Incidence and Risk Factors of Intraventricular Hemorrhage in Early Preterm Infants: A Cross-Sectional Study.

BACKGROUND: Early preterm infants are susceptible to a serious disorder called intraventricular hemorrhage (IVH), which may cause severe neurological damage. OBJECTIVE: To determine the incidence of IVH in preterm infants at Lady Reading Hospital, Peshawar, Pakistan, and to identify associated risk factors and potential preventive measures. METHODOLOGY: This cross-sectional research examined the prevalence of IVH among early preterm infants and was carried out at Lady Reading Hospital in Peshawar from 1 January 2021 to 31 December 2023. After excluding individuals with congenital defects, insufficient medical records, or non-consent, the research comprised 210 newborns born before 28 weeks of gestation and diagnosed with IVH during the first 72 hours of life. Medical record reviews and in-person observations were used to gather data, with an emphasis on clinical, risk, and demographic characteristics. Using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY) with a significance threshold of p < 0.05, descriptive techniques were used in the statistical studies to summarize the features and inferential approaches, such as univariate and multivariate logistic regression, to identify IVH risk variables. RESULTS: Among the 210 early preterm newborns studied, the frequency of IVH according to severity was as follows: 79 infants (37.62%) had Grade I, 65 infants (30.95%) had Grade II, 39 infants (18.57%) had Grade III, and 27 infants (12.86%) had Grade IV. Three key demographic findings were that 63 births (30.00%) occurred before 26 weeks of gestation, 87 infants (41.43%) had birth weights of less than 1000 grams, and 111 infants (52.86%) were male. Significant predictors of IVH identified through multivariate logistic regression included birth weight less than 1000 grams (odds ratio (OR) = 3.10, 95% confidence interval (CI): 1.78-5.42, p < 0.01), gestational age less than 26 weeks (OR = 2.68, 95% CI: 1.50-4.76, p < 0.01), Apgar score ≤5 (OR = 4.01, 95% CI: 2.23-7.21, p < 0.01), resuscitation at birth (OR = 2.23, 95% CI: 1.12-4.45, p = 0.02), mechanical ventilation (OR = 3.55, 95% CI: 1.85-6.82, p < 0.01), and sepsis (OR = 2.98, 95% CI: 1.50-5.92, p = 0.02). CONCLUSION: The high incidence of IVH and its association with critical risk factors underscore the need for improved neonatal care practices and targeted interventions in early preterm infants.

Influence of Graphene Nanoplatelets and Post-Curing Conditions on the Mechanical and Viscoelastic Properties of Stereolithography 3D-Printed Nanocomposites.

This study presents an innovative approach to improving the mechanical and viscoelastic properties of 3D-printed stereolithography (SLA) nanocomposites by incorporating graphene nanoplatelets (xGNP) into photopolymer matrices. Utilizing an SLA 3D printer, photopolymer formulations with xGNP concentrations of up to 0.25 wt% were successfully produced. Post-print curing was carried out using two different methods: ultraviolet (UV) curing and high-temperature curing at 160 °C. Mechanical characterization using nanoindentation showed a significant increase in elastic modulus by 104% and an increase in hardness by 85% for nanocomposites containing 0.25 wt% xGNP. Furthermore, dynamic mechanical analysis (DMA) revealed a 39% improvement in storage modulus for samples without post-curing and an improvement of approximately 30% for samples subjected to high-temperature curing. These significant improvements highlight xGNP's potential to not only increase the performance of SLA 3D-printed components but also streamline the manufacturing process by reducing or eliminating energy-intensive post-curing steps. This innovative integration of graphene nanoplatelets paves the way for the production of high-performance, functional 3D-printed products and offers significant advances for various industries with a high impact. The results highlight the transformative role of nanomaterials in additive manufacturing and position this work at the forefront of materials science and 3D printing technology.

Asymmetric Organocatalytic Diels-Alder Reaction of Olefinic Azlactones with Unsaturated Thiazolones: Access to Spirocyclohexenone Thiazolone Skeletons.

Chiral bifunctional thiourea-catalyzed Diels-Alder reaction between olefinic azlactones and alkylidene thiazolone derivatives is reported here for the first time. The asymmetric Diels-Alder reaction delivers vicinal tertiary-quaternary stereocenters in spirocyclohexenone thiazolones in moderate to high yields and good stereochemical outcomes. The protocol can be adapted to a broad array of substrates. Moreover, the reaction is scaled up, and the chiral spirocyclohexenone thiazolone was converted into valuable spirocyclic-1,2-amidoalcohol highlighting the synthetic utility of our methodology.

GroupFormer for hyperspectral image classification through group attention.

Hyperspectral image (HSI) data has a wide range of valuable spectral information for numerous tasks. HSI data encounters challenges such as small training samples, scarcity, and redundant information. Researchers have introduced various research works to address these challenges. Convolution Neural Network (CNN) has gained significant success in the field of HSI classification. CNN's primary focus is to extract low-level features from HSI data, and it has a limited ability to detect long-range dependencies due to the confined filter size. In contrast, vision transformers exhibit great success in the HSI classification field due to the use of attention mechanisms to learn the long-range dependencies. As mentioned earlier, the primary issue with these models is that they require sufficient labeled training data. To address this challenge, we proposed a spectral-spatial feature extractor group attention transformer that consists of a multiscale feature extractor to extract low-level or shallow features. For high-level semantic feature extraction, we proposed a group attention mechanism. Our proposed model is evaluated using four publicly available HSI datasets, which are Indian Pines, Pavia University, Salinas, and the KSC dataset. Our proposed approach achieved the best classification results in terms of overall accuracy (OA), average accuracy (AA), and Kappa coefficient. As mentioned earlier, the proposed approach utilized only 5%, 1%, 1%, and 10% of the training samples from the publicly available four datasets.

Advanced federated ensemble internet of learning approach for cloud based medical healthcare monitoring system.

Medical image machines serve as a valuable tool to monitor and diagnose a variety of diseases. However, manual and centralized interpretation are both error-prone and time-consuming due to malicious attacks. Numerous diagnostic algorithms have been developed to improve precision and prevent poisoning attacks by integrating symptoms, test methods, and imaging data. But in today's digital technology world, it is necessary to have a global cloud-based diagnostic artificial intelligence model that is efficient in diagnosis and preventing poisoning attacks and might be used for multiple purposes. We propose the Healthcare Federated Ensemble Internet of Learning Cloud Doctor System (FDEIoL) model, which integrates different Internet of Things (IoT) devices to provide precise and accurate interpretation without poisoning attack problems, thereby facilitating IoT-enabled remote patient monitoring for smart healthcare systems. Furthermore, the FDEIoL system model uses a federated ensemble learning strategy to provide an automatic, up-to-date global prediction model based on input local models from the medical specialist. This assures biomedical security by safeguarding patient data and preserving the integrity of diagnostic processes. The FDEIoL system model utilizes local model feature selection to discriminate between malicious and non-malicious local models, and ensemble strategies use positive and negative samples to optimize the performance of the test dataset, enhancing its capability for remote patient monitoring. The FDEIoL system model achieved an exceptional accuracy rate of 99.24% on the Chest X-ray dataset and 99.0% on the MRI dataset of brain tumors compared to centralized models, demonstrating its ability for precision diagnosis in IoT-enabled healthcare systems.

Insight into physiological and biochemical markers against formaldehyde stress in spider plant (Chlorophytum comosum L.).

Formaldehyde is a prominent volatile organic compound and also considered as an indoor air pollutant. Chlorophytum comosum, an indoor plant, has been reported to metabolize indoor formaldehyde. But the phytotoxic effects of formaldehyde, being a pollutant, on C. comosum are not well explored. Furthermore, C. comosum responses that can be considered as markers at the physiological and biochemical level against formaldehyde stress are not yet investigated. Therefore, the current research study was aimed to evaluate such potential markers against formaldehyde in C. comosum. Briefly, C. comosum was exposed to 5-, 10-, and 20-ppm formaldehyde doses in an airtight glass chamber. Plant samples were then taken to analyze morpho-anatomical, physiological, and biochemical responses after short (2, 4, and 6 h), medium (12 and 24 h), and extended durations (48 and 96 h) for each tested dose. Application of 10 and 20 ppm formaldehyde doses leads to a significant incline in enzymatic antioxidants. Formaldehyde concentration of 10 ppm leads to a maximum increase in catalase (30.30 U/mg of protein), guaiacol peroxidase (135.64 U/mg of protein), and superoxide dismutase (44.76 U/mg of protein) compared to their respective controls. A significant change is also observed in non-enzymatic parameters, including total phenolic content, which ranged from 3.62 mg GAE/g (control) to 10.51 mg GAE/g, total antioxidants vary from 27.37% (control) to 85.05% in 20 ppm formaldehyde, respectively. However, formaldehyde application negatively affected the physiological responses of C. comosum by reducing its photosynthetic rate, transpiration rate, and stomatal conductance. Additionally, extended exposure of C. comosum to 10- and 20-ppm formaldehyde doses leads to visible leaf damage. Principal component analysis indicated that enzymatic parameters including SOD, CAT, and GPX and non-enzymatic parameters including MDA, TPC, TFC, TAOs, carotenoids, TSS, and intercellular CO2 contributed the most to the total variance. Thus, these parameters have potential to serve as physiological and biochemical markers in C. comosum against formaldehyde stress.

Diarrhea and cholera surveillance for early warning and preparedness to prevent epidemics among Rohingya Myanmar nationals in Cox's Bazar, Bangladesh.

Diarrheal diseases, especially cholera, can be a serious threat to Rohingya refugees in Cox's Bazar due to overcrowding and inadequate hygiene infrastructure. Assessing the risk, cholera surveillance network was established with the aim to identify the outbreak of diarrhea and cholera and help to take appropriate preventive measures including a vaccination campaign. The surveillance network has been ongoing for 6 years (2017-2023) in 17 health facilities. Diarrhea patients from Rohingya Myanmar nationals matched with case definition were enrolled and stool samples were tested by Rapid diagnostic test (RDT) for early cholera detection Multiple Logistic regression models were fitted to examine the associations of risk factors among cholera cases. A total of 17,252 stool samples were collected through surveillance. Among the tested samples, 588 (3.5 %) were detected positive by RDT, and 239 (1.4 %) Vibrio cholerae were isolated by microbiological culture. Between 2021 and 2023, the number of culture-confirmed cases exceeded that in the period from 2017 to 2020. In addition to V. cholerae; high positivity was identified for ETEC (11.8 %) followed by Salmonella (3.9 %) and Shigella (2.7 %). Most of the cholera cases were presented with vomiting, dehydration and loose watery and rice watery nature of stool (p value = <0.001). Major risk factors for cholera were 2-4 years age group (OR = 5.72; 95 % CI, 3.84-8.53.14; P = .001), process of water treatment (OR = 1.54; 95 % CI, 1.01-2.37; P = .046) and hand washing with soap before taking meals (OR = 0.6; 95 % CI, 0.39-0.92; P = .020. This study highlights the epidemiology of cholera among the Rohingya population and underscores the effectiveness of integrating surveillance data with early warning, alert, and response systems (EWARS) system, along with oral cholera vaccine (OCV) campaigns, in preventing major cholera outbreak.

Identification, mapping, and self-reported practice patterns of village doctors in Sitakunda subdistrict, Bangladesh.

Background: Informally trained health care providers, such as village doctors in Bangladesh, are crucial in providing health care services to the rural poor in low- and middle-income countries. Despite being one of the primary vendors of antibiotics in rural Bangladesh, village doctors often have limited knowledge about appropriate antibiotic use, leading to varied and potentially inappropriate dispensing and treatment practices. In this study, we aimed to identify, map, and survey village doctors in the Sitakunda subdistrict of Bangladesh to understand their distribution, practice characteristics, clinical behaviours, access to technologies, and use of these technologies for clinical decision-making. Methods: Using a 'snowball' sampling method, we identified and mapped 411 village doctors, with 371 agreeing to complete a structured survey. Results: The median distance between a residential household and the closest village doctor practice was 0.37 km, and over half of the practices (51.2%) were within 100 m of the major highway. Village doctors were predominately male (98.7%), with a median age of 39. After completing village doctor training, 39.4% had completed an internship, with a median of 15 years of practice experience. Village doctors reported seeing a median of 84 patients per week, including a median of five paediatric diarrhoea cases per week. They stocked a range of antibiotics, with ciprofloxacin and metronidazole being the most prescribed for diarrhoea. Most had access to phones with an internet connection and used online resources for clinical decision-making and guidance. Conclusions: The findings provide insights into the characteristics and practices of village doctors and point to the potential for internet and phone-based interventions to improve patient care and reduce inappropriate antibiotic use in this health care provider group.

Common pediatric surgical conditions and associated health-seeking behaviors in Pakistan: An urban and rural comparative assessment.

Approximately five billion people do not have access to necessary surgical treatment globally and up to 85% of children in LMICs are affected with conditions requiring surgical care by the age of 15 years. It is crucial to identify common surgical conditions in children in Pakistan to inform healthcare professionals and policymakers for effective resource allocation. This representative cross-sectional household survey conducted on children aged 5-10 years assessed existing surgical diseases and healthcare-seeking behaviors in the two largest provinces (Sindh and Punjab) of Pakistan. The data was collected through a validated cross-sectional survey tool [Surgeons OverSeas Assessment of Surgical Need (SOSAS)]. Caregivers were asked about their child's recent and past surgical conditions in six distinct anatomical regions and pictures were taken of identified conditions after appropriate consent for further diagnosis. Health-seeking behaviors including the kind of treatment sought, the nature of care received, and the reasons for not receiving care were noted. 13.5% of children surveyed reported a surgical condition, with a similar distribution across urban (13.2%) and rural (13.7) areas and the most common cause was trauma. The greatest number of surgical conditions were found to be on the head and neck region (57.7%), while the back accounted for the least number of conditions (1.7%). Our results outline a need for organizing all entities (governmental, non-governmental, and private) involved in child health to ensure efficient resource allocation to cater to existing surgical problems.

Assessing Barriers to Primary Prevention of Cardiovascular Diseases in Low and Middle-Income Countries: A Systematic Review.

The incidence of cardiovascular diseases (CVDs) in low- and middle-income countries (LMICs) has greatly increased. Previously dominated by infectious diseases, LMICs are the new epicentre of CVDs. CVD is a common problem amongst the population in the African continent; however, many countries in LMICs lack the resources to stem the rise of CVDs. A systematic review was conducted between March and July 2023 to assess barriers to the primary prevention of CVDs in studies conducted in LMICs. Online databases, such as Embase, Cochrane, Scopus, and MEDLINE, were consulted. Keywords included primary prevention, cardiovascular diseases, diabetes, weight loss, and physical fitness, all of which focused on LMICs. To enrich the literature review, efforts were made to check other listed references and more papers were retrieved. The inclusion criteria were countries in LMICs, CVD, full-text, and peer-reviewed journals. Qualitative and quantitative studies were included. Exclusion criteria included high-income countries, secondary prevention, and research unrelated to CVDs, such as barriers in oncology or mental health. A total of 1089 papers were retrieved from the search engines. After applying the exclusion criteria for LMICs, only 186 papers were retained. A further search for quality, relevance, and duplicity reduced the qualifying number to 50 papers. Further efforts to retrieve the data and examine the quality of the studies resulted in 18 final selected studies. Three categories emerged based on the type of barriers: physician barriers, patient barriers, and health system barriers. Evidently, in several LMICs, guidelines for CVD prevention were lacking, and too much emphasis was placed on secondary prevention at the expense of primary prevention, a lack of human resources, and inadequate infrastructure. Overworked healthcare providers were unable to allocate adequate time to the patients. There was no shared decision-making process. Patient barriers included lack of motivation, no symptoms, low level of education, no insurance, long physical distances to the facilities, and inadequate medication or stock out. Some of the major barriers included closing and opening hours, poor operating space, inadequate funding from the government or donors, and lack of electronic medical services. There are many barriers to accessing primary prevention services for CVDs. These barriers can be divided into patient, physician, or health system barriers. More research needs to be conducted in LMICs to address the increasing risk factors for CVDs. Greater investment is required by national governments to provide more resources. Task shifting and shared decision-making are some of the quick wins.

A Systematic Review and Meta-Analysis on the Role of Bempedoic Acid in Cardiovascular Outcomes for Patients With Statin Intolerance.

Atherosclerosis, a multifaceted pathogenic process affecting the arteries and aorta, poses a significant threat because of its potential to impede or entirely obstruct blood flow by narrowing blood vessels. This intricate progression involves various factors such as dyslipidemia, immunological responses, inflammation, and endothelial dysfunction. The initial phase manifests as the formation of fatty streaks, considered a pivotal hallmark in the inception of atherosclerotic plaques, a process that can commence as early as childhood. Over time, this process evolves, characterized by the thickening of the arterial inner layer (intima) and accumulation of lipid-laden macrophages, commonly known as foam cells, along with the buildup of the extracellular matrix. Subsequent stages witness the proliferation and aggregation of smooth muscle cells, culminating in the formation of atheroma plaques. As these lesions progress, apoptosis can occur in the deeper layers, further recruiting macrophages, which may undergo calcification and transform into atherosclerotic plaques. Notably, mechanisms such as arterial remodeling and intraplaque hemorrhage also contribute significantly to the progression of atherosclerotic cardiovascular disease, although these facets fall beyond the scope of this article. This study aimed to systematically review and conduct a meta-analysis of randomized controlled trials investigating the efficacy and safety of bempedoic acid in statin-intolerant patients with hyperlipidemia and to provide conclusions and recommendations accordingly. A systematic search of databases, such as PubMed, Web of Science, and Embase, will be performed. Only randomized trials will be included comparing bempedoic acid with placebo in statin-intolerant patients. This study aimed to provide a comprehensive understanding of the role of bempedoic acid in managing hyperlipidemia in statin-intolerant patients. In primary prevention, for patients unable to tolerate recommended statins, bempedoic acid was associated with a significant reduction in major adverse cardiovascular events (MACE) as the primary endpoint.

An Interesting Case of Wolf-Parkinson-White Syndrome in a Young Patient With Sensorineural Deafness.

Wolff-Parkinson-White (WPW) syndrome is a condition associated with tachycardia due to accessory pathways in the heart, and it is one of the most common causes of tachycardia in infants and children. WPW may also be associated with mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes (MELAS syndrome) or LEOPARD syndrome (LS). We report a case of pre-excitation WPW syndrome in a 17-year-old man who was brought to the hospital by ambulance following the collapse. WPW syndrome type A was diagnosed from precordial leads. Electrocardiography (ECG) revealed a short PR interval, delta waves, and positive waves with dominant R in all pericardial leads. Blood test results showed an isolated elevated ALT level. Subsequent echocardiography was unremarkable, with an ejection fraction of 55%, apart from septal and inferior wall dyssynchrony. With regard to the past medical history, he had sensorineural deafness (SND) since childhood and had a family history of SND. Consequently, the patient was transferred to the cardiac electrophysiology department at another hospital after consultation and underwent ablation. A successful post-ablation electrocardiogram revealed the resolution of the WPW syndrome signs and post-ablation features, such as peak T waves.

Recurrent Pericardial Effusion Secondary to Cardiac Angiosarcoma.

Cardiac angiosarcoma is a malignant cardiac tumour. We present the case of a young patient in his mid-30s with recurrent pericardial effusion. He had flu-like symptoms a month earlier and had shortness of breath, lethargy, and tightness in his throat for the past ten days. Echocardiography demonstrated global pericardial effusion > 4 cm with tamponade features, and the patient was blue-lighted to our hospital. He underwent emergency pericardiocentesis, and > 1 litre of pericardial fluid was drained. Computed tomography of the chest, abdomen, and pelvis revealed small-volume ascites and moderate right-sided pleural effusion, with associated lobar collapse. The patient presented to the hospital with global pericardial effusion requiring emergency pericardiocentesis three weeks later and underwent cardiac magnetic resonance imaging demonstrating global pericardial effusion and a 48 × 26 mm pericardial space mass adjacent to the right atrium. He underwent surgical resection of the tumour, followed by chemotherapy, and tolerated the treatment well. The patient is currently under follow-up.

Acute Large Pericardial Effusion With Haemodynamic Compromise Secondary to Undiagnosed Tuberculosis.

Tuberculous pericardial effusion is uncommon in the developed countries. However, it remains one of the main causes of presentation with a pericardial presentation with pericardial effusion in the developing world. We present the case of a 24-year-old male patient who presented with a weekly history of diarrhoea, vomiting, shortness of breath and feeling hot. Chest computed tomography revealed a large pericardial effusion with significant haemodynamic compromise. The patient underwent emergency pericardiocentesis, and the pericardial fluid interferon-gamma assay result was positive for tuberculosis. He was unable to tolerate endobronchial biopsy under ultrasound despite heavy sedation and was commenced on anti-tuberculous therapy following a discussion in a multidisciplinary team meeting. He was started on four standard anti-tuberculosis medications, including rifampicin, isoniazid, pyrazinamide, ethambutol and prednisolone. The patient had re-accumulation of pericardial fluid on repeat echocardiography in the first few weeks, which eventually resolved with anti-tuberculous therapy.

Effect of Dietary Simulating Solvents on the CAD-CAM Provisional Restorative Materials' Microhardness and Color Stability Properties: An in vitro Study.

Purpose: This in vitro study investigated the effects of dietary solvents on the microhardness and color stability of CAD/CAM provisional restorations compared to conventional materials. Methods: Disc-shaped specimens (n=200) were fabricated from self-cured acrylic resin, two 3D-printing resins (FormLabs, NextDent), and a milled material (TelioCAD). Randomization assigned specimens (n=10/group) to immersion solutions: artificial saliva, citric acid, heptane, coffee, and tea. Microhardness and color stability were evaluated. One-way and three-way ANOVA with Tukey's post hoc test analyzed the data. Results: Dietary solvents significantly reduced the surface microhardness of all tested materials (p<0.05). Unpolished surfaces exhibited greater color changes compared to polished ones (p<0.05) across all materials. Coffee and tea induced the most substantial reductions in hardness and the most significant color alterations (p<0.05), whereas saliva and citric acid had minimal effects. Conclusion: Milled provisional restorations exhibited superior hardness and color stability. Dietary solvents significantly affected material properties over time, highlighting the importance of material selection for clinical applications.

Advancements in intrusion detection: A lightweight hybrid RNN-RF model.

Computer networks face vulnerability to numerous attacks, which pose significant threats to our data security and the freedom of communication. This paper introduces a novel intrusion detection technique that diverges from traditional methods by leveraging Recurrent Neural Networks (RNNs) for both data preprocessing and feature extraction. The proposed process is based on the following steps: (1) training the data using RNNs, (2) extracting features from their hidden layers, and (3) applying various classification algorithms. This methodology offers significant advantages and greatly differs from existing intrusion detection practices. The effectiveness of our method is demonstrated through trials on the Network Security Laboratory (NSL) and Canadian Institute for Cybersecurity (CIC) 2017 datasets, where the application of RNNs for intrusion detection shows substantial practical implications. Specifically, we achieved accuracy scores of 99.6% with Decision Tree, Random Forest, and CatBoost classifiers on the NSL dataset, and 99.8% and 99.9%, respectively, on the CIC 2017 dataset. By reversing the conventional sequence of training data with RNNs and then extracting features before applying classification algorithms, our approach provides a major shift in intrusion detection methodologies. This modification in the pipeline underscores the benefits of utilizing RNNs for feature extraction and data preprocessing, meeting the critical need to safeguard data security and communication freedom against ever-evolving network threats.

Statins As Anti-Hypertensive Therapy: A Systematic Review and Meta-Analysis.

Hypertension is the most prevalent condition in clinical practice. Hypertension, diabetes, and hypercholesterolaemia are major contributing factors to cardiovascular diseases. They commonly coexist in a single patient. Statins have been used as prominent medicines for the reduction of cardiovascular events. Statins have been shown to reduce blood pressure in patients with hypertension and have lipid-lowering properties in recent articles. Statins reduce blood pressure because of their impact on endothelial function, their interactions with the renin-angiotensin system, and their influence on major artery compliance. This meta-analysis aimed to ascertain the effectiveness and efficacy of statins for managing hypertension in patients with hypertension. Systematic searches were conducted on PubMed, Science Direct, Embase, Cochrane Library, and Google Scholar. Randomized controlled trials, systematic trials, and cohort studies were retrieved using keywords on statins and their use in patients with hypertension. Exclusion criteria included studies that were not in the English language, studies that did not include patients on statins with hypertension, studies that did not provide enough information, technical reports, opinions, or editorials, and studies involving patients < 18 years old. The inclusion criteria were randomized controlled trials, meta-analyses, adult patients aged > 18 years old, and studies that were freely available or through institutional login. This meta-analysis scrutinized 9361 randomized controlled trials, clinical trials, meta-analyses, and systematic reviews, of which 32 articles including 25 randomized controlled trials and seven meta-analyses were included in the final analysis. This meta-analysis of the role of statins in hypertensive patients aimed to determine the outcome of hypertension control along with antihypertensive medication. Our study showed that statins are useful in reducing both systolic and diastolic blood pressure. We used a heterogeneous model for analysis due to variations in the study characteristics. The I2 value was 0.33 (0.76, 0.10) for systolic blood pressure and 0/88 (0.86, 0.90) for diastolic blood pressure. The I2 value for the seven meta-analyses included in the study was 1.79 (2.88, 0.69).

A Young Patient With Acute Ostial Right Coronary Artery Aneurysm Presenting As ST Elevation Myocardial Infarction.

A coronary artery aneurysm (CAA) is a localized dilatation of a coronary artery segment >1.5 times the diameter of the adjacent normal segment. CAA is more common in men than women and has multiple etiologies, including genetic causes, infections, and atherosclerotic diseases. Kawasaki disease is the most common cause of CAA in children, whereas atherosclerosis is the most common etiology in adults. We present the case of a male in his 30s who presented with sudden-onset chest pain and inferior ST segment elevation on an ECG. Echocardiography revealed preserved left ventricular function and mild hypokinesia. The patient underwent an emergency coronary angiogram that showed an ostial right CAA with thrombi. He was initially managed with a glycoprotein IIb/IIIa inhibitor tirofiban infusion, followed by triple therapy with aspirin, clopidogrel, and rivaroxaban. The patient underwent magnetic resonance imaging of his head, which was normal, and he did not attend outpatient computed tomography coronary angiography. The patient was discharged with lifelong rivaroxaban 20 mg once daily.