Chloroquine and Hydroxychloroquine in Treatment of Coronavirus Disease-19

At present, we are facing coronavirus disease (COVID)-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 with several treatment choices and reports of different treatment outcomes. Chloroquine and hydroxychloroquine use for the management of severely ill patients started as a quite enthusiastic treatment option, following several small clinical trials, case series reports, public authorities, and media affirmation. However, the evidence we have so far is conflicting and some national societies and professional institutions implicate that we should wait for definite treatment recommendations until there are solid data for or against the use of these drugs. Until we have more powerful evidence in our hands, we should be aware of safety issues of the old drugs for the new application in the emergency state we are facing today with the COVID-19 pandemic. We performed a concise review of strengths, limitations, and awareness for chloroquine and hydroxychloroquine use for COVID-19 infection treatment based on the evidence the science has today

Coronavirus Disease-19 and Cardiovascular Disease

 We are facing serious coronavirus disease-19 pandemic, caused by the severe acute respiratory syndrome coronavirus-2. Among infected individuals, there is a higher prevalence of the cardiovascular disease, which leads to their poor prognosis. Myocardial injury is present in more than 15% of critical ill patients in the form of acute myocardial dysfunction or subsequent myocardial injury that develops as disease severity. This new virus pandemic is a global challenge for health-care system which was we still have much to learn

Prevalence of risk factors and asymptomatic carotid atherosclerosis in diabetic patients screened for silent myocardial ischemia by SPECT myocardial imaging

BACKGROUND: The aim of the study was to evaluate whether there is any association between myocardial ischemia, common risk factors and carotid artery ultrasound parameters in asymptomatic type 2 diabetic (DMT2) patients. MATERIAL AND METHODS: 60 asymptomatic DMT2 patients (pts) without known coronary artery disease (CAD) underwent one day rest Dypiridamole stress Tc-99m sestamibi single photon emission computed tomography myocardial perfusion scintigraphy (MPS). We used 17 segment models for perfusion analysis with the assessment of perfusion scores. Patients were studied for age, sex, hypertension, hyperlipidemia, hs-CRP, smoking, obesity and family history of cardiac disease. Color Ultrasound examination of carotid arteries was performed in all patients. RESULTS: 51 patients (pts) had hypertension, 48 pts had hyperlipidemia, 15 were smokers, 6 pts had BMI > 30 kg/m2 and 26 patients had positive family history for CAD. 18 (31%) patients had myocardial ischemia. Mild ischemia was found in 6 pts, moderate in 7 patients and severe ischemia in 5 patients. Carotid IMT was increased in 34 pts and 15 pts had carotid plaques. Mean c-IMT value in patients with normal MPS results was 0.7 ± 0.1; in moderate ischemia 0.9 ± 0.1 and in pts severe ischemia 1.0 ± 0.2. Multivariate analysis showed obesity, low HDL and increased diastolic blood pressure predictors of increased c-IMT. Increased pulse pressure (PP), age and non-HDL cholesterol were predictors for presence of carotid plaques. Multivariable analysis for prediction of stress induced ischemia showed OR 2.9 (95% CI 2.1−5.1) for male gender, OR 3.1 for systolic blood pressure (95% CI 1.9–3.8) and OR 2.8 for LDL cholesterol (95% CI 1.7−3.6). CONCLUSIONS: Our study has shown high prevalence of traditional risk factors and silent myocardial ischemia in type 2 diabetic patients, with the importance of SPECT imaging in selected diabetes type 2 patients. The study highlights the importance of screening for carotid atherosclerosis, which may be useful to identify diabetic patients at higher risk for coronary artery disease..

Histological Characteristics of Bruises with Different Age

BACKGROUND: In forensics bruises as injuries take an important part in the interpretation of the causes of death. Since activating the inflammatory response of the body in their formation, histological analysis of the bruised tissue can provide data on the determination the time when the injury occurred.AIM: The aim of this study is to compare the histological features of 1-day and 5-days old bruises.MATERIAL AND METHODS: Bruised human skin samples, 1-day old in group A and 5-day-old in group B, obtained at autopsy from individuals who died from a violent death, were analyzed in this study. The qualitative microscopic analysis was performed on serial paraffin sections of tissues stained with Hematoxylin-eosin and Pearls Prussian Blue method, using a light microscope connected to a digital camera.RESULTS: Qualitative histological analysis of the studied group A  presented with fresh bruises, less than 24 hours old, showed ruptured smaller vessels and extravasated red blood cells in the connective tissue of the skin, with subsequent expansion and infiltration of fibrous septa of the skin. In the area of bleeding an initial infiltration by macrophages was observed. In the studied group B, presented with bruises 3-7 days old, histological analysis showed a marked presence of hemosiderin-laden macrophages and presence of hematoidin granules in the area of bleeding, as well as ruptured small blood vessels and red blood cells extravasation in the dilated fibrous septa.CONCLUSION: A detailed analysis of tissue changes in bruises every day from the initiation until their recovery, a detailed description of the histological finding can be given, which will be supported in the precise determination of the age of the injuries themselves

Евалуација на квалитетот на ејакулат кај младите мажи во Република Северна Македонија

Research data show that in the last 50 years (1938-1991) there has been a trend of decreasing sperm concentration in the male population in Europe by 2.3% and in the USA by 0.8%. The reasons for such negative trend are not known, but it is assumed that lifestyle and environmental factors have an influence on genetic factors. Aim of this study was to evaluate sperm quality in young, healthy men in our country, and to compare sperm quality in our population with others in the world. Material and methods: Ejaculates from 203 healthy male subjects, aged 18-32, were stored in a thermostat at 36⁰C and analyzed manually on a native slide and hematoxylin-eosin-stained slides, under a phase contrast microscope. Sperm motility was assessed at two-time intervals, group A, 60 minutes after ejaculation and group B, 120 minutes after ejaculation, while sperm concentration and sperm morphology were assessed at one time interval. Results: Semen analysis showed an average volume of ejaculate 3.45 ± 1.5 ml, sperm concentration in 1 milliliter62.4 ± 39.2 x10(6) /ml, while total sperm concentration was 211.2 ± 173.2 x10(6). In group A, values for progressive spermatozoa were 48.6 ± 18.1 x10(6) /ml and in group B, values for progressive spermatozoa were 47.9 ± 17.3 x10(6) /ml. There was no statistically significant difference between the two time intervals (group A and group B) when interpreting sperm motility, p>0.005. Analysis of morphology of spermatozoa showed a mean value of 6.9% for morphologically normal spermatozoa. Conclusion: The quality of ejaculate in young men in North Macedonia is in the range of reference values according to WHO, and also our results are similar to those from Germany, Turkey, Bulgaria, Faroe Islands.Истражувачките податоци покажуваат дека во последните 50 години (1938-1991) постои тренд на намалување на концентрацијата на сперматозоиди кај машката популација во Европа за 2,3% и во САД за 0,8%. Причините за ваквиот негативен тренд не се познати, но се претпоставува дека начинот на живот и факторите на околината имааt влијаниe врз генетските фактори. Целта на оваа студија беше да се оцени квалитетот на ејакулатот кај млади, здрави мажи во нашата земја, за да можеме да го споредиме квалитетот на ејакулатот кај нашата популација со другите популации во светот. Материјал и методи: Ејакулите од 203 здрави машки испитаници, на возраст од 18-32 години, беа складирани во термостат на 36⁰C и рачно анализирани на нативен препарати препарати обоени со хематоксилин/еозин, под фазно-контрастен микроскоп. Подвижноста на сперматозоидите беше проценета во два временски интервала, група А, 60 минути по ејакулацијата и група Б, 120 минути по ејакулацијата, додека концентрацијата и морфологијата на сперматозоиди беа анализирани во еден временски интервал.  Резултати: Анализата на ејакулатите покажа просечен волумен на ејакулатот 3,45 ± 1,5 ml, концентрација на сперматозоиди во 1 милитар 62,4 ± 39,2 x10 (6) / ml, додека вкупната концентрација на сперматозоиди беше 211,2 ± 173,2 x10 (6). Во групата А, вредностите за прогресивни сперматозоиди беа 48,6 ± 18,1 x10 (6) /ml, во групата Б, вредностите за прогресивни сперматозоиди беа 47,9 ± 17,3 x10 (6) /ml. Немаше статистички значајна разлика помеѓу двата временски интервала (група А и група Б) при интерпретација на подвижноста на сперматозоидите, p>0,005. Анализата на морфологијата на сперматозоидите покажа вредност од 6,9% за присуство на морфолошки нормални сперматозоиди. Заклучок: Квалитетот на ејакулатот кај младите мажи во Северна Македонија е во опсегот на референтните вредности според СЗО. Нашите резултати се слични на оние од Германија, Турција, Бугарија, Фарските Острови

Post-COVID-19 plućna embolija i Takotsubo kardiomiopatija koja se prikazala kao infarkt miokarda s neopstruktivnim koronarnim arterijama – prikaz slučaja

SUMMARY Venous thromboembolism (VTE) remains a major diagnostic and treatment challenge in COVID-19 patients. Early diagnosis is essential, since anticoagulant treatment determines patient outcomes. Pulmonary embolism is a frequent complication of COVID-19 infection that has important prognostic implications. Over 60% of PE episodes occur during the first 90 days after the discharge, where properly selected thromboprophylaxis is prognostically essential. Recurrent embolisms and fatal outcomes can be prevented with timely diagnosis and treatment. Takotsubo cardiomyopathy is one the causes of myocardial infarction with non-obstructive coronary arteries with generally good prognosis. We present a case of high-risk PE in a post-COVID-19 infection patient additionally complicated by Takotsubo cardiomyopathy.Venska tromboembolija (VTE) i dalje je veliki dijagnostički i terapijski izazov u bolesnika s bolešću COVID-19. Rano je postavljanje dijagnoze ključno jer primjena antikoagulantne terapije određuje ishode. Plućna embolija (PE) česta je komplikacija infekcije virusom uzročnikom bolesti COVID-19 te ima važne implikacije za prognozu bolesti. Više od 60 % epizoda PE-a događa se u prvih 90 dana nakon otpusta iz bolnice, pri čemu je pravilno izabrana tromboprofilaksa od ključne važnosti za prognozu. Opetovane pojave embolije i smrtni ishodi mogu se spriječiti pravodobnom dijagnozom i liječenjem. Takotsubo kardiomiopatija jedan je od uzroka infarkta miokarda s neopstruktivnim koronarnim arterijama, a prognoza je najčešće dobra. Predstavljamo slučaj visokorizične PE u post-COVID-19 bolesnice, dodatno zakomplicirane pojavom Takotsubo kardiomiopatije

2019 ESC/EAS guidelines for the management of dyslipidaemias : Lipid modification to reduce cardiovascular risk

Correction: Volume: 292 Pages: 160-162 DOI: 10.1016/j.atherosclerosis.2019.11.020 Published: JAN 2020Peer reviewe

COVID-19 and Cardiovascular Disease: Mechanisms and Implications

We are living and fighting serious COVID-19 pandemic, which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Cardiovascular diseases are highly prevalent in the infected individuals, which modifies their treatment and prognosis. The injury of the myocardium is reported in over 15% of hospitalized severely ill patients, mostly presented in the form of acute heart failure, acute coronary syndrome, cardiac arrythmias, myocarditis and thromboembolic complications. All these complications may appear at early in the course of the disease, during the disease progress or in the later stage of the COVID-19 disease. Thromboembolic complications accompany more severe cases, caused by excessive inflammation, platelet activation, endothelial dysfunction, and stasis. This new virus pandemic is a global challenge for health care system where we still have much to learn

Prognostic Value Of Normal Myocardial Perfusion Imaging In Asymptomatic Diabetic Patients With Moderate And High Calcium Scores

The purpose of this study was to evaluate the intermediate prognostic value of normal myocardial perfusion imaging (MPI) in asymptomatic diabetic patients with intermediate and high coronary artery calcium (CAC) scores. Methods: A total of 115 asymptomatic diabetic patients with no known coronary artery disease (CAD) underwent MPI after multi-slice computed tomography CAC assessment for the detection of suspected CAD. The study included 75 patients with normal MPI results. A 17-segment model for myocardial perfusion and function analysis was used. Patients were divided into three groups: I gr-20 patients with a diabetes duration between 1-5 years; II gr-24 patients with a diabetes duration 5-10 years; and III gr-31 patients with a diabetes duration >10 years. End points (cardiac death, non-fatal myocardial infarction, heart failure, new angina, revascularization) were assessed at 6, 12 and 24 months