An Anomalous Left Main Coronary Artery Arising From the Right Sinus of Valsalva With Anginal Chest Pain.

An anomalous coronary artery (ACA) is a congenital malformation or variation where one or both coronary arteries have an abnormal origin. This condition has been associated with a high risk of adverse cardiac events, including sudden cardiac death. Our patient initially presented nine years before the diagnosis of the ACA with anginal chest pain on exertion. The patient had positive nuclear stress with both ST depressions and ST elevations, as well as transient ischemic dilatation of 1.36. A coronary artery angiogram revealed an anomalous left coronary artery originating from the right coronary sinus. The distal anatomy was determined with coronary computed tomography angiography (CCTA), which showed an interarterial course. The patient underwent coronary artery bypass surgery following CCTA.

Efficacy and Safety of the Non-Vitamin K Antagonist Oral Anticoagulant Among Patients With Nonvalvular Atrial Fibrillation and Cancer: A Systematic Review and Network Meta-analysis.

Patients with cancer are at higher risk of atrial fibrillation (AF). Currently there are no definitive data on clinical outcomes for nonvitamin K antagonist oral anticoagulant (NOACs) and warfarin in cancer patients with AF. Therefore, we conducted a meta-analysis to evaluate the efficacy and safety of NOACs compared with warfarin. A search through Pubmed/MEDLINE, Embase, and Cochrane library was done from the databases inception to March 2022. Studies that compared NOACs to warfarin in the setting of AF and cancer were included. The primary outcomes were the incidence of major bleeding and ischemic stroke/systemic embolism (SE). Secondary outcomes were major adverse cardiovascular event (MACE), intracranial bleeding, and Major gastrointestinal bleeding. Risk ratios (RRs) with 95% confidence intervals (CI) were used to report the outcomes. A total of 11 studies were included. We found that NOACs were associated with a lower incidence of major bleeding and combined ischemic stroke/SE in patients with AF and cancer compared with warfarin (RR 0.57; 95% CI 0.44-0.75, P < 0.0001 and RR 0.59; 95% CI 0.47-0.75, P < 0.0001, respectively). Also, there was lower incidence of Intracranial and major gastrointestinal bleeding in patients who received NOACs compared with warfarin (P < 0.0001). Network analyses revealed that apixaban and dabigatran were associated with reduction of major bleeding compared with warfarin. Among patients who diagnosed with AF and cancer, NOACs were associated with lower incidence of major bleeding ischemic stroke/SE compared with warfarin. Furthermore, NOACs were associated with lower gastrointestinal and intracranial bleeding.

IV Versus Subcutaneous Enoxaparin in Critically Ill Infants and Children: Comparison of Dosing, Anticoagulation Quality, Efficacy, and Safety Outcomes.

OBJECTIVE: Subcutaneous enoxaparin is the mainstay anticoagulant in critically ill pediatric patients although it poses several challenges in this patient population. Enoxaparin infused IV over 30 minutes represents an attractive alternative, but there is limited experience with this route of administration in children. In this study, we assess dosing, anticoagulation quality, safety, and clinical efficacy of IV enoxaparin compared to subcutaneous enoxaparin in critically ill infants and children. DESIGN: Retrospective single-center study comparing dosing, anticoagulation quality, safety, and clinical efficacy of two different routes of enoxaparin administration (IV vs subcutaneous) in critically ill infants and children. Key outcome measures included dose needed to achieve target antifactor Xa levels, time required to achieve target antifactor Xa levels, proportion of patients achieving target anticoagulation levels on initial dosing, number of dose adjustments, duration spent in the target antifactor Xa range, anticoagulation-related bleeding complications, anticoagulation failure, and radiologic response to anticoagulation. SETTING: Tertiary care pediatric hospital. PATIENTS: All children admitted to the cardiac ICU, PICU, or neonatal ICU who were prescribed enoxaparin between January 2014 and March 2016 were studied. INTERVENTIONS: One hundred ten patients were identified who had received IV or subcutaneous enoxaparin and had at least one postadministration peak antifactor Xa level documented. MEASUREMENTS AND MAIN RESULTS: Of the 139 courses of enoxaparin administered, 96 were therapeutic dose courses (40 IV and 56 subcutaneous) and 43 were prophylactic dose courses (20 IV and 23 subcutaneous). Dosing, anticoagulation quality measurements, safety, and clinical efficacy were not significantly different between the two groups. CONCLUSIONS: Our study suggests that anticoagulation with IV enoxaparin infused over 30 minutes is a safe and an equally effective alternative to subcutaneous enoxaparin in critically ill infants and children.

Bioprospecting for acidophilic lipid-rich green microalgae isolated from abandoned mine site water bodies.

With fossil fuel sources in limited supply, microalgae show tremendous promise as a carbon neutral source of biofuel. Current microalgae biofuel strategies typically rely on growing high-lipid producing laboratory strains of microalgae in open raceways or closed system photobioreactors. Unfortunately, these microalgae species are found to be sensitive to environmental stresses or competition by regional strains. Contamination by invasive species can diminish productivity of commercial algal processes. A potential improvement to current strategies is to identify high-lipid producing microalgae, which thrive in selected culture conditions that reduce the risk of contamination, such as low pH. Here we report the identification of a novel high-lipid producing microalgae which can tolerate low pH growth conditions. Lig 290 is a Scenedesmus spp. isolated from a low pH waterbody (pH = 4.5) in proximity to an abandoned lignite mine in Northern Ontario, Canada. Compared to a laboratory strain of Scendesmus dimorphus, Lig 290 demonstrated robust growth rates, a strong growth profile, and high lipid production. As a consequence, Lig 290 may have potential application as a robust microalgal species for use in biofuel production.