Impact of chronic thrombocytopenia on healthcare resource utilization, in-hospital outcomes, and costs following percutaneous coronary intervention of chronic total occlusion: a nationwide propensity weighted analysis.

BACKGROUND: Data on the impact of chronic thrombocytopenia (CT) on outcomes following chronic total occlusion (CTO) percutaneous coronary interventions (PCI) is limited. Most studies are case reports and focused on postprocedural thrombocytopenia. The purpose of this present study is to assess the impact of CT (> one year) on health resource utilization (HRU), in-hospital outcomes, and cost following CTO PCI. METHODS: We used discharge data from the 2016-2018 National Inpatient Sample and propensity score-weighted approach to examine the association between CT and HRU among patients undergoing CTO PCI. HRU was measured as a binary indicator defined as a length of stay greater than seven days and/or discharge to a non-home setting. The cost was measured as total charges standardized to 2018 dollars. Both outcomes were assessed using generalized linear models adjusted for survey year, and baseline characteristics. RESULTS: Relative to its absence, the presence of CT following CTO PCI was associated with a 4.8% increased probability of high HRU (Population Average Treatment Effect (PATE) estimate = 0.048; 95% Confidence Interval (CI) = 0.041-0.055; P<0.001) and approximately $18,000 more in total hospital charges (PATE estimate = +$18,297.98; 95% CI = $15,101.33-$21,494.63, P<0.001). CONCLUSION: Among chronic total occlusion patients undergoing percutaneous coronary intervention, those with chronic thrombocytopenia had higher resource use, including total hospital charges, and worse in-hospital outcomes when compared with those without chronic thrombocytopenia.

Comparative Healthcare Resource Utilization of Percutaneous Mechanical Circulatory Support Using Impella Versus Intra-aortic Balloon Pump Use for Patients With Acute Coronary Syndrome and Cardiogenic Shock Undergoing Percutaneous Coronary Interventions: Insights From National Inpatient Sample.

The use of percutaneous mechanical circulatory support (MCS) devices, including Impella and Intra-aortic balloon pump (IABP), in patients with cardiogenic shock has increased in recent times. We aimed to evaluate the impact of the choice of an MCS device on healthcare resource utilization. We queried the National Inpatient Sample registry between October 2016 and December 2018 to identify adults admitted for acute coronary syndrome-related cardiogenic shock and who received percutaneous coronary intervention (PCI). The study population was segregated into Impella and IABP groups using ICD 10 diagnosis codes. The primary endpoint was high healthcare resource utilization (HRU), while secondary outcomes included periprocedural complications. Propensity scoring matching was used to determine which patients in the Impella cohort had similar health to IABP patients. During the study period, 439,610 patients were admitted who received hemodynamic support using, Impella or IABP on account of acute coronary syndrome complicated by cardiogenic shock (CS). The median age (years) of the Impella cohort and IABP cohorts were similar (64.1 vs 65.1, P = 0.08). Gender distribution of the Impella CS patients was like IABP patients with female majorities in both groups, (71.9% vs 67.9%, P = 0.05). Impella CS patients had a higher representation of those with hypertension (P = 0.002), smoking (P = 0.040), obesity (P = 0.034), diabetes mellitus (P = 0.009), CHF (P = 0.030), COPD (P = 0.034), chronic liver disease (P = 0.028), and chronic kidney disease (P = 0.031). 1:1 Propensity score matching identified 2620 Impella patients' comparable severity index with the IABP patients. Patients with hemodynamic support using Impella had higher healthcare resource utilization, (HRU), the surrogate of length of stay (LOS) ≥7 or nonhome disposition at discharge, when compared with those with IABP (57.41% vs 42.76%, P < 0.0001). Impella CS patients had higher in-hospital mortality as compared to the IABP patients (55.45% vs 45.86%, P < 0.0001). Impella CS patients developed more periprocedural complications, including vascular injury (4.8% vs 1.4%, P < 0.0001), acute kidney injury (58.36% vs 41.64%, P < 0.0001), end-stage renal disease requiring dialysis (8.75% vs 1.25%, P = 0.002) when compared to the IABP patients. Among patients with ACS undergoing PCI and receiving MCS devices, those receiving Impella demonstrated higher healthcare resource utilization, higher LOS ≥7 days, and more nonhome disposition at discharge compared to patients receiving IABP. Further investigation is warranted to elucidate factors associated with these findings.

Inclisiran: A First-in-Class siRNA Therapy for Lowering Low-Density Lipoprotein Cholesterol.

OBJECTIVE: To review the current pharmacology, pharmacokinetics/pharmacodynamics, safety, and efficacy of inclisiran in lowering lipid levels. DATA SOURCES: A PubMed (from December 1, 2014 to April 15, 2022) and ClinicalTrials.gov search was conducted using ALN-PCSsc, ALN-60212, PCSK9si KJX-839, and inclisiran. Additional articles were identified by hand from references. STUDY SELECTION AND DATA EXTRACTION: We included English-language articles evaluating inclisiran pharmacology, efficacy, or safety in humans for lowering low-density lipoprotein cholesterol (LDL-C). DATA SYNTHESIS: Inclisiran is a novel small interfering RNA-based therapy administered as a twice-yearly subcutaneous injection. By binding to the messenger RNA (mRNA) precursor of proprotein convertase subtilisin/kexin type 9 (PCSK9), inclisiran inhibits expression of the PCSK9 gene, resulting in increased recycling and expression of LDL receptors and decreased levels of LDL-C. Like PCSK9 inhibitors, inclisiran was associated with a comparable extent of LDL-C reduction in several phase II/III trials. Compared with placebo, inclisiran was found to have similar adverse events except for injection-site reaction. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Currently, inclisiran lacks data on clinical outcome improvement or long-term safety. However, it may play a role in patients with atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk equivalent if optimal LDL-C cannot be achieved by statins and PCSK9 inhibitors cannot be tolerated. The drug may be used for heterozygous familial hypercholesterolemia. CONCLUSION: Inclisiran is an effective and safe medication for lowering LDL-C levels. Additional data regarding efficacy on cardiovascular outcomes and long-term safety profile with inclisiran are needed.

Post-Discharge Initiation of Angiotensin Receptor-Neprilysin Inhibitor in an Inotrope-Dependent Patient in the Outpatient Setting: A Case Report.

Purpose: Angiotensin receptor-neprilysin inhibitor (ARNI) therapy has been reported to be initiated in patients on vasoactive medications during acute decompensated heart failure. However, there is no report regarding the safety of initiating ARNI therapy in patients receiving inotrope infusion in an outpatient setting. Summary: We described a case of initiating post-discharge ARNI therapy in a 41-year-old man with inotrope-dependent heart failure in an outpatient setting. Two weeks after the initiation of low dose sacubitril/valsartan, milrinone was successfully discontinued without any adverse effects. Conclusion: With close monitoring, ARNI therapy could be safely initiated in hemodynamically stable patients receiving intravenous inotrope, and further investigation is needed to confirm our findings.

Chemical polarization effects of electromagnetic field radiation from the novel 5G network deployment at ultra high frequency.

The wide-spectrum of non-ionizing, non-visible radiation emitted from the novel 5G network deployment was investigated and found liable to produce effects capable of heating up and altering human body nomenclature. The Ultra-high frequency magnetic fields, induced circulation of currents in the surrounding human body when potentially exposed. The quantum of these electromagnetic charges is influenced by the magnitude of the external magnetic field. The Magnetic fields warming is the major organic consequence of the electromagnetic fields radiofrequency radiation emitted from 5G network installation especially at a very high frequencies. From the current research, the levels of electromagnetic fields to which individuals are naturally unmasked under 4G network and 5G network technology in SCENARIO1, SCENARIO 2 and SCENARIO 3 are very negligible to alter human body dipolar chemistry. On the several findings of the research, deploying 5G network technology under the ultra-high frequency above 20 GHz will produce effect that will heat up the human body tissues due to electromagnetic field inducement since human body is dipolar in nature. The research established that while the current digital society will continue investment into 5G network technology, caution must be applied not to deploy 5G network under ultra-high frequency above 20 GHz due to its adverse health effects.

Applications of the Multisensor HeartLogic Heart Failure Monitoring Algorithm During the COVID-19 Global Pandemic.

In the COVID-19 era, the heart failure community has witnessed an unprecedented reduction in heart failure-related patient visits and hospitalizations. Social distancing measures present a dilemma for patients with heart failure who require frequent surveillance of volume status and vital signs to minimize heart failure-related symptoms and hospitalizations. With the rise of telemedicine comes an increased focus on remote monitoring technologies. This report describes use of a multisensor device algorithm in implantable cardioverter defibrillator devices by Boston Scientific, called HeartLogic. We present 2 cases of patients with advanced heart failure who were actively surveilled by the HeartLogic device algorithm to guide care. (Level of Difficulty: Beginner.).

Photocatalytic degradation of local dyeing wastewater by iodine-phosphorus co-doped tungsten trioxide nanocomposites under natural sunlight irradiation.

In the present work, one-step green synthesis of WO3 based on the interaction of ammonium paratungstate and Spondias mombin leaves extract is reported. Different concentrations of iodine and phosphorus in the range of (2%, 5% and 10%) were firstly incorporated into the prepared WO3 nanoparticles to obtain Iodine doped and Phosphorus doped WO3 nanoparticles respectively. Subsequently, iodine and phosphorus co-doped WO3 nanocomposites was prepared using a wet impregnation method followed by calcination at high temperature. The nanomaterials were characterized by HRSEM, HRTEM, BET, UV-Visible, EDS, XRD and XPS. The photo-oxidation of dyeing wastewater by the synthesized WO3 nanomaterials were tested and assessed using Total organic carbon (TOC) and Chemical oxygen demand (COD) as indicator parameters. XRD and HRSEM analysis demonstrated the formation of only monoclinic phase of WO3 irrespective of the dopants. The UV-Visible diffuse reflectance spectroscopy showed the band gap energy of 2.61 eV for undoped WO3 and 2.02 eV for I-P co-doped WO3 nanocomposites. The surface area of I-P co-doped WO3 (416.18 m2/g) was higher than the undoped WO3 (352.49 m2/g). The XPS demonstrated interstitial and substitution of oxygen (O2-) vacancies in WO3 by I- and P3+ and formed I-P-WO(3-x). The I-P co-doped WO3 exhibited higher catalytic activities (93.4% TOC, 95.1% COD) than the undoped (54.9% TOC, 79.2% COD) due to the synergistic effects between the two dopants. The experimental data better fitted to pseudo-second order than first order and pseudo-first order model. This study demonstrated the enhanced photocatalytic performance of I-P co-doped WO3 nanocomposites under sunlight.

The influence of maternal anthropometric characteristics on the birth size of term singleton South-East Nigerian newborn infants.

OBJECTIVE: This study examined the usefulness of maternal anthropometry in predicting the birth size of term singleton newborn infants at NAUTH, Nnewi, Nigeria. MATERIALS AND METHODS: A cross-sectional study was conducted among 301 mother/newborn infant pairs. RESULTS: The mean birth weight was 3.27 ± 0.60 kg whereas the incidence of low birth weight and fetal macrosomia were 8.0% and 11.3%, respectively. The anthropometric indices varied in their ability to detect newborn babies who experienced abnormal intrauterine growth. The rate of subnormal intrauterine growth was 9.0%, 11.6%m and 18.6% using weight-for-gestational age (GA), ponderal index (PI), and mid-arm circumference (MAC)/occipito-frontal circumference (OFC) criteria, respectively. On the other hand, the rate of excessive intrauterine growth was 16.6% and 12.0% using weight-for-GA and PI criteria, respectively. Apart from maternal height, all the assessed maternal anthropometric parameters had a significant relationship with size at birth. Mothers of newborn infants who experienced subnormal intrauterine growth were more likely to have MAC < 25 cm, intrapartum weight < 65 kg, intrapartum BMI < 25 kg/m2, and rate of third trimester weight gain < 250 g/week. On the other hand, mothers of newborn infants who experienced excessive intrauterine growth were more likely to have MAC > 30 cm, intrapartum BMI ≥ 30 kg/m2, and rate of third trimester weight gain ≥ 500 g/week. Conclusion/Recommendation: Maternal anthropometry is a very useful tool in identifying mothers at risk of having newborn infants who experienced abnormal intrauterine growth. Therefore, its routine application is recommended to enable such mothers benefit from interventions targeted at ensuring optimal intrauterine growth and improved pregnancy outcomes.

Data on coronary artery calcium score performance and cardiovascular risk reclassification across gender and ethnicities.

The current guidelines recommend the new risk score, Atherosclerotic Cardiovascular Disease score (ASCVD), to assess an individual׳s risk of future cardiovascular disease (CVD) events. No data exist on the predictive utility of ASCVD score with the incremental value of coronary artery calcium scoring (CACS) across ethnicities and gender. Multi-Ethnic Study of Atherosclerosis (MESA) is a population based study (n=6814) of White (38%), Black (28%), Chinese (22%) and Hispanic (12%) subjects, aged 45-84 years, free from clinical cardiovascular disease. We performed a post-hoc analysis of 6742 participants (mean age 62, 53% female) from the MESA cohort. We evaluated the predictive accuracy for the ASCVD score for each participant in accord with the American College of Cardiology/American Heart Association guidelines using pooled cohort equations. Similar to the publication by Fudim et al. "The Metabolic Syndrome, Coronary Artery Calcium Score and Cardiovascular Risk Reclassification" [1] the analytic properties of models incorporating the ASCVD score with and without CACS were compared for cardiovascular disease CVD prediction. Here the analysis focused on ASCVD score (with and without CACS) performance across gender and ethnicities.

Lessons learnt from the management of a case of Lassa fever and follow-up of nosocomial primary contacts in Nigeria during Ebola virus disease outbreak in West Africa.

OBJECTIVE: To describe our experiences in the management of a case of Lassa fever (LF) and follow-up of nosocomial primary contacts during the 2014 Ebola outbreak in West Africa. METHODS: Clinical management of the index case and infection control/surveillance activities for primary contacts are described. Laboratory confirmation was by Lassa virus-specific reverse-transcriptase PCR. RESULTS: A 28-year-old man with a 10-day history of febrile illness was referred to a major tertiary hospital in south-east Nigeria from a city that previously experienced a LF outbreak and was recently affected by Ebola. On observation of haemorrhagic features, clinicians were at a crossroads. Diagnosis of LF was confirmed at a National Reference Centre. The patient died despite initiation of ribavirin therapy. Response activities identified 121 primary contacts comprising 78 (64.5%) hospital staff/interns, 19 (15.7%) medical students, 18 (14.9%) inpatients and 6 (5.0%) relatives. Their mean age was 32.8 ± 6.6 years, and 65.3% were women. Twenty (16.5%) had high-risk exposure and were offered ribavirin as post-exposure prophylaxis. No secondary case of LF occurred. Fatigue (43.8%) and dizziness (31.3%) were the commonest side effects of ribavirin. CONCLUSIONS: Response activities contained nosocomial spread of LF, but challenges were experienced including lack of a purpose-built isolation facility, absence of local Lassa virus laboratory capacity, failure to use appropriate protective equipment and stigmatisation of contacts. A key lesson is that the weak health systems of Africa should be comprehensively strengthened; otherwise, we might win the Ebola battle but lose the one against less virulent infections for which effective treatment exists.

Intracardiac thrombus: diagnosis, complications and management.

Intracardiac thrombus is a condition of increasing clinical significance not only because of its potential complications but also because of the lack of clinical evidence to guide clinicians in selecting optimal therapies. Thus, 2 recent cases encountered at the Vanderbilt University Medical Center illustrate the clinical challenges one may encounter in patients with intracardiac thrombus. A careful review of the diagnostic challenges, potential complications and current recommendations for management are presented.