Efficacy and safety of ticagrelor monotherapy following a brief DAPT vs. prolonged 12-month DAPT in ACS patients post-PCI: a meta-analysis of RCTs.

BACKGROUND: As per current guidelines, acute coronary syndrome (ACS) patients who undergo percutaneous coronary intervention (PCI) should be started on dual antiplatelet therapy (DAPT) for a period of 12 months. OBJECTIVE: To assess the efficacy and safety of brief DAPT (up to 3 months) succeeded by ticagrelor monotherapy compared with a 12-month DAPT in ACS patients following PCI. METHODS: We systematically searched Cochrane, Embase, and PubMed to find relevant randomized clinical trials. Examined outcomes included the incidence of major adverse cerebrovascular and cardiovascular events (MACCE), bleeding events, and the composite incidence of net adverse clinical events (NACE). RESULTS: Our primary analysis included 21,927 ACS patients from six RCTs. Our pooled results indicate that following PCI in individuals with ACS, brief DAPT followed by ticagrelor did not increase the risk of MACCE (OR 0.92, 95% CI 0.79-1.07) but significantly reduced the risk of minor or major bleeding (OR 0.52, 95% CI 0.44-0.62) and NACE (OR 0.71, 95% CI 0.59-0.86) compared with a long-term DAPT within a follow-up of 12 months. CONCLUSION: Brief DAPT followed by ticagrelor monotherapy is superior to a 12-month DAPT in offering a net clinical advantage in ACS patients following PCI.

Year-round dengue fever in Pakistan, highlighting the surge amidst ongoing flood havoc and the COVID-19 pandemic: a comprehensive review.

Dengue fever (DF) is an arthropod-borne viral infection caused by four serotypes of dengue virus (DENV 1-4) transmitted to the host by the vector mosquito Aedes, which causes fever, vomiting, headache, joint pain, muscle pain, and a distinctive itching and skin rash, ultimately leading to dengue hemorrhagic fever and dengue shock syndrome. The first case of DF in Pakistan was documented in 1994, but outbreak patterns began in 2005. As of 20 August 2022, Pakistan has 875 confirmed cases, raising alarming concerns. Misdiagnosis due to mutual symptoms, lack of an effective vaccine, the weakened and overburdened health system of Pakistan, irrational urbanization, climate change in Pakistan, insufficient waste management system, and a lack of awareness are the significant challenges Pakistan faces and result in recurrent dengue outbreaks every year. The recent flood in Pakistan has caused massive destruction, and stagnant dirty water has facilitated mosquito breeding. Sanitization and spraying, proper waste management, an adequate and advanced diagnostic system, control of population size, public awareness, and promotion of medical research and global collaboration, especially amidst flood devastation, are recommended to combat this deadly infection in Pakistan. This article aims to comprehensively review the year-round DF in Pakistan, highlighting the surge amidst ongoing flood havoc and the coronavirus disease 2019 pandemic.

Double cortex syndrome (subcortical band heterotopia): A case report.

Double cortex syndrome is an uncommon familial syndrome with X-linked dominant inheritance and most commonly presents with developmental delay and seizures. We present a case of a 14-year-old girl who came to neurology department of the hospital with severe generalized tonic-clonic fits and loss of consciousness. The mother of child gave history of uneventful antenatal period and labor. There was history of immediate cry and normal APGAR score. She was achieving milestones normally until at the age of 3 years when she suffered decline in her speech and vision. She had problems with learning with lack of concentration during her schooling. Physical examination was also unremarkable. Her lab values including complete blood count, serum calcium, and arterial blood gas tests, all were within normal limits. Electroencephalogram showed significant changes suggestive of epilepsy. Magnetic resonance imaging of brain showed continuous band of gray matter that was located deep and paralleling the cortex in both cerebral hemispheres suggestive of band heterotopia or double cortex syndrome. She was discharged and prescribed antiepileptics; and was advised regular outpatient follow-up.

An infant with Joubert syndrome: A case report.

Joubert syndrome is a rare neurological and developmental malfunction represented by decreased muscle tone, ataxia, and delayed developmental milestones. Joubert syndrome-related disorders, besides central nervous system, can involve other systems and thus can lead to multi-organ malfunction. We report a case of pure Joubert syndrome who presented with developmental delay, decreased muscle tone, and ataxia. Identification of molar tooth sign on magnetic resonance imaging studies assisted to make a definitive diagnosis. Detailed examination revealed no other significant findings of any organ of the body. Patient was managed conservatively with symptomatic treatment. Although these types of cases are rarely encountered, they can lead to multiple organ disabilities. Therefore, clinicians should always keep this diagnosis in mind whenever an infant presents with the aforementioned neurodevelopmental symptoms.

Diseases caused by floods with a spotlight on the present situation of unprecedented floods in Pakistan: a short communication.

Few natural calamities surpass floods in their destructive capabilities. The recent floods in Pakistan were declared the world's deadliest since the South Asian floods of 2020 and were, by far, the most destructive floods in the country's history. They have resulted in significant loss of life and property and have served as the harbingers of cutaneous and noncutaneous diseases. These floods have dealt a critical blow to the country's already struggling healthcare system, which lacks resources for the prompt mobilization of medical personnel and resources to the flood-hit areas. Having lost their houses, the flood victims are wholly exposed to the elements. Lack of access to a clean water supply has predisposed them to a myriad of diseases. We believe that the consolidation of efforts by the national and international community will put an end to the plight of these flood victims. Our article highlights the significant diseases associated with floods, the challenges faced by the flood victims, and recommendations on how their situation can be improved.

Rift Valley fever virus outbreak in Mauritania yet again in 2022: No room for complacency.

Rift Valley fever is an important yet ignored viral hemorrhagic fever claiming many lives of African and Arabian countries over the past decade. Unfortunately, a recent outbreak of Rift Valley fever is currently ravaging in Mauritania. Death toll is rising continuously with 23 deaths reported in the month of October, 2022. Our article aims to shed light on the ongoing Rift Valley fever outbreak and recommendations to eradicate this potential threat to public health. Online databases including PubMed, the Lancet, and Science Direct as well as conferences, news, and press releases were used to for data collection. All the available medical literature related to Rift Valley fever in Mauritania were taken into consideration while writing the manuscript. As of October 17, 2022, 47 cases have been documented out of which 23 are dead. Case fatality rate has been reached to 49% which has given a wakeup call to the authorities. Efforts are being made by the concerned authorities and World Health Organization to halt the progression of this outbreak. Further investigations are required to completely eradicate the recurrent outbreaks in Mauritania especially in the area of vaccine development. Active involvement of public with the government authorities is of extreme significance in combating this disease.

COVID-19 and Cardiovascular Diseases: A Literature Review From Pathogenesis to Diagnosis.

The coronavirus disease 2019 (COVID-19) took the world by storm after the first case of COVID-19 emerged in China on December 8, 2019. The disease is generally considered as an infection of the respiratory system, but serious life-threatening myocardial injuries have been reported with this infection. Coronavirus can damage cardiac myocytes by entering the cell through angiotensin-converting enzyme 2 (ACE-2) receptor binding. Myocardial infarction, myocarditis, heart failure, cardiac arrhythmias, and Takotsubo cardiomyopathy are cardiac clinical manifestations commonly seen among patients affected by COVID-19. These cardiac pathologies are seen both during ongoing infection and post-infection. Elevated levels of myoglobin, troponin, creatine kinase-MB, plasma interleukin-6, lactate dehydrogenase (LDH), and N-terminal pro-b-type natriuretic peptide (NT-proBNP) have been found in COVID-19-associated myocardial injuries. The diagnostic modalities used in myocardial injuries due to COVID-19 include electrocardiography (ECG), cardiac magnetic resonance imaging (CMR), endomyocardial biopsy, echocardiography (Echo), and computerized tomography (CT-Scan). This literature review will discuss, in detail, the pathogenesis, clinical manifestations, and diagnosis of myocardial injuries due to COVID-19.