Introduction: To reduce contacts during the COVID-19 pandemic, we elaborated a protocol for ambulatory referrals for exercise testing that included discharges from the stress test laboratory (STL). Methods and Results: From 403 patients referred for chest pain (68%) or dyspnea (32%), 219 were straight discharged from the STL (54%), without findings of coronary artery disease in 192 (88%), whereas in 120 (29.5%), further visits were recommended. Medical treatment was modified after the tests in 116 patients (29%). Conclusions: A strategy consisting of discharge from the STL for patients with negative/spurious stress test results, making therapeutic recommendations, seems feasible, effective, and overall opportune in the current situation.

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Background and Objective: Patients with schizophrenia are more prone to develop metabolic syndrome (MetS) with its related complications, including cardiovascular diseases and diabetes mellitus compared to the general population. In this study, we aim to evaluate the effect of low-carbohydrate diet on MetS Z score, weight status, and symptomatology of patients with schizophrenia in Bahrain. Materials and Methods: This single-group pretest–posttest study was executed while considering an ethical approach of volunteer participants, a sample size of 35 patients with schizophrenia. The participants were instructed to follow a low-carbohydrate moderate-fat diet for 8 weeks. Anthropometric measurements, mean arterial pressure, basal metabolic index, body fat percentage (BFP), body surface area (BSA), and MetS Z score and Clinical Global Impression (CGI) Scale were collected before and after the diet intervention. Descriptive statistics, including the mean and standard deviations, were used for continuous variables and percentages for the categorical variables. Paired t-tests and effect size were used to analyze the mean difference of the values before and after the diet intervention. Results: A statistical significance in the mean difference was observed among the following variables: MetS Z score, weight, body mass index (BMI), high-density lipoproteins (HDL), low-density lipoprotein (LDL), thrombin generation test, waist circumference (WC), BFP, BSA, and CGI-improvement (CGI-I). Weight, BMI, TG, BFP, BSA, and CGI-I had a large effect size of the mean difference, whereas LDL, HDL, and WC had a moderate effect size. There was no statistically significant difference in the MetS Z score between male and female after the diet intervention (P = 0.274). Conclusion: Dietary modification with low-carbohydrates restriction is a workable approach in the management of schizophrenia and its related metabolic complications. Clinical trials need to be conducted to corroborate the implementation of dietary intervention as a co-treatment of schizophrenia.

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We present an extreme rare case of cristal atrial tachycardia (AT) in a 23-year-old male presenting with recurrent refractory palpitation since last 1 year treated with betablocker metoprolol 50 mg twice daily. We subjected the patient for electrophysiologic study and radiofrequency ablation and A wave in the mid cristal region preceded the surface P-wave by 16 ms. Ablation here terminated the tachycardia but interestingly patient turned up with recurrent palpitation after 1 month. In view of mid cristal AT, we treated the patient with Ivabradine 5 mg twice daily after which the patient was asymptomatic in follow up. Our case is a unique demonstration of sinus node funny current inhibitor Ivabradine being effective to relieve symptoms even in failed cases of radiofrequency ablation with partial modification of mid cristal region in a case of recurrent mid cristal AT. Our take home message from this electrophysiology experience is that even in cases with partial modification of crista terminalis or failed radiofrequency ablation of Cristal atrial tachycardia Ivabradine can serve as an alternative before proceeding to 3D ablation.

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Objective: The aim of the current study was to investigate cardiovascular responses to a brief social exclusion stressor, the Cyberball task, and to determine whether individual differences in depression, anxiety, and perceived social isolation moderate physiological stress responses. Methods: Sixty-four participants engaged in the Cyberball task while heart rate, blood pressure, and respiratory rate were continuously measured. Results: Systolic (M = 121.61, SD = 13.34) and diastolic (M = 77.34, SD = 7.56) blood pressure increased significantly during the exclusion condition compared with the rest condition (M = 117.81, SD = 12.71, M = 75.63, SD = 7.39, respectively). Significant correlations were also found between social anxiety (r = −0.25) and depression (r = −0.25) scores with systolic blood pressure from the exclusion condition. Further, participants who reported high depression scores had attenuated cardiovascular responses to social exclusion. Conclusions: Overall, cardiovascular activity were elevated after a brief social stressor, but those with clinically relevant cut off scores on the CES-D had attenuated cardiovascular responses These findings support the growing body of literature surrounding cardiovascular stress reactivity to stress induced from social exclusion.

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More than 20 million human beings got infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and suffered from coronavirus disease 2019 (COVID-19) disease in the current global pandemic. This disease flow showed a heterogeneous spectrum due to various personalized underlying causes and immunogenetics makeup of an individual. Substantial evidence suggests that the severity of pneumonia, acute respiratory distress syndrome, multi-organ failures, and deaths in COVID-19 is attributable to cytokine storm. Thus, in a cytokine storm, the dysregulated immune system is triggered by superantigen of SARS-CoV-2 to release various cytokines with high speed and increased blood circulation concentrations, leading to diverse clinical manifestations of massive multi-organ destruction and death due to exuberant hyperinflammation at a local and systemic level. SARS-CoV-2 can also significantly affect the cardiovascular system of the infected persons through a systemic outburst of the cytokine storm. SARS-CoV-2 infection accompanies many cardiovascular complications that include myocardial infarction, myocarditis, microangiopathy, venous thromboembolism, and a cytokine storm burden resulting in heart failure. This narrative review attempts to gather all recent evidence by Internet-based literature search with relevant keywords related to coronavirus disease with main objective and focus on possible mechanisms of pathophysiology of troponin elevation and cardiovascular complications, with its diagnosis and recent guidelines for its management.

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Heart rate variability (HRV) can be used as an objective measure of mental health and workplace stress. Workplace stress is associated with poor performance and organizations desire optimal performance from employees. In this case study, the researcher utilizes a heart rate variability biofeedback (HRVB) tool to biologically monitor the effectiveness of aromatherapeutic breathing intervention for his client, a manager who works in an educational center in Hong Kong. The researcher presents a review of each of the four sessions he has conducted with his client. Both aromatherapeutic breathing with “earth” (ABwE) and HRVB were used during the sessions, and the client was able to shift her physiology profoundly. Results were promising, and the researcher recommends using ABwE as an important intervention and agent for change for stressful clients.

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