's 3D construction programs, it is possible to easily, and to the most part automatically, vary the construction of blood pumps. It is thus optimally adapted to the geometric circumstances of a patient.

Using A 21-Year Real-World Database from a Private Cardiologist's Practice to Test the Hypothesis that Combining Pharmacological Therapies (Carvedilol, Spironolactone and Statins) with Weight Loss May Benefit Patients with HFpEF

Heart Failure with preserved Ejection Fraction (HFpEF) is a clinical syndrome in which patients have symptoms of Heart Failure (HF), such as dyspnea and fatigue, a Left Ventricular Ejection Fraction (LVEF) ≥ 50% and evidence of cardiac dysfunction as a cause of symptoms, such as abnormal Left Ventricular (LV) diastolic dysfunction with elevated filling pressures. Besides LV diastolic dysfunction, recent investigations suggest a more complex and heterogeneous pathophysiology, including systolic reserve abnormalities, chronotropic incompetence, stiffening of ventricular tissue, atrial dysfunction, secondary Pulmonary Arterial Hypertension (PAH), impaired vasodilatation and endothelial dysfunction. Unlike Heart Failure with Reduced Ejection Fraction (HFrEF), clinical trials over the years have not yet identified effective treatments that reduce mortality in patients with HFpEF. A database on use of carvedilol in a private cardiologist's practice was begun in 1997 and concluded at the end of 2018. We used this database to test the hypothesis that combining pharmacological interventions to address diastolic dysfunction (carvedilol), volume overload (spironolactone/eplerenone) and endothelial dysfunction (statins) with weight loss may benefit patients with HFpEF. We report analysis of 335 patients with HFpEF comprised of 61% female (mean age 74 ± 8) and 39% males (mean age 72 ± 7). Initial EF ranged between 50 and 77% with mean EF of 57 ± 6%. Only 15 patients were changed to metoprolol succinate, verapamil or diltiazem because of adverse side effects. Two hundred and twenty of the patients were in normal sinus rhythm when started on carvedilol, spironolactone/eplerenone and statin therapy with weight loss counseling. After 5 years, 191 patients were still on combination therapy, and only 31 (17%) had developed Atrial Fibrillation (AF). Compared to previous HFpEF trials reporting a 32% risk of developing atrial fibrillation after 4 years, our combination therapy significantly (p < 0.05) reduced the risk of developing AF over 5 years. Thus, irrespective of age and sex with comorbidities of type 2 Diabetes Mellitus (DM) and Chronic Kidney Disease (CKD), patients with HFpEF can be managed successfully with carvedilol, spironolactone/eplerenone and statins with a clinical benefit being a reduced risk of developing AF. We consider these data hypothesis-generating and hope these results will be tested further in database analyses and clinical trials.

Study on the Dynamic Changes in Chest CT Findings of COVID-19 Rehabilitated Patients

Objective: To study the dynamic changes in CT findings in COVID-19 (coronavirus disease-19, COVID-19) rehabilitated patients. Methods: A total of 148 chest CT images of 37 patients with COVID-19 were collected. In the first 21 days of the course of disease, 7 stages were performed every 3 days, and the eighth stage was performed after 21 days. Results: In the first chest CT examination, 19 cases were ground glass opacity, and 18 cases were high-density shadows with consolidation. The lesion shape was flaky and patchy in 33 cases. The percentage of consolidation, air bronchogram, fiber cord, interlobular septal thickening, subpleural line and pleural thickening were the highest on days 4-6, 7-9, 7-9, 10-12, 19-21 and 19-21, respectively. The highest percentage of disease progression was 80.00% on days 4-6, and then the percentage of disease progression gradually decreased with the extension of the onset time. The percentage of patients with improvement gradually increased from days 4-6, reaching 83.33% on days 16-18 and 100.00% on day 21. The percentage of lesion range enlargement and density increase was the highest on days 4-6, both of which were 60.00%，Then the percentage of both decreased gradually. The percentage of patients with lesion range reduction and density absorption dilution increased gradually with the onset time. There was no obvious regularity in the number of lesions. Conclusion: Patients with COVID-19 have regular changes in their lung conditions.

Is Real World Use of Carvedilol in Patients with HFrEF Consistent with Clinical Trial Data? A 21-Year Experience in a Private Cardiologist's

Carvedilol has been approved for treatment of New York Heart Association (NYHA) Class I, II, III and IV patients and post-Myocardial Infarction (MI) patients, if the patient's Ejection Fraction (EF) is less than 40% because this third-generation beta-blocker demonstrated a decrease in mortality. While clinical trials demonstrated the survival benefits of carvedilol, translating carvedilol's efficacy and usefulness in clinical practice requires understanding of its side effect profile and the importance of dosage and long-term monitoring.A database on use of carvedilol in a private cardiologist's practice was begun in 1997 and concluded at the end of 2018.We report analysis of 642 patients with HFrEF. Initial EF's ranged between 8 and 47% with mean EF 32 ± 6%. The average age of the patient when started on carvedilol was 69 ± 7 years. Only 7 patients were changed to metoprolol succinate because of adverse side effects. After up-titration of carvedilol, the average resting heart rate was 61 ± 8 beats per minute. Two hundred and forty patients with HFrEF on carvedilol for greater than 5 years had a significant mean increase in EF of 5.5 ± 8% (p < 0.05). Two hundred of the patients with HFrEF also had or developed type 2 diabetes and chronic kidney disease during followup. Thirty-one percent of these patients with type 2 diabetes and chronic kidney disease lived longer than 10 years. Carvedilol remains a well-tolerated beta-blocker which demonstrates long-term benefits in a real-world setting.

Modified Technique of Coronary Plaque Deformation Facilitating Side Branch Entrance in Difficult Wiring of Coronary Total Occlusion

The plaque rigidity is an important factor that can complicate proper deployment of coronary stents, consequently increasing the risk of stent thrombosis and Restenosis. While aggressive balloon dilation carries the risk of coronary dissections. Thus, pretreatment of calcific lesions by different modalities of equipments is mandatory to facilitate adequate angioplasty. Here in this case report I utilized the regular balloons with wires to open very tough lesion undilatable with regular PTCA balloons in a step wise technique.