The Impact of Severe COVID-19 on Corneal Endothelial Cells-Analysis of the In Vivo Noncontact Specular Microscopy.

PURPOSE: This study aimed to investigate the effects of severe COVID-19 infection on the corneal endothelium via in vivo specular microscopy. METHODS: This was an observational, prospective, and controlled study including 56 eyes of 56 severe COVID-19 patients, compared to after-recovery and 56 eyes of 56 age- and gender-matched healthy controls. RESULTS: Endothelial cell density was lower in the active disease period compared to healthy controls (p = .001) and decreased even more after recovery (p < .0001). After recovery, the average cell area and coefficient of variation were higher compared to the active disease period (p < .0001 and p = .008, respectively) and the healthy controls (for both, p < .0001), whereas hexagonality was lower (p < .0001). Central corneal thickness increased in the active disease period compared to after recovery (p < .0001) and healthy controls (p = .002). CONCLUSIONS: These results may be due to direct host-virus interaction or linked to immune dysregulation, subclinical corneal endotheliitis, or still yet a viral-mediated inflammation.

Retrospective analysis of the efficacy of early switching from bevacizumab to aflibercept or ranibizumab in diabetic macular edema.

PURPOSE: The study aimed to compare the anatomical and functional gains of switching to ranibizumab or aflibercept in eyes with treatment-naive diabetic macular edema (DME) which has an inadequate response to three consecutive bevacizumab injections. METHODS: This observational, retrospective, comparative study presented 12-month results of 80 patients with DME. One eye of each patient was enrolled, and bevacizumab was switched as aflibercept (40 eyes) or ranibizumab (40 eyes). DME was diagnosed based on a fundoscopic examination, fundus fluorescein angiography (FFA), central macular thickness (CMT), and best-corrected visual acuity (BCVA). RESULTS: Forty-one patients (51.2%) were male, and 39 (48.8%) were female, with a mean age of 62.3 ± 6.7 years. At the end of the study, the mean number of intravitreal injections was 8.1 ± 1.8 in the aflibercept group, whereas 8.9 ± 1.4 in the ranibizumab (p = 0.091). The mean CMT decreased from 449.2 ± 69.3 µm to 311.0 ± 48.9 µm in the aflibercept group, and from 444.9 ± 109.2 µm to 316.3 ± 54.5 µm in the ranibizumab group (for both, p < 0.0001). The mean BVCA increased from 49.2 ± 11.1 ETDRS letters to 62.5 ± 9.9 in the aflibercept group (p < 0.0001) and from 49.9 ± 12.0 ETDRS letters to 61.1 ± 9.1 in the ranibizumab group (p < 0.0001). Macular laser treatment was required in 17.5% of the aflibercept group and 22.5% of the ranibizumab group (p = 0.781). CONCLUSION: Significant improvement was observed with ranibizumab and aflibercept treatments in initial bevacizumab-resistant DME. Early switching therapy may contribute to better visual and anatomical outcomes.

Effect of chelation therapy on arrhythmogenic and basal ECG parameters of lead exposed workers.

Lead exposure has etiological role on cardiovascular system diseases as hypertension, atherosclerosis, stroke, and arrhythmic events. In this study, we aimed to compare the basal and arrhythmogenic ECG parameters of lead exposed workers before and after chelation therapy and to evaluate the effect of acute change of blood lead levels on ECG. Fourty consecutive occupationally lead exposed workers were enrolled, demographic, blood, echocardiographic, and electrocardiographic data's were analyzed before and after chelation therapy. Pmax, P min, P Wave Dispersion, and QT Dispersion values which are arrhythmia predictors were significantly lower after chelation therapy compared to values before chelation therapy. Lead exposed workers are under the risk of ventricular and atrial arrythmias and chelation treatment has a positive effect on these parameters.

Severe COVID-19 and Retina: Are There Any Retinal Manifestations?

PURPOSE: To investigate whether there are retinal lesions associated with severe COVID-19. METHODS: We studied 232 symptomatic subjects aged 18 - 65 years who had severe COVID-19 and had received treatment. The evaluations included ophthalmological examinations, optical coherence tomography (OCT), imaging modalities with near infrared reflectance (NIR), fundus autofluorescence (FAF), and fundus photography (FP). RESULTS: The mean age of the patients was 49 years, and 67.6% of them were men. There were no findings of microhemorrhage, cotton wool spots (CWS), vitritis, or retinitis in the examination and imaging. CONCLUSIONS: This study indicates that retinal involvement as a complication associated with COVID-19 is questionable, although some reports have demonstrated a relationship that may occur secondary to existing systemic diseases.

Monocyte-to-HDL-cholesterol ratio is associated with Ascending Aorta Dilatation in Patients with Bicuspid Aortic Valve.

BACKGROUND: The importance of monocyte count-to-HDL-cholesterol ratio (MHR) in cardio- vascular diseases has been shown in various studies. Ascending aortic dilatation (AAD) is a common complication in the patients with bicuspid aortic valve. In this study, we aimed to investigate the relationship between MHR and the presence of aortic dilatation in the patients with bicuspid aortic valve. METHODS: The study population included totally 347 patients with bicuspid aortic valve.169 patients with aortic dilatation (ascending aorta diameter ≥ 4.0 cm) and 178 patients with no aortic dilatation. Echocardiographic and laboratory measurement was done and compared between groups. RESULTS: The mean age of the participants was 44.7 ± 15.4 years and average ascending aorta diameter was 3.2 ± 0.3 cm in dilatation negative group and 4.4 ± 0.4 cm in positive group. MHR was significantly increased in in patients with aortic dilatation. MHR and uric acid level was independently associated with the presence of aortic dilatation in the patients with bicuspid aortic valve. CONCLUSION: We found a significant relationship between MHR and aortic dilatation in the patients with bicuspid aortic valve.

Diurnal rhythm of blood pressure in patients with polycythemia vera.

AIMS: Polycythemia vera increases the risk of hypertension, but there is limited information about the effect on daily blood pressure fluctuations. This study aimed to demonstrate how diurnal blood pressure rhythm is affected in polycythemia vera patients. METHODS: Fifty (50) patients (33 men; mean age 48 ± 15 years) with a diagnosis of polycythemia vera and 51 age and sex-matched healthy subjects for the control group were prospectively evaluated. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were evaluated by ambulatory blood pressure monitoring (ABPM) as average 24-hour, daytime and nighttime measures. RESULTS: Average 24-hour SBP and DBP, daytime SBP and DBP were similar in both groups. However, nighttime SBP and DBP were significantly higher in the polycythemia vera group compared with the control group (125.3 ± 17.2 and 73.7 ± 12.2 vs. 118.9 ± 12.2 and 69.5 ± 8.5; P = 0.034 and P = 0.044). Both nocturnal SBP fall and nocturnal DBP fall were blunted in the polycythemia vera group compared with the control group (-6.9 ± 8.9 and -11.3 ± 12.2 vs. -11.6 ± 7.7 and -16.3 ± 12.0, respectively). Both hemoglobin and hematocrit levels were positively correlated with nocturnal SBP fall (r = 0.306, P = 0.002 and r = 0.355, P < 0.001; respectively) in all patients. CONCLUSION: We found that the polycythemia vera group had significantly decreased nocturnal dipping compared with healthy controls. The SBP fall was also positively correlated with hemoglobin and hematocrit levels.

The association between cardiac resynchronization therapy response and sexual activity in patients with heart failure.

BACKGROUND: Sexual activity is an important indicator of quality of life and is significantly impaired in patients with heart failure (HF). Cardiac resynchronization therapy (CRT) has positive effects on cardiac dysfunction and endothelial dysfunction that lead to erectile dysfunction (ED). We aimed to evaluate whether CRT may improve sexual activity in patients with HF. METHODS: In total, 136 patients (mean age 61.8 ± 12.8 years) were evaluated for the study. All patients filled the Sexual Health Inventory for Men (SHIM) questionnaire for evaluation of their erectile functions before CRT device implantation. One hundred eighty days after CRT device implantation, the patients were re-evaluated with SHIM questionnaire. RESULTS: In the whole study population, SHIM test scores were significantly increased after CRT (12.99 ± 3.22 vs. 18.03 ± 5.00; p<0.001). The patients were divided into two groups according to the CRT response. The increase in SHIM test scores was significantly more in the response (+) group than in the response (-) group [response (+) group: 6.94 ± 3.36; p<0.001 vs. response (-) group: 0.81 ± 1.77; p = 0.465]. A positive CRT response was found to be an independent predictor of SHIM score (p<0.001). CONCLUSION: Our study showed that CRT had positive effects on ED of patients with HF.