Sociodemographic determinants of gender disparity in primary percutaneous coronary intervention in Pakistan.

OBJECTIVES: This study aims to contribute to the body of literature on gender disparities after acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS: We identified all adult patients who had AMI between January 2017, and December 2022 and were in follow-up at our institute. We collected data on PPCI, revascularization strategy, sociodemographic characteristics, and in-hospital complications in the years following the procedure. RESULTS: A total of 5,872 patients who underwent PCI for AMI were included in the study, out of which 2,058 (35%) were women and 3,814 (65%) were men. Regarding the timing of PCI, female patients had a significantly longer median door-to-balloon time compared to male patients (136 minutes vs 108 minutes, P-value = 0.006). Female patients had a significantly higher rate of in-hospital mortality compared to male patients (5.5% vs 1.2%, P-value = 0.011). Multivariate logistic regression analysis showed that female gender, older age, and lower household income were independent predictors of longer door-to-balloon time. CONCLUSION: This study highlights gender disparities in PPCI in Pakistan, with female patients facing longer door-to-balloon times and higher in-hospital mortality rates. The findings suggest the need for targeted interventions to improve the access and quality of care for female patients with AMI.

Co-occurrence of familial Mediterranean fever with systemic lupus erythematosus in South Asian population.

BACKGROUND AND OBJECTIVE: Familial Mediterranean fever (FMF) and systemic lupus erythematosus (SLE) are autosomal recessive auto-inflammatory diseases, triggered by FMF-associated gene mutations and auto-antigens. The literature on the co-occurrence of these two disorders is limited to case reports and their correlation is considered rare. We investigated the proportion of FMF among SLE patients when compared with a healthy adult cohort in South Asia. METHODS: For this observational study, data from our institutional database were collected for the patients diagnosed with SLE. The control group was randomly selected from the database and were age- matched for SLE. The overall proportion of FMF among patients with and without SLE was considered. Student's t-test, Chi-square, and ANOVA were used for univariate analysis. RESULTS: The study population included 3623 SLE patients and 14,492 controls. In the SLE group, there was a significantly higher proportion of FMF patients compared with the non-SLE group (1.29% vs. 0.79% respectively; p=0.015). SLE was prevalent in Pashtun's (50%) in the middle socioeconomic group while FMF was dominant in Punjabi's and Sindhi's (53%) in the low socioeconomic class. CONCLUSION: This investigation demonstrates that FMF is more prevalent in a South-Asian population cohort of SLE patients.

Social Determinants of Clinical Visits After Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting.

This study aims to investigate the social determinants of clinical visits after LM-PCI versus CABG and their impact on post-treatment care and outcomes. We identified all adult patients who underwent LM-PCI or CABG between January 1, 2015, and December 31, 2022, and were in follow-up at our institute. We collected data on clinical visits, including outpatient visits, emergency department visits, and hospitalizations, in the years following the procedure. The study included 3816 patients, of which 1220 underwent LM-PCI and 2596 underwent CABG. The majority of patients were Punjabi (55.8%), males (71.8%), and had low socioeconomic status (69.2%). The strongest predictors of having a follow-up visit were age (OR (95%CI): 1.41 (0.87-2.35); P value = 0.03), female gender (OR (95%CI): 2.16 (1.58-4.21); P value = 0.07), LM-PCI (OR (95%CI): 2.32 (0.94-3.64); P-value = 0.01), government entitlement (OR (95%CI): 0.67 (0.15-0.84); P value = 0.16), high SYNTAX (OR (95%CI): 1.07 (0.83-2.58); P value = 0.02), 3-vessel disease (OR (95%CI): 1.76 (1.05-2.95); P value <0.01), and peripheral arterial disease (OR (95%CI): 1.52 (0.91-2.45); P value = 0.01). Hospitalizations, outpatient, and emergency visits were more in the LM-PCI cohort as compared to CABG. In conclusion, the social determinants of health, including ethnicity, employment, and socioeconomic status were associated with differences in clinical follow-up visits after LM-PCI and CABG.

Co-occurrence of familial Mediterranean fever with systemic lupus erythematosus in South Asian population / Coocurrencia de fiebre mediterránea familiar con lupus eritematoso sistémico en la población del sudeste asiático

Background and objective: Familial Mediterranean fever (FMF) and systemic lupus erythematosus (SLE) are autosomal recessive auto-inflammatory diseases, triggered by FMF-associated gene mutations and auto-antigens. The literature on the co-occurrence of these two disorders is limited to case reports and their correlation is considered rare. We investigated the proportion of FMF among SLE patients when compared with a healthy adult cohort in South Asia. Methods: For this observational study, data from our institutional database were collected for the patients diagnosed with SLE. The control group was randomly selected from the database and were age- matched for SLE. The overall proportion of FMF among patients with and without SLE was considered. Student's t-test, Chi-square, and ANOVA were used for univariate analysis. Results: The study population included 3623 SLE patients and 14,492 controls. In the SLE group, there was a significantly higher proportion of FMF patients compared with the non-SLE group (1.29% vs. 0.79% respectively; p=0.015). SLE was prevalent in Pashtun's (50%) in the middle socioeconomic group while FMF was dominant in Punjabi's and Sindhi's (53%) in the low socioeconomic class. Conclusion: This investigation demonstrates that FMF is more prevalent in a South-Asian population cohort of SLE patients.(AU)

Antecedentes y objetivo: La fiebre mediterránea familiar (FMF) y el lupus eritematoso sistémico (LES) son enfermedades autoinflamatorias autosómicas recesivas, desencadenadas por mutaciones genéticas asociadas a la FMF y autoantígenos. La literatura sobre la coexistencia de estos dos trastornos se limita a informes de casos y su correlación se considera rara. Investigamos la proporción de FMF entre pacientes con LES en comparación con una cohorte de adultos sanos en el sudeste asiático. Métodos: Para este estudio observacional se recolectaron datos de nuestra base de datos institucional para los pacientes diagnosticados con LES. El grupo control se seleccionó al azar de la base de datos y se emparejaron por edad y sexo para LES. Se consideró la proporción global de FMF entre pacientes con y sin LES. Se utilizaron la prueba t de Student, χ2 y ANOVA para el análisis univariado. Resultados: La población de estudio incluyó a 3.623 pacientes con LES y 14.492 controles. En el grupo de LES, hubo una proporción significativamente mayor de pacientes con FMF en comparación con el grupo sin LES (1,29 vs. 0,79%, respectivamente; p=0,015). LES prevaleció en la región pastún (50%) en el grupo socioeconómico medio, mientras que FMF fue dominante en Punyab y Sind (53%) en la clase socioeconómica baja. Conclusión: Esta investigación demuestra que la FMF es más frecuente en una cohorte de pacientes con LES del sudeste asiático.(AU)

Tricuspid regurgitation in His bundle pacing: A systematic review.

OBJECTIVE: This systematic review aimed to explore an association of new TR and its quantification in patients undergoing His bundle pacing (HBP). METHODS: A literature review was conducted using Mesh terms (His bundle pacing, tricuspid regurgitation, tricuspid valve incompetence, etc.) in PubMed, EMBASE, Web of science CINAHL, and the Cochrane Library till October 2021. Relevant studies evaluating tricuspid regurgitation in HBP were included and information regarding TR and its related factors (ejection fraction (EF) and New York Heart Association (NYHA) class) were retrieved from the eligible studies. RESULTS: Out of 196 articles, 10 studies met the inclusion criteria, which consisted of 546 patients with HBP. The mean age of the patients ranged between 61.2 ± 12.3 and 75.1 ± 7.9 years with 54.1% males. The overall implant success rate was 79.2%. Only one study reported a 5% incidence of TR, while 9 studies reported no new TR after HBP. Four studies reported overall decrease in TR by 1 grade and 3 studies demonstrated increased TR from baseline. Two studies showed no change from baseline TR. CONCLUSION: HBP causes improvement in TR grade after HBP for cardiac resynchronization therapy (CRT) as well as atrioventricular block (AVB). Further studies in the form of randomized controlled trials are required to further evaluate the effect of HBP on tricuspid valve functioning.

Heat, Heatwaves and Cardiorespiratory Hospital Admissions in Helsinki, Finland.

Background: There is a lack of knowledge concerning the effects of ambient heat exposure on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summertime temperature and heatwaves with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. Methods: Time series models adjusted for potential confounders, such as air pollution, were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions during summer months of 2001-2017. Daily number of hospitalizations was obtained from the national hospital discharge register and weather information from the Finnish Meteorological Institute. Results: Increased daily temperature was associated with a decreased risk of total respiratory hospital admissions and asthma. Heatwave days were associated with 20.5% (95% CI: 6.9, 35.9) increased risk of pneumonia admissions and during long or intense heatwaves also with total respiratory admissions in the oldest age group (≥75 years). There were also suggestive positive associations between heatwave days and admissions due to myocardial infarction and cerebrovascular diseases. In contrast, risk of arrhythmia admissions decreased 20.8% (95% CI: 8.0, 31.8) during heatwaves. Conclusions: Heatwaves, rather than single hot days, are a health threat affecting morbidity even in a Northern climate.

An in vitro assessment of anti-SARS-CoV-2 activity of oral preparations of iodine complexes (RENESSANS)

Since the emergence of CoVID-19 pandemic in China in late 2019, scientists are striving hard to explore non-toxic, viable anti-SARS-CoV-2 compounds or medicines. We determined In Vitro anti-SARS-CoV-2 activity of oral formulations (syrup and capsule) of an Iodine-complex (Renessans). A monolayer of vero cells were exposed to SARS-CoV-2 in the presence and absence of different concentrations (equivalent to 50, 05 and 0.5 g/ml of I2) of Renessans. Anti-SARS-CoV-2 activity of each of the formulation was assessed in the form of cell survival, SARS-CoV-2-specific cytopathic effect (CPE) and genome quantization. With varying concentrations of syrup and capsule, a varying rate of inhibition of CPE, cells survival and virus replication was observed. Compared to 0.5 g/ml concentration of Renessans syrup, 5 and 50 g/ml showed comparable results where there was a 100% cell survival, no CPEs and a negligible viral replication ({Delta}CT= 0.11 and 0.13, respectively). This study indicates that Renessans, containing iodine, may have potential activity against SARS-CoV-2 which needs to be further investigated in human clinical trials.

Prevalence of and factors associated with under-5 mortality in South Asia.

BACKGROUND: This study investigated the prevalence of and the factors associated with under-5 mortality across five South Asian countries. METHODS: Cross-sectional pooled data from 1999 through 2014 collected from the Demographic and Health Survey (DHS) in five South Asian countries (Bangladesh, India, Maldives, Nepal and Pakistan) were used. Associations of under-5 mortality with sociodemographic characteristics and maternal and child factors were studied using the Cox proportional-hazard method. The estimates were presented as hazard ratios (HR) and their 95% CIs. Kaplan-Meier survival curves were used to describe time-to-event of under-5 survival patterns. RESULTS: Overall, 15-year prevalence of under-5 mortality in South Asian countries was 10%, with Nepal having the highest prevalence (11.1%) and the Maldives the lowest (5%). In a multivariable model in pooled data, older age of mother (HR 0.70, 95% CI 0.68-0.72), being employed (HR 1.09, 95% CI 1.07-1.12), having a higher level of education (HR 0.36, 95%, CI 0.32-0.40) and having a husband with higher level of education (HR 0.74, 95% CI 0.70-0.78) were significantly associated with under-5 mortality. Factors associated with under-5 mortality were mostly common across countries. CONCLUSION: The prevalence of under-5 mortality is still high in South Asia. Most of the studied sociodemographic factors were associated with under-5 mortality and were common across South Asian countries.