Efficacy and safety of cangrelor as compared to ticagrelor in patients with ST-elevated myocardial infarction (STEMI): a systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis aimed to compare the efficacy and safety of cangrelor as compared to ticagrelor in patients with ST-elevated myocardial infarction (STEMI) who underwent percutaneous intervention. METHODS: PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov databases were searched for relevant head-on-comparison or swapping studies. The primary outcome was the rate of high platelet reactivity (HPR) at specific time intervals after stopping cangrelor infusion during the first 24 h. Secondary outcomes were the risks of thrombosis, all-cause mortality and bleeding. Pooled odds ratios (ORs) were calculated using random-effects models. RESULTS: A total of 1018 studies were screened and eight were included in the analysis. There were four head-on-comparison studies and four swapping studies. There was no significant difference in the proportion of patients achieving a high platelet reactivity in swapping studies [OR, 0.71 (95% CI 0.04, 13.87), p = 0.82, i2 = 88%]. In head-on-comparison studies, PRU from Fig. 2B shows there was no significant reduction in high platelet reactivity [mean difference - 77.83 (95% CI - 238.84, 83.18), p < 0.001, i2 = 100%]. PRU results from (Fig. 2C) show a mean difference of 7.38 (95% CI - 29.74, 44.51), p < 0.001, i2 = 97%. There was no significant difference in the risks of thrombosis [OR, 0.91 (95% CI 0.20, 4.13), p = 0.81, i2 = 0%], all-cause mortality [OR, 3.52 (95% CI 0.44, 27.91), p = 0.24, i2 = 26%] and bleeding [OR, 0.89 (95% CI 0.37, 2.17), p = 0.93, i2 = 0%] between the two groups as revealed in the head-on-comparison studies. CONCLUSION: The efficacy and safety profiles of cangrelor and ticagrelor were similar in patients with STEMI.

Human health risk exposure with respect to particulate-bound polycyclic aromatic hydrocarbons at mine fire-affected coal mining complex.

Particulate-bound poly-aromatic hydrocarbons (PAHs) are of great concern due to their mutagenicity and carcinogenicity effect on human health. In this context, identification, quantification and inhalation cancer risk (ICR) assessment due to PM10- and PM2.5-bound PAHs has been carried out at six monitoring stations in a critically polluted Jharia coalfield/Dhanbad City. Identification of pollution sources at study area has been performed by using PCA statistical methods. Air quality index (AQI) and air quality health index (AQHI) were calculated based on the concentration levels of PM10. Location-wise direct comparison between AQI, AQHI and ICR was performed to analyse the risk levels. Consequently, maximum concentration levels of particulate (PM2.5 and PM10)-bound total PAHs (400 and 482 ng/m3) were recorded at the monitoring station Lodna Thana, followed by Bank More and Sijua Stadium, respectively. It was also observed that mine fire-affected station Lodna Thana was exaggerated with presence of PAHs due to wood and open coal burning activities. Moreover, about 1000 and 889 cases of inhalation cancer risk were estimated due to direct exposure of PM10- and PM2.5-bound PAHs in the study area, respectively. Active mine fire-affected station Lodna Thana was recorded with maximum probability of lung tumour due to inhalation cancer risk. This study has reported higher AQHI at station Dugdha Basti, Lodna Thana and Bank More, which results increased number of tumours due to ICR. This result concludes that Jharia coalfield/Dhanbad City are not only critically polluted area but it is also an inhalation cancer prone area due to direct exposure of active mine fire.