Percutaneous mechanical thrombectomy in acute pulmonary embolism: Outcomes from a safety-net hospital.

BACKGROUND: Our study aims to present clinical outcomes of mechanical thrombectomy (MT) in a safety-net hospital. METHODS: This is a retrospective study of intermediate or high-risk pulmonary embolism (PE) patients who underwent MT between October 2020 and May 2023. The primary outcome was 30-day mortality. RESULTS: Among 61 patients (mean age 57.6 years, 47% women, 57% Black) analyzed, 12 (19.7%) were classified as high-risk PE, and 49 (80.3%) were intermediate-risk PE. Of these patients, 62.3% had Medicaid or were uninsured, 50.8% lived in a high poverty zip code. The prevalence of normotensive shock in intermediate-risk PE patients was 62%. Immediate hemodynamic improvements included 7.4 mmHg mean drop in mean pulmonary artery pressure (-21.7%, p < 0.001) and 93% had normalization of their cardiac index postprocedure. Thirty-day mortality for the entire cohort was 5% (3 patients) and 0% when restricted to the intermediate-risk group. All 3 patients who died at 30 days presented with cardiac arrest. There were no differences in short-term mortality based on race, insurance type, citizenship status, or socioeconomic status. All-cause mortality at most recent follow up was 13.1% (mean follow up time of 13.4 ± 8.5 months). CONCLUSION: We extend the findings from prior studies that MT demonstrates a favorable safety profile with immediate improvement in hemodynamics and a low 30-day mortality in patients with acute PE, holding true even with relatively higher risk and more vulnerable population within a safety-net hospital.

Developmental Assessment in Neonatal Hypernatremic Dehydration Cohort at 18-30 months of Age Using DASII Score.

Developmental assessment of neonatal hypernatremic dehydration cohort was done at 18-30 mo of age using Developmental Assessment Scale for Indian Infants (DASII) score in relation to brain lesions detected on brain imaging. Long-term follow-up evaluations were performed in 45 out of initial cohort of neonatal hypernatremic dehydration and compared with 45 controls with normal sodium levels. Seven percent of infants in the study group had a delay in development at 24 mo of age. The severity of hypernatremia was strongly correlated with poor developmental outcome at 24 mo (p = 0.001). Abnormal magnetic resonance imaging patterns strongly correlated with poor developmental outcome at 24 mo (p = 0.001). Brain was found to be particularly vulnerable to the effects of hypernatremic dehydration in neonates with brain imaging showing brain changes which presented with developmental delay on follow-up. Motor score was found to be more severely affected than mental facet using DASII score.

The risk vs. benefit calculus of anticoagulation in patients with ibrutinib-related atrial fibrillation.

For ibrutinib-related atrial fibrillation (IRAF), guidelines for anticoagulation do not exist. We sought to describe stroke, bleeding, and anticoagulation rates among patients with IRAF. We performed a single-center retrospective review of 168 patients treated with ibrutinib followed from 2013 to 2022. Over a median follow-up of 6.4 years, 44 (26.0%) patients developed IRAF of which 38 (86.4%) had a CHA2DS2-VASc ≥2 and 7 (15.9%) had a HAS-BLED ≥3. Anticoagulation was initiated in 20 (45.5%) without a clear pattern in scores, risk factors, or cumulative dose, besides having another reason for anticoagulation. Few patients with IRAF developed non-hemorrhagic CVA (n = 3, 6.8%) or significant bleeding (n = 3, 6.8%). Among those with each adverse outcome, 2 in each group were anticoagulated and all were older than 65 years old. In conclusion, decisions for anticoagulation vary widely and patients who are elderly or with HTN may be most at risk for CVA or significant bleed.

Anomalous right coronary artery originating from the opposite sinus of Valsalva: Fractional flow reserve and intravascular ultrasound-guided management.

There remains significant controversy in the risk stratification and management of patients with anomalous right coronary artery originating from the opposite sinus (R-ACAOS). We present the case of a patient with an inferior ST-elevation myocardial infarction, found to have R-ACAOS and severe atherosclerotic right coronary artery disease, treated with fractional flow reserve and intravascular ultrasound-guided percutaneous coronary intervention.

Development of a PNA-DiSc2 based portable absorbance platform for the detection of pathogen nucleic acids.

We report the development of a portable absorption (PortAbs)-based pathogen nucleic acid detection system using peptide nucleic acid (PNA) and a cyanine dye, DiSc2(5). When the dye binds to the PNA-DNA hybrid, it results in a characteristic ∼110 nm shift in the dye absorbance, which we measure using PortAbs. The protocol involves amplification of the target DNA, PNA-DNA hybridization and dye complexing steps followed by absorption measurement. The system is built using a broad-spectrum photodiode whose output is amplified and then measured by a high resolution (24 or 32 bit) analog-to-digital converter. The excitation pulses of light are delivered by a color-changing LED. The sequence of excitation, measurement and display of results are all controlled by an embedded Raspberry-Pi board (or alternatively a laptop). At higher concentrations of the target amplicon (∼200 ng), the color change can be detected visually. At lower concentrations, PortAbs outperforms a plate reader and can detect target DNA as low as 30 ng or approximately 10 nM which is at least 10 fold better than previously reported studies. We validate the methodology using SARS-CoV-2 clinical samples containing about 1000 copies of the viral RNA and show that the entire workflow takes about 90 min. The cost of the complete standalone system is less than INR 40 000 (approx. 500 USD).

What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis.

Despite billions of dollars invested into Sexual and Reproductive Health and Rights (SRHR) efforts, the effect of incorporating sexual pleasure, a key driver of why people have sex, in sexual health interventions is currently unclear. We carried out a systematic review and meta-analysis following PRISMA guidelines across 7 databases for relevant articles published between 1 January 2005-1 June, 2020. We included 33 unique interventions in our systematic review. Eight interventions reporting condom use outcomes were meta-analyzed together with a method random effects model. Quality appraisal was carried out through the Cochrane Collaborations' RoB2 tool. This study was pre-registered on Prospero (ID: CRD42020201822). We identified 33 unique interventions (18886 participants at baseline) that incorporate pleasure. All included interventions targeted HIV/STI risk reduction, none occurred in the context of pregnancy prevention or family planning. We find that the majority of interventions targeted populations that authors classified as high-risk. We were able to meta-analyze 8 studies (6634 participants at baseline) reporting condom use as an outcome and found an overall moderate, positive, and significant effect of Cohen's d = 0·37 (95% CI 0·20-0·54, p < 0·001; I2 = 48%; τ2 = 0·043, p = 0·06). Incorporating sexual pleasure within SRHR interventions can improve sexual health outcomes. Our meta-analysis provides evidence about the positive impact of pleasure-incorporating interventions on condom use which has direct implications for reductions in HIV and STIs. Qualitatively, we find evidence that pleasure can have positive effects across different informational and knowledge-based attitudes as well. Future work is needed to further elucidate the impacts of pleasure within SRHR and across different outcomes and populations. Taking all the available evidence into account, we recommend that agencies responsible for sexual and reproductive health consider incorporating sexual pleasure considerations within their programming.

Efficacy and safety of diuretics in heart failure with preserved ejection fraction: a scoping review.

OBJECTIVE: Diuretics reduce congestion in patients with heart failure with preserved ejection fraction (HFpEF). However, comparison of clinical effects across diuretic classes or combinations of diuretics in patients with HFpEF are not well described. Therefore, we sought to conduct a scoping review to map trial data of diuretic efficacy and safety in patients with HFpEF. REVIEW METHODS AND RESULTS: We searched multiple bibliometric databases for published literature and ClinicalTrials.gov, and hand searched unpublished studies comparing different classes of diuretics to usual care or placebo in patients with HFpEF. We included randomised controlled trials or quasi-experimental studies. Two authors independently screened and extracted key data using a structured form. We identified 13 published studies on diuretics in HFpEF, with 1 evaluating thiazide use, 7 on mineralocorticoid receptor antagonists (MRAs) and 5 on sodium-glucose co-transporter 2 inhibitors (SGLT2i). There remain 17 ongoing trials evaluating loop diuretics (n=1), MRAs (n=5), SGLT2i (n=10) and a polydiuretic (n=1), including 2 well-powered trials of SGLT2i that will be completed in 2021. CONCLUSIONS: The limited number of published trials evaluating different classes of diuretics in patients with HFpEF have been generally small and short term. Ongoing and emerging trials of single or combination diuretics with greater power will be useful to better define their safety and efficacy. SCOPING REVIEW REGISTRATION: doi:10.18131/g3-dejv-tm77.

Utilizing left atrial strain to identify patients at risk for atrial fibrillation on ibrutinib.

BACKGROUND: Ibrutinib is associated with atrial fibrillation (AF), though echocardiographic predictors of AF have not been studied in this population. We sought to determine whether left atrial (LA) strain on transthoracic echocardiography could identify patients at risk for developing ibrutinib-related atrial fibrillation (IRAF). METHODS: We performed a retrospective review of 66 patients who had an echocardiogram prior to ibrutinib treatment. LA strain was measured with TOMTEC Imaging Systems, obtaining peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) on 4-chamber and 2-chamber views. Statistical analysis was performed with chi-square analysis, t test, or binomial regression analysis, with a P-value < .05 considered statistically significant. RESULTS: Twenty-two patients developed IRAF (33%). Age at initiation of ibrutinib was significantly associated with IRAF (65.1 years vs 74.1 years, P = .002). Mean ibrutinib dose was lower among patients who developed IRAF (388.2 ± 121.7 vs 448.6 ± 88.4, P = .025). E/e' was significantly higher among patients who developed IRAF (11.5 vs 9.3, P = .04). PALS was significantly lower in patients who developed AF (30.3% vs 36.3%, P = .01). On multivariate regression analysis, age, PALS, and PACS were significantly associated with IRAF. On multivariate regression analysis, only PACS remained significantly associated with IRAF while accounting for age. CONCLUSIONS: Age, ibrutinib dose, E/e', and PALS on pre-treatment echocardiogram were significantly associated with development of IRAF. On multivariate regression analyses, age, PALS, and PACS remained significantly associated with IRAF. Impaired LA mechanics add to the assessment of patients at risk for IRAF.

'I tell them that sex is sweet at the right time' - A qualitative review of 'pleasure gaps and opportunities' in sexuality education programmes in Ghana and Kenya.

Pleasure is a key motivator for sex globally, while unsafe sex is the largest risk factor for young women's mortality and the second for young men. However, framing of sex education and sexual health programmes continues to be around avoiding danger, death and disease, rather than striving for pleasurable, satisfying, and safe sexual experiences. Omission of pleasure and sex-positivity goes against growing evidence that shows that people with more positive views of sexuality are more likely to practice safer sex, use contraception consistently, have higher sexual self-esteem and be more assertive.The Pleasure Project and Rutgers, with GH SRHR Alliance (Ghana) and SRHR Alliance (Kenya), conducted a qualitative pilot study of sexuality education under the Get Up Speak Out programme, analysing the extent to which they included sex-positive content, with recommendations to enhance sex-positivity. Data were collected through interviews with facilitators, focus group discussions with learners, observation of sessions, and curricula content analysis. Findings reveal possibilities of sex-positivity in restrictive contexts, illustrating ways for sexuality education to become more sex-positive and pleasure inclusive. This study enables the development of a new tool for a 'pleasure audit', with markers of high-quality, sex-positive and pleasure-inclusive sexuality education or sexual health programmes.

How to Navigate a Blindspot: Pleasure in Sexual and Reproductive Health and Rights Programming and Research.

Objectives: Despite billions of dollars in funding spent each year on sexual and reproductive health and rights (SRHR) and HIV programming, sexual pleasure is insufficiently addressed. This paper therefore has three key aims: (1) to introduce the concept of sexual pleasure in SRHR programming, while providing context regarding investment and research, (2) to introduce and situate an upcoming systematic review and meta-analysis to quantify whether and to what extent incorporating sexual pleasure into SRHR interventions can improve health outcomes, and (3) to examine the key practical, methodological, and theoretical challenges in carrying out such a review. Methods: We undertook a literature review and analysis of conference abstract publications to highlight the 'pleasure gap' in evidence in sexual and reproductive health and rights programming and research. We detailed the scope, search strategy and challenges for our subsequent systematic review. Results: This paper and the subsequent review highlights the need to equip the SRHR and HIV fields to better meet the needs of communities by considering key reasons people have sex, and understand the challenges of undertaking a review of this nature. Conclusions: We conclude that this a focus on pleasure is particularly pertinent in the context of the Sustainable Development Goals and the ratification of the declaration on sexual pleasure at the 2021 World Congress of the World Association for Sexual Health.

Microporous Drug Delivery System for Sustained Anti-VEGF Delivery to the Eye.

Purpose: To describe a novel microporous drug delivery system (DDS) for sustained anti- vascular endothelial growth factor (VEGF) delivery to the eye and to evaluate its efficacy in a corneal injury model. Methods: A macro-porous DDS (1.5 × 1.5 × 4 mm) loaded with 2 mg of bevacizumab was implanted subconjunctivally in three Dutch-belted pigmented rabbits after corneal alkali injury (2N NaOH). Three rabbits received sham DDS. Animals were followed for three months and assessed in vivo and ex vivo for corneal neovascularization (NV), epithelial defect, stromal scarring, endothelial cell loss, and expression of angiogenic and inflammatory markers in the cornea and retina. Results: Anti-VEGF DDS treatment led to complete inhibition of superior cornea NV and complete corneal re-epithelialization by day 58 whereas sham DDS resulted in severe cornea NV and persistent epithelial defect (9%∼12% of total cornea area) through the end of the study. Histologically, anti-VEGF DDS significantly reduced CD45+ and F4/80 CD11b+ cell accumulation (79%, P < 0.05) in the cornea, ameliorated tumor necrosis factor-α expression (90%, P < 0.05), reduced corneal stromal scarring and prevented corneal endothelial cell loss, as compared to sham DDS. Moreover, anti-VEGF DDS achieved retinal penetration and reduction in retinal VEGF levels at 3 months. Conclusions: Use of subconjunctival anti-VEGF DDS suppresses cornea NV, inflammation, stromal scarring, prevents endothelial cell loss, and abrogates retinal VEGF upregulation in a rabbit corneal alkali burn model. Moreover, it delivers anti-VEGF antibodies to the retina for three months. This delivery platform could enable antibody therapy of other corneal and retinal vascular pathologies. Translational Relevance: We describe a method for sustained anti-VEGF delivery to the eye for the treatment of ocular injuries.

The Diagnostic and Prognostic Value of Echocardiographic Strain.

Importance: Myocardial deformation or strain by speckle-tracking echocardiography (STE) has become an established echocardiographic modality for the diagnostic and prognostic evaluation of cardiac dysfunction. Current literature supports the incremental value of strain in diagnosis, risk stratification, and prognostication of a multitude of cardiac disease states. Observations: Strain has been studied across the clinical spectrum from common to obscure pathologic conditions. This review presents the current literature evaluating characteristic strain patterns across this clinical spectrum, discusses prognostic implications, and provides a case series of classic strain polar maps, which are also known as bull's-eye plots. Conclusions and Relevance: Characteristic bull's-eye patterns can be used to guide patient evaluation and management.