Investigating the effect of an education programme on diabetes and lipid lowering medication usage following coronary artery bypass graft surgery.

BACKGROUND: Guidelines advocate multifactorial cardiovascular risk management in patients with diabetes and atherosclerotic cardiovascular disease. AIM: In hospitalised patients with diabetes following coronary artery bypass graft (CABG), we aimed to evaluate the impacts of decision-support algorithms for optimising glycaemia and lipid-lowering. We also assessed the safety of initiating sodium-glucose cotransporter 2 (SGLT2) inhibitors near time of hospital discharge. METHODS: This was a single-site, pre- and post-intervention analysis of glucose and lipid management in consecutive hospitalised patients with diabetes undergoing CABG surgery. The intervention involved education and decision-support algorithms designed by a multidisciplinary committee to guide cardiac surgery unit clinicians. RESULTS: A total of 200 patients were included in the study. The pre- and post-intervention groups had similar baseline characteristics (HbA1c 7.9 ± 1.9% vs 8.1 ± 1.8%). Of 4092 blood glucose measurements, the incidence of levels between 5 and 10 mmol/L was not different post-intervention (55.5% vs 57.0%; P = 0.441). Fewer endocrinology consultations occurred (59.0% vs 45.0%; P = 0.048) and rates of hypoglycaemia remained low. High-intensity statin was prescribed in >90% pre- and post-intervention, although non-statin lipid-lowering agents remained <10% despite patients not achieving LDL-C targets. No 30-day readmissions for diabetic ketoacidosis occurred in patients prescribed SGLT2 inhibitors. CONCLUSION: The intervention did not improve inpatient glycaemia or increase non-statin lipid-lowering prescriptions in patients with diabetes following CABG surgery but did reduce reliance on specialty input. Initiation of SGLT2 inhibitor therapy near time of hospital discharge was not associated with safety concerns. Alternative interventions or strategies are required to optimise glycaemia and non-statin lipid-lowering therapy prescribing in this setting.

Formation of Ultimate Thin 2D Crystal of Pt in the Presence of Hexamethylenetetramine.

Platinum naturally crystalizes into a three-dimensional crystal due to its highly symmetrical fcc lattice, with a metallic bond which is non-directional and highly isotropic. This inherently means ultimately that 2D crystals of a few atoms thick growth are hardly available in this material. Here, we discovered that a combinative effect of formic acid reductant and hexamethylenetetramine surfactant during the reduction of their metal ions precursor can realize an ultimate thin 2D crystal growth in platinum. High-resolution transmission electron microscopy and filed-emission electron microscopy analysis have also discovered that the 2D crystal of Pt has 111 facets with a lateral dimension that can be up to more than 5 µm × 2 µm. The thickness of the 2D crystal of Pt is 1.55 nm. A mechanism for obtaining ultimate thin 2D crystal of Pt using the present approach is proposed.

Outcomes of Cardiac Transplantation in Western Australia - A Contemporary Single Centre Experience.

BACKGROUND: Cardiac transplantation remains the gold standard therapy for select patients with end-stage heart failure and outcomes have improved significantly over the past few decades. We report the 5-year contemporary experience of cardiac transplantation in Western Australia, one of the most remote transplant centres worldwide. METHODS: Patients undergoing isolated cardiac transplant at Fiona Stanley Hospital (FSH) from February 2015 until April 2021 were included. Donor details were collected using donor electronic records (Donate Life, Australia). Recipient data was collated from electronic medical records at FSH and the Australia and New Zealand Society of Cardiothoracic Surgery database. The primary outcome measure was all-cause mortality. Secondary outcome measures included postoperative intensive care and total hospital length of stay and rates of acute kidney injury, rejection, serious infections, and cardiac allograft vasculopathy. Frailty indices were also assessed. RESULTS: A total of 60 patients were included (mean age 53±14 yrs, 66.7% male). The commonest indication for transplant was a non-ischaemic cardiomyopathy (46.7%). Mean donor age was 35±12 years and median donor ischaemia time was 171 minutes (IQR=138-240). After median follow-up of 3.7 years, there were no mortalities. Postoperative renal failure occurred in 21 (35.0%) patients, pneumonia in four (6.7%), deep sternal wound infection in three (5.1%), acute rejection in 17 (28.3%) and cardiac allograft vasculopathy (CAV) in 23 (38.3%). CONCLUSION: With recipient and donor criteria comparable to national and international standards, compounded by the challenges of geographic isolation, we report the first published data on contemporary outcomes post isolated cardiac transplantation in Western Australia.

Q Fever Endocarditis: A Review of Local and all Reported Cases in the Literature.

BACKGROUND: Q fever endocarditis by Coxiella burnetii is rare and presents a diagnostic challenge. With limited data available, the aim of this study was to review all reported cases together with unpublished local cases to understand risk factor profiles, diagnostic methods, clinical features, treatments and outcomes. METHODS: A search of the PubMed database using the term 'Q fever endocarditis' identified cases between 1950-2019. Included cases had positive polymerase chain reaction testing, valve culture or serology. Separately, to identify local cases meeting our criteria we queried the Western Australian Health Open Patient Administration System at two local hospitals for the ICD-10-AM diagnosis code A78 between 2013-2019. RESULTS: We identified 181 cases from 31 publications and four local cases to create a combined series of 185 cases. The majority 141 (76%) were male and only 11% had normal cardiac valves. Most (72%) of patients had a history of contact with animals or travel. Nearly all (98%) cases had positive serology and over half (56%) had surgery performed. Overall mortality was 17%, and mortality for native valve endocarditis and prosthetic valve endocarditis was 12% and 3% respectively. No patients treated with doxycycline and hydroxychloroquine died. Mortality prior to 1999 was 28%, compared with 5% for more recent cases. CONCLUSION: Serological diagnosis is key in Q fever endocarditis and possible risk factors exist such as male gender, pre-existing valvular conditions and contact with animals or travel. Native valve endocarditis and treatment with drugs other than doxycycline and hydroxychloroquine increase the risk of death.

Preoperative Intra-Aortic Balloon Pumps in Cardiac Surgery: A Propensity Score Analysis.

INTRODUCTION: The role of intra-aortic balloon pumps (IABP) in high-risk patients undergoing coronary artery bypass graft (CABG) surgery remains controversial. We report the 5-year experience from a new Australian centre. METHODS: We retrospectively analysed 690 patients undergoing urgent isolated CABG surgery at a Western Australian tertiary centre from February 2015 to May 2020. De-identified data was obtained from the Australia & New Zealand Society of Cardiothoracic Surgeons database. Patients were stratified according to preoperative IABP use. A propensity score was created for the probability of IABP use and a propensity adjusted analysis was performed using logistic regression. The primary outcome was 30-day mortality. Secondary outcomes were postoperative inhospital outcomes. RESULTS: Preoperative IABP was used in 78 patients (11.3%). After propensity score adjustment, in a subgroup of patients with reduced ejection fraction or left main disease, 30-day mortality (7.0% vs 2.0%, OR 6.03, 95% CI 1.89-19.28, p=0.002) was significantly higher in the IABP group. Red blood cell transfusions (19.7% vs 12.6%, OR 1.86, 95% CI 1.02-3.35, p=0.039), prolonged inotrope use (78.9% vs 50.9%, OR 6.11, 95% CI 2.77-13.48, p<0.001), prolonged invasive ventilation (28.2% vs 3.4%, OR 20.2, 95% CI 8.24-49.74, p<0.001), mesenteric ischaemia (2.8% vs 0%, OR 4.52, 95% CI 1.15-17.77, p=0.031) and multisystem organ failure (1.3% vs 0.7%, OR 25.68, 95% CI 2.55-258.34, p=0.006) were significantly higher in the IABP group. CONCLUSION: In patients undergoing isolated CABG surgery, preoperative IABP use was associated with increased 30-day mortality and adverse outcomes. Large randomised controlled trials are required to confirm our findings.

Deep Sternal Wound Infections After Cardiac Surgery: A New Australian Tertiary Centre Experience.

BACKGROUND: Deep sternal wound infections (DSWI) after cardiac surgery impose a significant burden to patient outcomes and health care costs. The objective of this study is to identify risk factors, microbiological characteristics and protective factors for deep sternal wound infections following cardiac surgery in an Australian hospital. METHODS: We performed a retrospective study on 1,902 patients who underwent cardiac surgery at Fiona Stanley Hospital, a tertiary hospital in Western Australia from February 2015 to April 2019. Patients were grouped into having either deep sternal wound infections or no wound infections. RESULTS: Of 1,902 patients, 26 (1.4%) patients had DSWI. On multivariate analysis, male gender was associated with DSWI with an adjusted odds ratio of 7.390 (95% CI 1.189-45.918, p=0.032). Increased body mass index (BMI) had an odds ratio of 1.101 (95% 1.03-1.18, p=0.008). Increased length of stay (LOS) had an odds ratio of 1.05 (95% CI 1.02-1.08, p=0.002). Left main disease had an odds ratio of 3.076 (95% CI 1.204-7.86, p=0.019). The presence of hypercholesterolaemia had an odds ratio of 0.043 (95% CI 0.009-0.204, p<0.001). Staphylococcus aureus and Staphylococcus epidermidis were the most common organisms found in deep sternal wound infections (23.1% and 26.9% respectively). Polymicrobial growth occurred in 19.2% of patients. One gram of topical cephazolin was applied in 315 patients. None of these patients developed a deep sternal wound infection (p=0.022). CONCLUSION: In a large Australian tertiary centre, male gender, increased BMI, presence of left main coronary artery disease, and increased length of hospital stay are significantly associated with the risk of deep sternal wound infections. Staphylococcus aureus and Staphylococcus epidermidis are common organisms in deep sternal wound infections. Topical antibiotics such as cephazolin are useful in preventing deep sternal wound infections. The presence of hypercholesterolaemia is a protective factor and we hypothesise that this is due to long-term statin use.

Ischaemic Stroke and the Echocardiographic "Bubble Study": Are We Screening the Right Patients?

BACKGROUND: Patent foramen ovale (PFO) is a potential mechanism for paradoxical embolism in cryptogenic ischaemic stroke or transient ischaemic attack (TIA). PFO is typically demonstrated with agitated saline ("bubble study", BS) during echocardiography. We hypothesised that the BS is frequently requested in patients that have a readily identifiable cause of stroke, that any PFO detected is likely incidental, and its detection often does not alter management. METHODS: This was a retrospective observational study of patients with recent ischaemic stroke/TIA referred for a BS. Patient demographics, stroke risk factors, vascular/cerebral imaging results and transoesophageal echocardiogram (TOE) reports were recorded. A "modified" Risk of Paradoxical Embolism (RoPE) score was calculated. Change in management was defined as antiplatelet/anticoagulant therapy alteration or referral for PFO closure. Bubble Study complications were recorded. RESULTS: Among 715 patients with ischaemic stroke/TIA referred for a BS, 8.7% had atrial fibrillation and 9.2% had carotid stenosis ≥70%. At least three stroke risk factors were present in 39.3% and only 47.1% of patients screened had a "modified" RoPE score of >5. A PFO was detected in 248 patients of whom only 31% (77/248) had a subsequent change in management. Of BS performed, 1/924 patients (0.1%) suffered a TIA as a complication. CONCLUSIONS: The echocardiographic BS is frequently performed in patients that have a readily identifiable cause of stroke and whose PFO unlikely relates to the stroke/TIA. Bubble Study findings resulted in a change in management in the minority. The procedure is safe but the complication rate warrants informed consent.

Gold Nanoplates for a Localized Surface Plasmon Resonance-Based Boric Acid Sensor.

Localized surface plasmon resonance (LSPR) properties of metallic nanostructures, such as gold, are very sensitive to the dielectric environment of the material, which can simply be adjusted by changing its shape and size through modification of the synthesizing process. Thus, these unique properties are very promising, particularly for the detection of various types of chemicals, for example boric acid which is a non-permitted preservative employed in food preparations. For the sensing material, gold (Au) nanoplates with a variety of shapes, i.e., triangular, hexagonal, truncated pentagon and flat rod, were prepared using a seed-mediated growth method. The yield of Au nanoplates was estimated to be ca. 63% over all areas of the sensing material. The nanoplates produced two absorption bands, i.e., the transverse surface plasmon resonance (t-SPR) and the longitudinal surface plasmon resonance (l-SPR) at 545 nm and 710 nm, respectively. In the sensing study, these two bands were used to examine the response of gold nanoplates to the presence of boric acid in an aqueous environment. In a typical process, when the sample is immersed into an aqueous solution containing boric acid, these two bands may change their intensity and peak centers as a result of the interaction between the boric acid and the gold nanoplates. The changes in the intensities and peak positions of t-SPR and l-SPR linearly correlated with the change in the boric acid concentration in the solution.

Computing the Laplacian spectrum and Wiener index of pentagonal-derivation cylinder/Möbius network.

The Laplacian spectrum significantly contributes the study of the structural features of non-regular networks. Actually, it emphasizes the interaction among the network eigenvalues and their structural properties. Let Pn(Pn') represent the pentagonal-derivation cylinder (Möbius) network. In this article, based on the decomposition techniques of the Laplacian characteristic polynomial, we initially determine that the Laplacian spectra of Pn contain the eigenvalues of matrices LR and LS. Furthermore, using the relationship among the coefficients and roots of these two matrices, explicit calculations of the Kirchhoff index and spanning trees of Pn are determined. The relationship between the Wiener and Kirchhoff indices of Pn is also established.

Obesity in patients without diabetes undergoing coronary artery bypass graft surgery: Time to select patients for semaglutide.

Patients undergoing coronary artery bypass graft (CABG) surgery require intensive secondary prevention. Semaglutide reduced cardiovascular events in patients with cardiovascular disease and overweight or obesity but without diabetes in the SELECT trial. In this real-world study of 1386 patients without diabetes undergoing CABG surgery in an Australian hospital, approximately 1 in 2 patients (53.3 %) were potentially eligible for semaglutide based on the SELECT trial criteria. These findings highlight that a significant percentage of this very high-risk cohort merit receiving semaglutide for weight management and cardiovascular risk reduction. The implications for optimal care, healthcare costs and clinical guidelines require further evaluation.

Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis.

BACKGROUND: The human gastrointestinal tract harbours a complex multi-kingdom community known as the microbiome. Dysbiosis refers to its disruption and is reportedly extreme in acute critical illness yet its clinical implications are unresolved. The review systematically evaluates the association between gut dysbiosis and clinical outcomes of patients early in critical illness. METHODS: Following PRISMA guidelines, a prospectively registered search was undertaken of MEDLINE and Cochrane databases for observational studies undertaking metagenomic sequencing of the lower gastrointestinal tract of critically ill adults and children within 72 h of admission. Eligible studies reported an alpha diversity metric and one or more of the primary outcome, in-hospital mortality, or secondary clinical outcomes. After aggregate data were requested, meta-analysis was performed for four studies with in-hospital mortality stratified to high or low Shannon index. RESULTS: The search identified 26 studies for systematic review and 4 had suitable data for meta-analysis. No effect of alpha diversity was seen on in-hospital mortality after binary transformation of Shannon index (odds ratio 0.52, CI 0.12-4.98, I2 = 0.64) however certainty of evidence is low. Pathogen dominance and commensal depletion were each more frequently associated with in-hospital mortality, adverse clinical and ecological sequelae, particularly overabundance of Enterococcus. CONCLUSIONS: There is a paucity of large, rigorous observational studies in this population. Globally, alpha diversity was dynamically reduced in early ICU admission in adults and children and was not associated with in-hospital mortality. The abundance of taxa such as Enterococcus spp. appears to offer greater predictive capacity for important clinical and ecological outcomes.

Air-Processable Perovskite Solar Cells by Hexamine Molecule Phase Stabilization.

Perovskite solar cells have emerged as a potential energy alternative due to their low cost of fabrication and high power conversion efficiency. Unfortunately, their poor ambient stability has critically limited their industrialization and application in real environmental conditions. Here, we show that by introducing hexamine molecules into the perovskite lattice, we can enhance the photoactive phase stability, enabling high-performance and air-processable perovskite solar cells. The unencapsulated and freshly prepared perovskite solar cells produce a power conversion efficiency of 16.83% under a 100 mW cm-2 1.5G solar light simulator and demonstrate high stability properties when being stored for more than 1500 h in humid air with relative humidity ranging from 65 to 90%. We envisage that our findings may revolutionize perovskite solar cell research, pushing the performance and stability to the limit and bringing the perovskite solar cells toward industrialization.

Optoelectrical Properties of Hexamine Doped-Methylammonium Lead Iodide Perovskite under Different Grain-Shape Crystallinity.

The crystallinity properties of perovskite influence their optoelectrical performance in solar cell applications. We optimized the grain shape and crystallinity of perovskite film by annealing treatment from 130 to 170 °C under high humidity (relative humidity of 70%). We found that the grain size, grain interface, and grain morphology of the perovskite are optimized when the sample was annealed at 150 °C for 1 h in the air. At this condition, the perovskite film is composed of 250 nm crystalline shape grain and compact inter-grain structure with an invincible grain interface. Perovskite solar cells device analysis indicated that the device fabricated using the samples annealed at 150 °C produced the highest power conversion efficiency, namely 17.77%. The open circuit voltage (Voc), short-circuit current density (Jsc), and fill factor (FF) of the device are as high as 1.05 V, 22.27 mA/cm2, and 0.76, respectively. Optoelectrical dynamic analysis using transient photoluminescence and electrochemical impedance spectroscopies reveals that (i) carrier lifetime in the champion device can be up to 25 ns, which is almost double the carrier lifetime of the sample annealed at 130 °C. (ii) The interfacial charge transfer resistance is low in the champion device, i.e., ~20 Ω, which has a crystalline grain morphology, enabling active photocurrent extraction. Perovskite's behavior under annealing treatment in high humidity conditions can be a guide for the industrialization of perovskite solar cells.

Knowledge and practices of ergonomics in computer users.

OBJECTIVE: To assess knowledge and practices of ergonomics among desktop users of different professions. METHODS: It was an observational cross-sectional study conducted over a two-week timeframe (from November 7 to 21 2009), through a self-reporting questionnaire. Responses were analysed using SPSS version 15 and considered significant at p value<0.05. RESULTS: The study population comprised 210 males and 134 females. Of the total, 52% said they had heard about ergonomics, while 92% were aware of its importance. Knowledge about the importance of arm-rest (24%) and backrest inclination at 120 degrees (32%) was there, but practised by 21% and 31% respectively (p = <0.02). Straight placement of wrist in line with elbow was known to 194 (56.39%) and practiced by 138 (40%), while 186 (54.06%) respondents had knowledge about the ideal height of the chair, but it was adjusted only by 112 (32%). Disproportion was observed between the knowledge and practices of correct viewing distance from the computer screen, maintaining print at eye level, keeping computer screen free of glare and moving the chair for better keyboard use. CONCLUSION: Almost half of the respondents were not aware of the principles behind safe ergonomic practices. Even those who had the knowledge were not able to carefully and entirely apply this for prevention from health hazards.

2,6-Dibromo-4-chloro-aniline.

The title compound, C(6)H(4)Br(2)ClN, is almost planar (r.m.s. deviation = 0.024 Å) and two intra-molecular N-H⋯Br hydrogen bonds generate S(5) rings. In the crystal, N-H⋯Br hydrogen bonds link the mol-ecules into chains propagating in [010].

Preoperative patient factors associated with blood product use in cardiac surgery, a retrospective cohort study.

BACKGROUND: Cardiac surgery is associated with a high rate of blood use. The aim of this study is to identify preoperative patient factors associated with allogeneic Red Blood Cell (RBC) or non-Red Blood Cell (NRBC) use in cardiac surgery. METHODS: All adult cardiac surgical procedures conducted at a single Western Australian institution were retrospectively analysed. Data was collected from the Australia and New Zealand Cardiac Surgery Database from 2015 to 2018. A number of preoperative factors were identified, relating to past medical history or preoperative cardiac status. Outcome 1 was defined as the use of one or more RBC products intra or post-operatively. Outcome 2 was defined as the use of one or more NRBC products intra or post-operatively. Multivariate logistical regression analysis was done to assess for the association between preoperative factors and allogeneic blood product use. RESULTS: A total of 1595 patients were included in this study, of which 1488 underwent a Coronary Artery Bypass Graft, Valve or a combined procedure. Patients on dialysis preoperatively and those who had preoperative cardiogenic shock demonstrated the greatest risk of requiring RBC transfusion with an odds ratio of 5.643 (95% CI 1.305-24.40) and 3.257 (95% 1.801-5.882) respectively. Patients who had preoperative cardiogenic shock demonstrated the greatest risk of requiring NRBC transfusion with an odds ratio of 3.473 (95% CI 1.970-6.135). Patients who have had a previous cardiothoracic intervention are at increased risk of both RBC and NRBC transfusion, with adjusted odds ratios of 1.774 (95% CI 1.353-2.325) and 2.370 (95% CI 1.748-3.215) respectively. CONCLUSION: A number of factors relating to past medical history or preoperative cardiac status are implicated with increased allogeneic blood product use in cardiac surgery. Identifying high-risk patients in a preoperative setting can enable us enrol them in a blood conservation program, therefore minimizing the risk of exposure to blood transfusion.

The Psychological Impact of Coronavirus Disease 2019 on Patients Attending a Tertiary Healthcare Facility in Pakistan: A Cross-Sectional Study.

The COVID-19 pandemic has had a damaging impact on global health. Post-infection, patients may experience mental health difficulties and therefore require suitable psychological treatment and support. The objective of this study was to identify the psychological impact of COVID-19 on patients who were recovering from the physical effects of the disease, and to examine socio-demographic correlates within one month of treatment at a tertiary healthcare facility in Pakistan. A cross-sectional study was employed that utilized the Depression Anxiety Stress Scale-21 and Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5. A questionnaire was administered to 250 patients, with data collected over three months. Mild to extremely severe scores of depression, anxiety and stress were reported by approximately 43%, 52% and 42% of participants, respectively, and 8% developed PTSD. The incidence of depression, anxiety, stress or PTSD was not significantly associated with gender, age or previous interaction with COVID-19 patients. Depression was significantly associated with levels of education, severity of COVID-19 disease and a patient's current condition. Anxiety was associated with healthcare worker status. The severity of disease and a patient's current condition were also linked to the levels of anxiety, stress and the presence of PTSD. Collectively, these results indicate that a high percentage of patients recovering from COVID-19 experience psychological distress.

Coronary computed tomographic angiography derived findings and risk score improves the allocation of lipid lowering therapy compared to clinical score.

ABSTRACT: The initiation of therapy for atherosclerotic cardiovascular disease (ASVCD) is currently guided by cohort-based risk scores. Coronary computed tomographic angiography (CCTA) offers more personalised risk assessments to optimise therapy allocation. This study investigates the utility of CCTA determined coronary stenosis (both obstructive and non-obstructive plaque) to guide allocation of lipid lowering therapy. A retrospective analysis of 450 patients with CCTA performed for the assessment of chest pain at a single centre was conducted. Baseline characteristics, investigations, treatments and clinical outcomes were recorded. The allocation of lipid lowering therapy was evaluated with three models, cohort-based risk score (pooled cohort equation), a previously validated CCTA based clinical risk score (pooled cohort equation and CCTA findings) and CCTA alone (without clinical characteristics). The reclassification analysis included 266 patients. Compared to the cohort-based risk score, CCTA based clinical risk score in total reassigned 23% of patients. CCTA alone compared to the CCTA based clinical risk score correctly reassigned 23% and incorrectly reassigned 10%. When comparing the performance of CCTA alone against the cohort-based risk score, both the additive NRI of 25.8 (95% CI 4.12-37.56) and absolute NRI of 13.2 (95% CI 5.88-19.77) was significant. Revascularisation was required in 3% with a low cohort-based risk, but no patients with low risk as per CCTA alone or CCTA based clinical risk score required revascularisation The use of a CCTA based clinical risk score or CCTA alone compared to cohort-based risk scores can improve the allocation of lipid lowering therapy.

An Opportunity to Improve Secondary Prevention With Icosapent Ethyl in Patients Who Have Undergone Coronary Artery Bypass Graft Surgery.

INTRODUCTION: Icosapent ethyl reduces cardiovascular events in high-risk patients with hypertriglyceridaemia on statin therapy. However, it is not widely available and the potential application following coronary artery bypass graft (CABG) surgery is not well-established. We aimed to determine the real-world percentage of CABG surgery patients who may be eligible for the therapy. METHODS: A retrospective analysis was performed between February 2015 and August 2020 in an Australian hospital. Patients were included if a lipid profile was performed at least three weeks following CABG surgery. Data was extracted from electronic medical records. Eligibility for icosapent ethyl was defined according to inclusion criteria from the REDUCE-IT trial. RESULTS: Of 484 patients with follow-up lipid profiles, 21 (4.3%) were not eligible for icosapent ethyl based on age and 39 (8.1%) were not prescribed statin therapy or were prescribed a fibrate. After applying triglyceride and low-density lipoprotein cholesterol level criteria, 124 (25.6%) patients were potentially eligible for icosapent ethyl therapy. Of those eligible, high-intensity statin therapy were prescribed in 108 (87.1%). DISCUSSION: A substantial percentage of CABG surgery patients may be eligible for icosapent ethyl and could potentially benefit from its cardiovascular protection. Further research should evaluate the additional cardiovascular benefits of icosapent ethyl in this very high-risk group of patients who are already treated with high-intensity statins.

Comparison of Local and Intravenous Zoledronic Acid on Histopathology and Recurrence Rate after Extended Curettage in Giant Cell Tumors of Proximal Tibia: A Prospective Study.

Introduction: The bone pathology-giant cell tumor (GCT) is a locally aggressive and recurrent lesion. A bisphosphonate-zoledronic acid (ZA) has been known to lower the recurrence and resorption in similar bone lesions. Hence, we evaluated the effectivity of the ZA for the GCT of the proximal tibia. Materials and Methods: We piloted a prospective clinical observational study. We included 100 subjects with GCT, who were divided into two equal groups of case (given ZA) and control (no ZA). The histopathological features and the recurrence rates along with other findings were compared with P < 0.05 deliberated as significant. Results: We observed that for in the case group, calcification and fibrosis that were beneficial were observed. Reduced giant cells and lower recurrence rate are seen in the case group. No significant variation in the functional outcome was seen between the groups. Conclusions: ZA was shown to have beneficial effect on the outcome for the treatment of the GCT.