Antiviral activity of amiodarone in SARS-CoV-2 disease.

Amiodarone seems to exhibit some antiviral activity in the disease caused by SARS-CoV-2. Here we have examined the SARS-CoV-2 disease course in the entire population of the Czech Republic and compared it with the course of the disease in patients treated with amiodarone in two major Prague's hospitals. In the whole population of the Czech Republic SARS-CoV-2 infected 1665070 persons (15.6 %) out of 10694000 (100 %) between 1 April 2020 and 30 June 2021. In the same time period only 35 patients (3.4 %) treated with amiodarone were infected with SARS-CoV-2 virus out of 1032 patients (100 %) who received amiodarone. It appears that amiodarone can prevent SARS-CoV-2 virus infection by multiple mechanisms. In in-vitro experiments it exhibits SARS-CoV-2 virus replication inhibitions. Due to its anti-inflammatory and antioxidant properties, it may have beneficial effect on the complications caused by SARS-CoV-2 as well. Additionally, inorganic iodine released from amiodarone can be converted to hypoiodite (IO-), which has antiviral and antibacterial activity, and thus can affect the life cycle of the virus.

Levels of circulating biomarkers at rest and after exercise in coronary artery disease patients.

As traditional risk factors are unable to fully explain the pathogenesis of coronary artery disease (CAD), novel mechanisms became a target of many investigations. Our aim was to study the response of selected markers to physical exercise. High-sensitive C-reactive protein (hs-CRP), matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), advanced oxidation protein products (AOPP), soluble receptor for advanced glycation end-products (sRAGE), pregnancy-associated plasma protein A (PAPP-A), E-selectin, vascular endothelial growth factor (VEGF) and B-type natriuretic peptide (BNP) levels were measured in serum of 21 CAD patients and in 22 healthy controls at rest and after exercise bicycle stress test performed up to the maximal tolerated effort. At rest, hs-CRP, AOPP, MMP-9 and BNP were significantly elevated in the CAD patients as compared with controls. In contrast, P-selectin was significantly lower in CAD patients and a tendency to lower levels of sRAGE was noted. After exercise MMP-9 and BNP, increased significantly in both groups. In conclusions, CAD patients have elevated hs-CRP, AOPP, MMP-9 and BNP--novel markers related to cardiovascular risk or left ventricular overload. MMP-9 and BNP increase significantly with exercise in both healthy individuals and CAD patients.

Hemodynamic response to thoracoscopy and thoracotomy.

Operations in the pleural cavity are connected with circulatory changes in pulmonary circulation and general changes of hemodynamics. These changes are influenced by the position of patient's body on the operation table and by the introduction of artificial pneumothorax. Thoracoscopy is an advanced surgical approach in thoracic surgery, but its hemodynamic effect is still not known. The aim of the present study was to compare the hemodynamic response to surgeries carried out by open (thoracotomy - TT) and closed (thoracoscopy - TS) surgical approach. Thirty-eight patients have been monitored throughout the operation--from the introduction of anesthesia to completing the surgery. Monitored parameters were systolic blood pressure (BPs), diastolic blood pressure (BPd), O2 saturation (SaO2), systolic blood pressure in pulmonary artery (BPPAs), diastolic blood pressure in pulmonary artery (BPPAd), wedge pressure (P(W)), central venous pressure in right atrium (CVP), cardiac output (CO) and total peripheral resistance (TPR). No significant difference has been found in hemodynamic response between TT and TS groups. Significant changes of hemodynamic parameters occurring during the whole surgical procedure were detected in both technical approaches. The most prominent changes were found after the position of patients was changed to the hip position (significantly decreased BPs, BPd, MAP, SaO2 and BPPAs) and 5 min after the pneumothorax was established (restoration of the cardiac output to the initial value and significant decrease of the TPR). It can be concluded that the thoracoscopy causes almost identical hemodynamic changes like the thoracotomy.

Association of the -344T/C aldosterone synthase gene variant with essential hypertension.

The aldosterone synthase gene (CYP11B2) is an important candidate gene region in essential hypertension. We therefore studied the association of -344T/C polymorphism of the CYP11B2 gene with the presence and severity of hypertension in a case-control study. We studied 369 individuals, of whom 213 were hypertensive patients (139 controlled hypertensive, 74 resistant hypertensive) and 156 were healthy normotensive subjects. The -344T/C polymorphism of the CYP11B2 gene was determined using polymerase chain reaction - restriction fragment length polymorphism analysis. The distribution of genotypes in normotensive controls and hypertensive subjects were: TT 25.6 vs. 31.9 %, TC 51.9 vs. 57.3 % and CC 22.4 vs. 10.8 %. The -344T/C variant was associated with hypertension. Subjects carrying the -344T allele had a greater risk of hypertension compared to those having C allele (chi(2)=5.89, p<0.05). The frequency of CC genotype was significantly lower in hypertensive patients than in normotensive controls (chi(2)=9.44, p<0.01). A stepwise logistic regression analysis confirmed these findings. We did not find an association of -344T/C variant with the resistance of hypertensive patients to combination therapy, but we observed an association of -344T/C polymorphism of aldosterone synthase gene with increased risk of hypertension. These results support a potential role of -344T/C CYP11B2 gene polymorphism in genetic predisposition to develop hypertension.

[Embolism of the upper mesenteric artery]. / Embolie do horní mezenterické tepny.

The article presents a case report of a 53-year-old man, who underwent abdominal surgery for the ischemic vascular necrosis of the small bowel and right colon of the embolic aetiology and who has had several serious comorbidities. Resection of the major part of the small bowel and right hemicolectomy with high jejunostomy and transversostomy was performed. Not only has the patient very well tolerated the first surgery, but he tolerated also the other one with recovery of passage continuity. The other surgery was necessary due to mycotic infection in the right atrium (vegetations at the heart pacing electrode). After 5 months the patient died because of generalisation of mycotic infection. The problem of mesenteric vascular occlusions is discussed.

Hemodynamic response to laparoscopic cholecystectomy--impacts of increased afterload and ischemic dysfunction of the left ventricle.

The authors describe the results of intra-operative hemodynamic monitoring during laparoscopic cholecystectomy in patients with ischemic left ventricular dysfunction and with significant aortic stenosis. The results in the groups composed of 13 and 12 patients were compared with the findings in 10 young, non-obese, non-smokers without significant cardiovascular history and with normal findings during resting transthoracic echocardiography. Monitoring itself was conducted using transesophageal echocardiography 1) after the induction of anesthesia, 2) after the induction of capnoperitoneum, and 3) after setting the operative anti-Trendelenburg position. The measurements were performed at least in triplicate and the results were processed using ANOVA test. Significant differences were identified in the time course patterns of heart rate, mean arterial pressure, dual product (pressure-rate-product), and cardiac output. In terms of pathophysiology, we believe that the most important achievement was the identification of different time course patterns of individual parameters in the respective groups. The results in the group of patients with aortic stenosis were based particularly on the different time course of the mean arterial pressure, while the results in patients with ischemic disease were more dependent on the time course of the heart rate. Very interesting is a drop of peripheral vascular resistance after positioning of these patients which could be explained only partially by a beta-blocking or ACEI medication. In clinical terms, the most important finding was probably that no complications occurred in the entire group of 35 patients, of which 25 suffered from severe organic cardiopathies.

How does delaying treatment affect the long-term prognosis for patients with acute myocardial infarction treated with primary coronary angioplasty?

BACKGROUND: The benefit of thrombolysis in patients with acute myocardial infarction (AMI) strongly depends on the time from the onset of symptoms to the initiation of treatment. For AMI patients treated with percutaneous coronary interventions (PCI) this delay of treatment seems to be important only up to a certain time level. AIM: To assess the effects of time to treatment of AMI with PCI on the short- and long-term prognosis. METHODS: We followed 339 consecutive AMI patients treated with PCI from 1995 to 1999 in our centre. Patients were divided into five groups according to the time to treatment and ischaemic time (time from symptom onset to reperfusion). RESULTS: Time to treatment <90 min was achieved in 35 (10.5%) patients; 91-210 min in 105 (31%); 211-330 min in 72 (21%); 331-690 min in 74 (22%); and >691 min in 53 (15.5%) patients. According to ischaemic time, the patients were divided into groups: <2 h, 2-4 h, 4-6 h, 6-12 h, and >12 h. The ejection fraction of the left ventricle 3-5 days after AMI was 50%, 51%, 45%, 40%, and 46%, and the 30 day mortality - 5.7%, 2.9%, 11.1%, 10.8%, and 11.3%, respectively. Compared with patients treated later, patients with time to treatment <3.5 h had a significantly higher rate of TIMI 3 flow (93.6% vs 83.9%, p=0.007), lower 30-day mortality (3.6% vs 11.1%, p=0.012), lower 3-year mortality (8.6% vs 19.1%, p=0.003), lower frequency of heart failure during hospitalisation (11.4% vs 28.1%, p<0.001) as well as lower maximal level of creatine kinase (32+/-29 vs 44+/-39 micro kat/l, p=0.005). CONCLUSIONS: The success rate of primary PCI to achieve normal flow in an infarct-related artery is high, but it decreases when treatment is started later than 3,5 h from AMI onset. The short-term and long-term mortality as well as the incidence of heart failure during the acute phase of MI are the lowest when PCI is started within 3,5 h from the onset of symptoms.

[Cardiac problems in patients with progressive muscular dystrophy]. / Kardiologická problematika u nemocných s progresivní svalovou dystrofií.

Progressive muscular dystrophy causes both skeletal and significant cardiological changes. Electrocardiographic and echocardiographic examinations were provided in 30 patients with muscular dystrophy (17 of them with progressive muscular dystrophy Duchenne type, 13 with skeletal muscular dystrophy). In 50% cases were found left ventricle filling disorder, in two cases echocardiographic signs of pulmonary hypertension. ECG showed in one third of cases incomplete right bundle branch block, supraventricular tachycardia was also frequently found.

[Cardiovascular stress in laparoscopic surgery]. / Kardiovaskulární zátez pri laparoskopických chirurgických výkonech.

AIM: To evaluate response of cardiovascular system in laparoscopic surgery. The main aim was: 1--comparison of healthy subjects and morbid obese population, 2--comparison of healthy subjects and cohort of patients with organic cardiopathy. Secondly we compared the influence of the operation position. PATIENTS AND METHODS: Patients (n = 17) were divided into 3 subgroups:--Control group of "normal" subjects: mean age 36.8 +/- 11.2 years; BMI 25.33 +/- 3.62; BSA 1.84 +/- 0.21 m2; two men and four women; op. diagnosis: 3x cholecystectomy, 1x appendectomy, 1x inguinal herniotomy, 1x hiatal hernia operation. --Group of patients with morbid obesity: mean age 38 +/- 8.1 years; BMI 45.82 +/- 7.54!; BSA 2.66 +/- 0.32 m2; one man and five women; all of them were operated for obesity (laparoscopic gastric banding).--Group of patients with severe cardiopathy: mean age 64.0 +/- 11.55; BMI 26.4 +/- 4.09; BSA 1.89 +/- 0.23; three men and two women; card. diagnosis: 2x aortic stenosis, 1x combined aortic valvulopathy, 1x aortic stenosis with secondary mitral regurgitation, 1x secondary mitral regurgitation (both caused by coronary artery disease); op. diagnosis: 4x cholecystectomy; 1x extraction of catheter for peritoneal dialysis. The method of our examination was transesophageal echocardiography with use of omni planar sond with continual monitoring of each patient. Our data are based on repeated measurements (3x minimal for each state and each patient) before and after peritoneal cavity insufflation and third after positioning of patient (in Trendelenburg or Fowler position). Examinations were recorded and data analysed off-line. Following parameters were analysed: mean age, BMI, BSA, heart rate, mean arterial pressure (MAP), ejection fraction of left ventricle (EF), E/A ratio of transmitral flow, cardiac output (CO), cardiac index (CI), systemic (peripheral) vascular resistance (SVR) and pressure-rate-product (PRP). For statistical analysis were used: ANOVA tests, t-tests with Benforroni correction and Friedman's tests. RESULTS AND DISCUSSION: In comparison of normal and obese patients statistically significant differences were found (after exclusion of BMI and BSA) in cardiac output values, after recalculation on body surface (cardiac index) remained only non-significant trend to fall. Differences between control group and group of cardiacs were also non significant with exclusion of E/A ratio of transmitral flow. This result we explain by pseudonormalization. All 17 operations were successfully done without any complication. CONCLUSIONS: Our data were obtained on relatively small cohort of patients but the number of patients was respected by statistics and results might be borderline but significant. Laparoscopic gastric band (operation is done in semi-sitting position) in morbid obese patients is well tolerated without any differences in comparison to healthy population. The population of patients with severe organic cardiopathy needs careful approach. Our data are favourable but significant change in the left ventricle filling together with non-significant hemodynamic disadvantageous trends in EF, CI and MAP requires care. Further investigations are needed and with intraoperative monitoring (transesophageal echocardiography is preferred) can be considered as safe.

[Multiple extrarenal complications in Wegener granulomatosis]. / Mnohocetné extrarenální komplikace Wegenerovy granulomatózy.

This is a case report of a patient with Wegener's granulomatosis (WG), who initially presented with a corneal perforation. In addition to the eye involvement, the pauciimmune necrotizing glomerulonephritis with crescent formation, E.N.T. and pulmonary involvement were diagnosed. The patient also suffered from the acute myocardial infarction, most likely due to coronal arteritis. In addition to the coronal ischaemia she also had vasculitis of the aortic valve due to the WG. Another rare complication was the massive intestinal bleeding. The patient had also a skin vasculitis and non-specific symptoms such as artralgias and fever. The correct diagnosis was supported by positive cANCA. A clinical and laboratory remission of the disease was achieved by combined immunosuppressive therapy. Subsequently, she developed a subglotic stenosis possibly due to reparative changes.

Does the laparoscopic approach significantly affect cardiac functions in laparoscopic surgery? Pilot study in non-obese and morbidly obese patients.

BACKGROUND: Laparoscopy in bariatric surgery represents a modern method generally associated with lower morbidity and mortality, compared with the traditional surgical approach. However, in patients with impaired cardiovascular function, the laparoscopic approach is limited by the potential adverse hemodynamic impact. We assessed the influence of some laparoscopic procedures on selected cardiac functions in significantly obese patients and in subjects with normal body weight, using transesophageal echocardiography (TEE). PATIENTS AND METHODS: Six subjects with normal body weight (mean BMI 25.3 +/- 3.6 kg/m2), and six patients undergoing laparoscopic gastric banding for morbid obesity (mean BMI 45.8 +/- 7.5 kg/m2) were studied. Heart rate (HR), blood pressure (BP), ejection fraction, cardiac output (CO) and transmitral flow were measured. Parameters were recorded at baseline before the operation (BL), after installation of capnoperitoneum (CP), and after positioning the patient for surgery (SP). RESULTS: Compared to BL, CP and SP were characterized by an increase in HR and BP in both groups of patients. As ejection fraction did not change significantly, the HR changes were accompanied by an increase in CO: (BL 5.8 +/- 2.2 l/min, CP 6.5 +/- 2.6 l/min, SP 6.7 +/- 2.7 l/min, p < 0.05 BL vs CP and SP). Transmitral flow parameters did not change significantly. Hemodynamic changes in subgroups with normal body build and in the obese patients were comparable. There was an increase in CO and pressure-rate product in obese individuals. CONCLUSIONS: Our results suggest that the hemodynamic response to laparoscopic surgery is characterized by an increase in CO (due to increased HR) and BP. In subjects without a manifest cardiovascular disease, neither systolic nor diastolic performance was significantly affected by the introduction of capnoperitoneum and positioning of the patient for surgery. Similar results were observed in obese and non-obese subjects. Phase II of this on-going study is focusing on impact and safety of laparoscopy in obese patients with known cardiovascular disease.

[Shock-wave lithotripsy in choledocholithiasis in a female patient with a cardiac pacemaker]. / Litotrypse rázovou vlnou pro choledocholitiázu u nemocné s kardiostimulátorem.

BACKGROUND: Extracorporeal shock wave lithotripsy is relatively contraindicated in patients with an implanted cardiac pacemaker. Shock waves can damage the pacemaker by mechanical pressure and also by electromagnetic induction. Since the distance between the applicator and the pacemaker is small during biliary lithotripsy, the risk of damaging the pacemaker is greater. In the following case, the patient presented with a stone in the common bile duct, and had an implanted pacemaker. Lithotripsy with non-synchronized shock waves was the method of choice since conventional surgery was high risk in this specific case. CASE REPORT: In an 84-year-old woman with a stone in the proximal part of the common bile duct, endoscopic attempts of extraction failed. Therefore, shock wave lithotripsy was indicated. This patient had serious heart disease with an interference of spontaneous heart action with the pacemaker at a ratio of 1:1. We decided to treat with shock wave lithotripsy. The application of shock waves was without side effects on the patient and the pacemaker. CONCLUSION: This case is interesting as it highlights the possibility of using the Czech made MEDILIT lithotriptor in the treatment of choledocholitiasis in patients with a pacemaker. Even so, it is necessary to monitor the patient's ECG to ensure the possibility of immediate external stimulation.

[Survival after accidental poisoning with a triple lethal dose of paraquat (Gramoxon)]. / Prezití po náhodné otrave trojnásobnou letální dávkou paraquatu (Gramoxon).

A case of a 22-year old man who accidentally poisoned himself with a triple lethal dose of organophosphate paraquat (commercially produced as Gramoxon). Owing to the quantity consumed and belated medical treatment, toxicologists initially considered the condition incurable but a complex therapy during a 52-day hospitalization eventually saved the patients's life. Following is an analysis of the case a treatment survey and a discussion of mechanisms that possibly led to the successful result.

[Silent myocardial ischemia in outpatients being treated for hyperlipoproteinemia]. / Nemá ischémie myokardu u pacientu ambulance pro lécbu hyperlipoproteinémií.

BACKGROUND: Hyperlipoproteinaemias, in particular those associated with hypercholesterolaemia, are in a causal relationship with the development and acceleration of atherogenesis. One of the serious forms of coronary heart disease is silent myocardial ischaemia--an asymptomatic objectively confirmed ischaemic episode. The objective of the present study was to 1. assess the prevalence of this disease in subjects with hyperlipoproteinaemia and 2. to assess the optimal diagnostic procedure to detect it. METHODS AND RESULTS: The group comprises 57 subjects selected at random (23 men and 34 women) from the out-patient department for genetics and treatment of hyperlipoproteinaemias. In all subjects an ergometric loading test was made and 24-hour ambulatory ECG monitoring. Suspected silent myocardial ischaemia (i.e. positive results of the two examinations) was confirmed by load scintigraphy of the heart muscle. Silent myocardial ischaemia was proved in 3 of 23 examined men (13%) and in 4 of 34 women (11.8%). CONCLUSIONS: Prevalence of silent myocardial ischaemia is significantly higher in high risk subjects--with hyperlipoproteinaemia than in the general asymptomatic population. The best screening test for its detection is a loading test and ambulatory ECG monitoring, supplemented by loading scintigraphy of the heart muscle.

[Amyloid light-chain amyloidosis with primary involvement of the cardiorespiratory system--2 case reports]. / AL amyloidóza s dominantním postizením kardiopulmonálního systému--dve pozorování.

The authors describe the cases of two women suffering from AL amyloidosis with affection of the heart muscle in particular. In one of the patients there were also massive amyloid deposits in the lungs which is an exceptional finding. The observations confirm the adverse prognosis of amyloidosis, the rapid progression of the disease after the onset of symptoms of cardiac failure. The first cardial manifestation in both patients were palpitations. The first patient, but not the second one, had a myeloma confirmed on necropsy.

[Comparison of the effects and safety of atenolol and nifedipine in the treatment of angina pectoris]. / Srovnání úcinku a bezpecnosti atenololu a nifedipinu v lécbe anginy pectoris.

The effects of atenolol (100 mg/day) and nifedipine (60 mg/day) on angina symptoms and exercise tolerance were compared in an open, randomized study. Twelve-week treatment period was compared with two weeks of placebo treatment in 51 patients with chronic stable angina pectoris. Mean frequency of angina attacks decreased significantly from 8.3 to 1.6 attacks per week after atenolol treatment (p < or = 0.05). Both drugs increased exercise tolerance to development of signs of ischemia on electrocardiogram (p < or = 0.05) and increased maximal exercise tolerance as well (p < or = 0.05). Mean ST segment depressions at peak exercise were significantly decreased after treatment with atenolol and nifedipine (p < or = 0.05). Both drugs also increased total exercise capacity in comparison with placebo period, stated as 100%:192% after atenolol and to 191% after nifedipine. No significant changes of heart rate and blood pressure were noted during treatment period. Twelve patients did not finished study, two of them suffered myocardial infarction with death in one of them (atenolol group, other one nifedipine group). Thus, atenolol in one daily dose is as effective as nifedipine in chronic stable angina patients when administered as single therapy.

[Noninvasive diagnosis of coronary spasm]. / Moznosti neinvazivní diagnostiky koronárních spazmu.

The objective of this work was to compare the sensitivity of non-invasive tests used for the diagnosis of variant angina pectoris (VAP). In a group of 38 patients with VAP the authors compare the sensitivity of the cold test (CT), hyperventilation test (HT), handgrip (HG), bicycle ergometry (BE) and a newly suggested combination of hyperventilation with HG and BE resp. The authors evaluated first the sensitivity of ST elevations which are an entirely specific sign and in particular denivelization of ST (by depression or elevation) which is a less specific sign. The sensitivity of different tests was as follows: CT 5% and 5% resp., HT 18% and 39% resp., HG 13% and 29% resp., BE 26% and 66% resp., HV+HG 37% and 63% resp., HV+BE 50% and 87% resp. Then the authors assessed the sensitivity of repeated examinations HV+HG 47% and evaluation during denivelization of ST 63%, HV+BE 66% and 89% resp. The authors evaluated moreover the sensitivity of ST elevations in patients according to the activity of the disease. Patients with at least five stenocardias per week had a higher sensitivity, as compared with patients with less frequent attacks: HV+HG 42% and 25% resp., HV+BE 60% and 33% resp. The highest sensitivity was found in a combination of HV+BE. Repetition of the test in case of a negative result increased markedly the sensitivity, a higher sensitivity was found also in patients with more frequent stenocardias.

[The role of beta-endorphins in silent forms of ischemic heart disease]. / Uloha beta-endorfinu u nemé formy ischemické choroby srdecní.

Silent--asymptomatic--ischaemia is one of the forms of ischaemic heart disease. Present possibilities of non-invasive diagnostics are based primarily on long-term ECG monitoring. With regards to the hypothesis that the raised algesic threshold at high level of analgetically reacting beta endorphins seems to be the pathophysiologic basis of this particular syndrome, we tried to verify the presumption by administering a beta-endorphin antagonist-naloxon. In 13 patients with a silent form of ischaemic heart disease (absence of stenocardia in objectively proved ischaemia in loading test) we made the loading test in a standard form and after administering of 2 mgs of naloxan intravenously. Owing to the fact that stenocardia developed only in one patient after endogenous opiate effect blockage we presume that pathophysiologic basis of this syndrome must be discovered elsewhere.