Background: In this systematic review and meta-analysis, we aimed to explore the association between cardiac injury and mortality, the need for intensive care unit (ICU) care, acute respiratory distress syndrome (ARDS), and severe coronavirus disease 2019 (COVID-19) in patients with COVID-19 pneumonia. Methods: We performed a comprehensive literature search from several databases. Definition of cardiac injury follows that of the included studies, which includes highly sensitive cardiac troponin I (hs-cTnl) N99th percentile.The primary outcome was mortality, and the secondary outcomes were ARDS, the need for ICU care, and severe COVID-19. ARDS and severe COVID-19 were defined per the World Health Organization (WHO) interim guidance of severe acute respiratory infection (SARI) of COVID-19. Results: There were a total of 2389 patients from 13 studies. This meta-analysis showed that cardiac injury was associated with higher mortality (RR 7.95 [5.12, 12.34], p b 0.001; I 2 : 65%). Cardiac injury was associated with higher need for ICU care (RR 7.94 [1.51, 41.78], p = 0.01; I 2 : 79%), and severe COVID-19 (RR 13.81 [5.52, 34.52], p b 0.001; I 2 : 0%). The cardiac injury was not significant for increased risk of ARDS (RR 2.57 [0.96, 6.85], p = 0.06; I 2 : 84%). The level of hs-cTnI was higher in patients with primary + secondary outcome (mean difference 10.38 pg/mL [4.44, 16.32], p = 0.002; I 2 : 0%). Conclusion: Cardiac injury is associated with mortality, need for ICU care, and severity of disease in patients with COVID-19.

Background and objective Coronavirus disease 2019 (COVID-19) survivors face societal stigma. The study aims to analyze the association of this stigma with the mental health and quality of life of COVID-19 survivors. Methods In this cross-sectional study, we observed 547 adults who were previously documented as severe acute respiratory syndrome coronavirus (SARS-CoV-2) positive by a polymerase chain reaction (PCR) test, treated in a hospital or an emergency hospital and proven to be SARS-CoV-2 negative by their latest PCR test. We adopted the Berger HIV Stigma Scale to measure stigma; the World Health Organization Quality of Life Brief Form to measure quality of life; and the Mental Health Inventory-38 to measure mental health. The chi-square and binary logistic regression tests were used to find the correlation between the variables. Results The multivariate analysis revealed that medium stigma was more likely related to quality of life and mental health than low stigma. Females were less likely to experience stigma related to mental health than men, and respondents who worked as laborers and entrepreneurs were less likely to experience stigma related to mental health than those who worked as civil workers/army personnel/teachers/lecturers. COVID-19 survivors experienced medium stigma in society and lower quality of life and mental health status. We found that quality of life and mental health were affected by stigma, sex, and occupation. Conclusion COVID-19 survivors are a vulnerable group that is most at risk when they return to their communities. Creating a safe environment and providing respectful care, including addressing complex stigma factors, is vital for developing appropriate interventions.

Background Several studies have reported that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can directly infect endothelial cells, and endothelial dysfunction is often found in severe cases of coronavirus disease 2019 (COVID-19). To better understand the prognostic values of endothelial dysfunction in COVID-19-associated coagulopathy, we conducted a systematic review and meta-analysis to assess biomarkers of endothelial cells in patients with COVID-19. Methods A literature search was conducted on online databases for observational studies evaluating biomarkers of endothelial dysfunction and composite poor outcomes in COVID-19 patients. Results A total of 1187 patients from 17 studies were included in this analysis . The estimated pooled means for von Willebrand Factor (VWF) antigen levels in COVID-19 patients was higher compared to healthy control (306.42 [95% confidence interval (CI) 291.37–321.48], p < 0.001; I 2 :86%), with the highest VWF antigen levels was found in deceased COVID-19 patients (448.57 [95% CI 407.20–489.93], p < 0.001; I 2 :0%). Meta-analysis showed that higher plasma levels of VWF antigen, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 antigen (PAI-1) antigen, and soluble thrombomodulin (sTM) were associated with composite poor outcome in COVID-19 patients ([standardized mean difference (SMD) 0.74 [0.33–1.16], p < 0.001; I 2 :80.4%], [SMD 0.55 [0.19–0.92], p = 0.003; I 2 :6.4%], [SMD 0.33 [0.04–0.62], p = 0.025; I 2 :7.9%], and [SMD 0.55 [0.10–0.99], p = 0.015; I 2 :23.6%], respectively). Conclusion The estimated pooled means show increased levels of VWF antigen in COVID-19 patients. Several biomarkers of endothelial dysfunction, including VFW antigen, t-PA, PAI-1, and sTM, are significantly associated with increased composite poor outcomes in patients with COVID-19. PROSPERO registration number CRD42021228821. What is known about this topic? The coronavirus disease 2019 (COVID-19) often manifests as cardiovascular complications such as myocarditis, myocardial injuries, arrhythmias, and venous thromboembolism events. Recent evidence suggests that increased inflammatory cytokines, including interleukin-6 in patients with severe and critical COVID-19, are lower compared to patients with sepsis and ARDS not associated with COVID-19, thus questioning the role of a cytokine storm in COVID-19-related multiple organ damage. Several studies have reported that the SARS-CoV-2 can directly infect en...

Background Electrocardiogram (ECG) is a widely accessible diagnostic tool that can easily be obtained on admission and can reduce excessive contact with coronavirus disease 2019 (COVID‐19) patients. A systematic review and meta‐analysis were performed to evaluate the latest evidence on the association of ECG on admission and the poor outcomes in COVID‐19. Methods A literature search was conducted on online databases for observational studies evaluating ECG parameters and composite poor outcomes comprising ICU admission, severe illness, and mortality in COVID‐19 patients. Results A total of 2,539 patients from seven studies were included in this analysis. Pooled analysis showed that a longer corrected QT (QTc) interval and more frequent prolonged QTc interval were associated with composite poor outcome ([WMD 6.04 [2.62‐9.45], P = .001; I2:0%] and [RR 1.89 [1.52‐2.36], P < .001; I2:17%], respectively). Patients with poor outcome had a longer QRS duration and a faster heart rate compared with patients with good outcome ([WMD 2.03 [0.20‐3.87], P = .030; I2:46.1%] and [WMD 5.96 [0.96‐10.95], P = .019; I2:55.9%], respectively). The incidence of left bundle branch block (LBBB), premature atrial contraction (PAC), and premature ventricular contraction (PVC) were higher in patients with poor outcome ([RR 2.55 [1.19‐5.47], P = .016; I2:65.9%]; [RR 1.94 [1.32‐2.86], P = .001; I2:62.8%]; and [RR 1.84 [1.075‐3.17], P = .026; I2:70.6%], respectively). T‐wave inversion and ST‐depression were more frequent in patients with poor outcome ([RR 1.68 [1.31‐2.15], P < .001; I2:14.3%] and [RR 1.61 [1.31‐2.00], P < .001; I2:49.5%], respectively). Conclusion Most ECG abnormalities on admission are significantly associated with an increased composite poor outcome in patients with COVID‐19.

Introduction. Nigella sativa is a commonly used traditional medicine which has been shown to have antioxidant properties. However, its supplementation in patients of clinical trials showed conflicting results. Materials and Method. Relevant articles were searched through PubMed/Medline, SCOPUS, and Google Scholar databases using “Nigella sativa” or “black seed” or “black caraway” or “thymoquinone” and “oxidative stress” or “antioxidant” and “clinical trial” keywords. Randomized, placebo-controlled human interventions using Nigella sativa were included in this study. The methodological quality of studies was assessed using Jadad’s quality scales. Results. Five studies using 293 subjects met the inclusion criteria. The overall quality of all included trials was determined based on the low risk of bias and the high quality of reported information (Jadad score ≥ 3). Meta-analysis of 293 eligible subjects showed that treatment with Nigella sativa improved the superoxide dismutase (SOD) level (48.18; 95% CI 30.29 to 66.08; p<0.01), but there was no significant effect on the malondialdehyde (MDA) level (−5.32; 95% CI −1.19 to 0.128; p=0.114) and total antioxidant capacity (TAC) level (0.219; 95% CI −0.136 to 0.573; p = 0.227). Conclusion. This meta-analysis suggests that Nigella sativa supplementation in humans may benefit as an antioxidant by increasing SOD levels but has no significant effect on the MDA level and TAC level.

BACKGROUND:Distinguishing between Acute Coronary Syndrom (ACS) and SCAD (Stable Coronary Artery Disease) requires advanced laboratory instrument and electrocardiogram. However, their availabilities in primary care settings in developing countries are limited. Hematologic changes usually occur in the ACS patient and might be valuable to distinguish ACS from SCAD.AIM:This study compares the hematologic indices between ACS and SCAD patients and analyses its predictive value for ACS.MATERIAL AND METHODS:A total of 191 patients (79 ACS and 112 SCAD) were enrolled in this study based on the inclusion criteria. Patient’s characteristic, hematologic indices on admission, and the final diagnosis were obtained from medical records. Statistical analyses were done using SPSS 23.0.RESULTS:In this research MCHC value (33.40 vs. 32.80 g/dL; p < 0.05); WBC (11.16 vs. 7.40 x109/L; p < 0.001); NLR (6.29 vs. 2.18; p < 0.001); and PLR (173.88 vs 122.46; p < 0.001) were significantly higher in ACS compared to SCAD patients. While MPV (6.40 vs. 10.00 fL; p < 0.001) was significantly lower in ACS patients. ROC curve analysis showed MPV had the highest AUC (95%) for ACS diagnosis with an optimum cut-off point at ≤ 8.35 fL (sensitivity 93.6% and specificity 97.3%).CONCLUSION:There was a significant difference between hematologic indices between ACS and SCAD patients. MPV is the best indices to distinguish ACS.

Introduction: Xpert MTB/RIF is a rapid diagnostic instrument for pulmonary tuberculosis (TB). However, studies reported varied accuracy of Xpert MTB/RIF in detecting Mycobacterium tuberculosis in pericardial effusion. Methods: We performed a systematic review of literature in PubMed, published up to February 1, 2020, according to PRISMA guidelines. We screened cross-sectional studies, observational cohort studies, and randomized control trials that evaluated the accuracy of Xpert MTB/RIF in diagnosing TB pericarditis. Papers with noninterpretable results of sensitivity and specificity, non-English articles, and unpublished studies were excluded. The primary outcomes were the sensitivity and specificity of Xpert MTB/RIF. We conducted a quality assessment using QUADAS-2 to evaluate the quality of the studies. A bivariate model pooled the overall sensitivity, specificity, positive likelihood ratios (PLRs), and negative likelihood ratios (NLRs) of included studies. Results: In total, 581 subjects from nine studies were analyzed in this meta-analysis. Our pooled analysis showed that the overall sensitivity, specificity, PLRs and NLRs of included studies were 0.676 (95% CI: 0.580–0.759), 0.994 (95% CI: 0.919–1.000), 110.11 (95% CI: 7.65–1584.57) and 0.326 (95% CI: 0.246–0.433), respectively. Conclusions: Xpert MTB/RIF had a robust specificity but unsatisfactory sensitivity in diagnosing TB pericarditis. These findings indicated that although positive Xpert MTB/RIF test results might be valuable in swiftly distinguishing the diagnosis of TB pericarditis, negative test results might not be able to rule out TB pericarditis. Registration: PROSPERO CRD42020167480 28/04/2020

MATERIAL AND METHODS Allicin and Vitamin C preparation Garlic extract contains Allicin (ChemFaces ®) 98% was dissolved in dimethyl sulphoxide (DMSO). Vitamin C powder (Sigma Aldrich, USA) was dissolved in double-distilled water and diluted with culture medium to acquire the dose of 250 mcg/mL. Sample criteria The blood sample was acquired from eight CAD patients in Dr Soetomo General Hospital who fulfilled the inclusion criteria, which are: male, aged ABSTRACT Endothelial Progenitor Cells (EPCs) have an important role in endothelial dysfunction repairment through neovasculogenesis and cardiac myocytes regeneration. However, EPCs migration is greatly reduced in the patient with Coronary Artery Disease (CAD). Allicin and Vitamin C are hypothesized to improve EPCs migration due to its antioxidant properties. Objective: To investigate the effect of Allicin and its combination with Vitamin C in EPCs migration of CAD patients. Material and Method: Mononuclear cells were isolated from CAD patients and cultured on fibronectin-coated plates with colony-forming unit Hill medium. The cells were divided into untreated (control), Allicin treatment (dose 100 mcg/ml, 200 mcg/ml, 400 mcg/ ml), and each dose of Allicin combined with 250 mcg/mL of Vitamin C. EPCs migration was assessed with Transwell Migration Assay Kit and evaluated by using statistical tests. Results: This research shows that EPC migration was significantly higher in the treatment. Allicin at all dose (dose 100 mcg/ml, 200 mcg/ml, 400 mcg/ml) and its combination with 250 mcg/mL of vitamin C compared to untreated group (p<0.05). Allicin increase EPCs migration in a dosedependent manner. However, the only combination of 400 mcg/ml Allicin with 250 mcg/mL of vitamin C which has significantly higher EPCs migration compared to Allicin treatment alone. Conclusion: Allicin improves EPCs migration in a dose-dependent manner. Improvement of the migration only observed on the Allicin dose 400 mcg/ml with Vitamin C.