Advanced approach combines integrated weight water quality index and potential toxic elements for environmental and health risk assessment supported by simulation technique in Oued Souf, Algeria.

The current research study evaluated the health and environmental risks issues associated with potentially toxic elements (PTEs) in the complex terminal aquifer located in the Algerian desert. The methods used included principal component and cluster (dendrogram) analysis to estimate source of ions and contamination. Various indices such as the Heavy Metal Pollution Index (HPI), Metal Index, hazard quotient, hazard index (HI), and cancer risk (CR) were applied to assess both environmental and human health risks. Furthermore, the Monte Carlo method was applied for probabilistic assessment of carcinogenic and non-carcinogenic risks through oral and dermal exposure routes in both adults and children. The results revealed that approximately 16% of the samples fell within the low pollution category (HPI < 100), indicating relatively lower levels of heavy metal contamination. However, the remaining 84% of the samples exhibited high pollution levels, indicating a significant presence of heavy metal pollutants in the northeastern part of the investigated area. The calculated average risk index (RI) for the collected samples was 18.99, with a range from 0.03 to 103.21. This indicates that a large portion, 82% of the samples, could cause low ecological risk (RI < 30), whereas the remaining 18% indicate a significant environmental pollution risk. The HI for oral ingestion showed that adults had HI values ranging from 0.231 to 1.54, while children exhibited higher values, ranging from 0.884 to 5.9 (Fig. 5a). For dermal exposure, HI values in adults ranged from 2.71E-07 to 8.74E-06 and in children, from 2.18E-06 to 7.03E-05. These findings highlight the potential non-carcinogenic risks associated with oral exposure to PTEs and underscore the increased vulnerability of children to metals such as Fe, Mn, Pb, and Cr. Most samples showed CR exceeding 1 × 10-4 for chromium (Cr) and lead (Pb), indicating a significant vulnerability to carcinogenic effects in both children and adults.

Assessing surface water quality in Hungary's Danube basin using geochemical modeling, multivariate analysis, irrigation indices, and Monte Carlo simulation.

Evaluation of water quality is crucial for managing surface water effectively, ensuring its suitability for human use, and sustaining the environment. In the lower Danube River basin, various methods were employed to assess surface water quality for irrigation, drinking, human health risk purposes and the main mechanism control the surface water chemistry. These methods included water quality indicators (WQIs), complex statistical analyses, geographic information systems (GIS), Monte Carlo simulation, and geochemical modeling. Physicochemical analyses of surface water samples revealed primarily Ca-Mg-HCO3- is the dominant water types. Principal component analysis (PCA), ionic ratios and piper, chloro alkaline index, Chadha, and Gibbs diagrams identified three distinct water characteristics influenced by water-rocks interaction, evaporation, ions exchange, and human activities. The geochemical modeling showed Danube River water's strong ability to dissolve gypsum, halite, and anhydrite (SI < 0) and precipitate aragonite, dolomite, and calcite with saturation index (SI) value greater than 0 along its flow path. The irrigation water quality index (IWQI = 99.6-107.6), sodium adsorption ratio (SAR = 0.37-0.68), sodium percentage (Na% = 13.7-18.7), soluble sodium percentage (SSP = 12.5-17.5), Potential Salinity (PS = 0.73-1.6), and Residual Sodium Carbonate (RSC = - 1.27-0.58) values were used, mainly indicating acceptable quality with some limitations. Danube River water was unsuitable for drinking based on WQI value (WQI = 81-104). Oral exposure of children to specific components showed a higher hazard index (HI > 1) compared to adults, indicating a 2.1 times higher overall non-carcinogenic risk hazard index. However, Monte Carlo simulation demonstrated negligible iron, manganese, and nitrate health hazards for both age groups. These findings are valuable for water quality management decisions, contributing to long-term resource sustainability.

Sex difference in outcomes and management of cardiogenic shock: A systematic review and meta-analysis.

BACKGROUND: Cardiogenic shock (CS) is associated with significant morbidity and mortality. Sex differences in the outcomes and management of cardiogenic shock are not well established. The primary objective of this study is to investigate the differences inik cardiogenic shock outcomes between males and females. METHODS: A systematic review and meta-analysis were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Studies were searched via the MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases from inception to December 2022. RESULTS: The analysis included 24 studies comprising 1,567,660 patients. Compared to females, males with CS had a significantly lower risk of in-hospital all-cause mortality (risk ratio [RR] 0.88, 95 % confidence interval [CI] 0.85-0.90, p < 0.001) and 1-year mortality (RR 0.90, 95 % CI 0.89-0.92, p < 0.001). Males were more likely to undergo percutaneous coronary intervention (RR 1.21, 95 % CI 1.13-1.31, p < 0.0001) and intra-aortic balloon pump placement (RR 1.21, 95 % CI 1.11-1.32, p < 0.0001), with no significant sex differences in the use of extracorporeal membrane oxygenation or Impella. During the index hospitalization, males were at higher risk of arrhythmias (RR 1.18, 95 % CI 1.05-1.34, p = 0.003) and less likely to develop acute kidney injury (RR 0.86, 95 % CI 0.79-0.94, p < 0.001). CONCLUSION: Men have a lower all-cause mortality risk in cardiogenic shock. Addressing disparities in management is crucial for improving CS outcomes, especially for women.

Comprehensive approach integrating water quality index and toxic element analysis for environmental and health risk assessment enhanced by simulation techniques.

Due to water shortages and the potential impact of Ethiopia's new dam on the Nile River, Egypt is seeking new water resources. This study assesses the drinking water quality and associated risks from potentially toxic elements (PTEs) in the Quaternary aquifer (QA) in Beni-Suef, Egypt. Using a comprehensive approach, including PHREEQC geochemical modeling, ionic ratios, multivariate statistical analyses, and the integrated weight water quality index (WQI), the study evaluated the sources of ion contamination and the mixing of Nile water with QA. Various indices, such as the Heavy Metal Pollution Index (HPI), ecological Risk Index (RI), Hazard Quotient (HQ), and Hazard Index (HI), were used to assess ecological and health risks. Monte Carlo simulations provided probabilistic assessments of non-carcinogenic risks for adults and children. GIS tools were used to map risk indices, identifying the most deteriorated locations for sustainable management. The hydrochemical analysis revealed water facies including Na-Cl, Ca-Mg-HCO3, and mixed types, influenced by carbonate dissolution, ion exchange, and silicate weathering. Contamination sources, particularly in the north and south, were linked to agricultural activities, irrigation return flow, municipal waste, and evaporation. The WQI indicated that 10.14% of samples were extremely poor, 21.7% were poor, 26% were medium, and 42% were good to excellent. PTE contamination varied, with HPI values indicating good water quality in the central area in 53.6% of the collected samples (HPI < 30), but contamination in the north and south is high (HPI > 51). Ecological Risk Index values were below the threshold in 100% of samples (RI < 30), confirming water safety regarding PTEs. In comparison, for hazard index (HI) through oral/ingestion, adults exhibited HI values ranging from 0.012 to 2.16, while children showed higher values, ranging from 0.045 to 8.25. However, the hazard index for oral/ingestion exceeded safe limits in the north and south (HI oral > 1), posing non-carcinogenic risks. Monte Carlo simulations revealed significant risks from oral exposure to manganese (HQ oral > 1), particularly in El-Wasta and El-Fashn, necessitating further treatment and management.

Evaluation of platelet-rich fibrin matrix combined with PGE-1 injection on erectile function in patients with refractory response to PDE5-I: a randomized placebo-controlled study.

PURPOSE: We studied the effect of a platelet-rich fibrin matrix (PRFM) combined with prostaglandin E-1 (PGE-1) injection on erectile function in patients refractory to response for phosphodiesterase type 5 inhibitors (PDE5-Is). METHODS: This randomized, double-blind, placebo-controlled study included 80 patients. The patients were randomly assigned to four groups and blinded together with the administrating physicians to the nature of the intracorporeal injection (ICI) therapies. Group (1) received saline, group (2) received platelet-rich fibrin matrix (PRFM), group (3) received prostaglandin E-1 (PGE-1), and group (4) received a combination of PRFM + PGE-1. The patients received ICI therapy weekly for 8 consecutive weeks. Clinical information and follow-up data were obtained at 1, 2, 3, and 6 months. RESULTS: A significant increase occurred in the validated Arabic version of the International Index of Erectile Function (ArIIEF-5) score in group (4) compared to the other three groups (p value = 0.037). There was a significant difference in erection hardness scale (EHS) scores among all groups after receiving the different treatments (p = 0.004). A significant increase was seen in the ArIIEF-5 score in groups 4 and 3 compared to that in groups 1 and 2 (p < 0.001). There was also a significant increase in the arterial dilatation % in groups 4 and 3 compared to that in groups 1 and 2 (p = 0.019). CONCLUSION: The combination of PRFM plus PGE-1 had shown significant improvement in the ArIIEF-5 score, yet the patients still had mild to moderate ED.

Anterior STEMI in a 25-year-old with Cogan syndrome.

Cogan syndrome (CS) is a chronic inflammatory disorder primarily affecting young adults. It is characterized by interstitial keratitis, vestibuloauditory dysfunction, and, rarely, systemic vasculitis and aortitis. In this case report, we present a rare instance of a young male with anterior ST-elevation myocardial infarction in the context of aneurysmal coronary vessels and proximal occlusion of the left anterior descending artery. This case underscores the importance of recognizing cardiac risk factors in the setting of CS, as they can be life-threatening. Regular follow up is necessary, especially for patients showing signs of vasculitis or experiencing cardiac symptoms. A multidisciplinary approach to management can help optimize the prognosis for these complex patients. Learning objective: Comprehend Cogan syndrome (CS): Grasp the clinical manifestations and potential cardiovascular complications of CS. Diagnostic approach in CS: Differentiate cardiac symptoms in CS from typical coronary diseases, emphasizing the role of heart catheterization. Multidisciplinary management: Recognize the importance of integrating rheumatologists, cardiologists, and surgeons for optimal CS patient outcomes.

Comprehensive approach integrating remote sensing, machine learning, and physicochemical parameters to detect hydrodynamic conditions and groundwater quality deterioration in non-rechargeable aquifer systems.

The current study integrates remote sensing, machine learning, and physicochemical parameters to detect hydrodynamic conditions and groundwater quality deterioration in non-rechargeable aquifer systems. Fifty-two water samples were collected from all water resources in Siwa Oasis and analyzed for physical (pH, T°C, EC, and TDS) chemical (SO4 2-, HCO3 -, NO3 -, Cl-, CO3 2-, SiO2, Mg2+, Na+, Ca2+, and K+), and trace metals (AL, Fe, Sr, Ba, B, and Mn). A digital elevation model supported by machine learning was used to predict the change in the land cover (surface lake area, soil salinity, and water logging) and its effect on water quality deterioration. The groundwater circulation and interaction between the deep aquifer (NSSA) and shallow aquifer (TCA) were detected from the pressure-depth profile of 27 production wells penetrating NSSA. The chemical facies evolution in the aquifer systems were (Ca-Mg-HCO3) in the first stage (freshwater of NSSA) and changed to (Na-Cl) type in the last stage (brackish water of TCA and springs). Support vector machine successfully predicted the rapid increase of the hypersaline lake area from 22.6 km2 to 60.6 km2 within 30 years, which deteriorated a large part of the cultivated land, reflecting the environmental risk of over-extraction of water for irrigation of agricultural land by flooding technique and lack of suitable drainage network. The waterlogging in the study was due to a reduction in the infiltration rate (low permeability) of the soil and quaternary aquifer. The cause of this issue could be a complete saturation of agricultural water with chrysotile, calcite, talc, dolomite, gibbsite, chlorite, Ca-montmorillonite, illite, hematite, kaolinite and K-mica (saturation index >1), giving the chance of these minerals to precipitate in the pore spaces of the soil and decrease the infiltration rate. The NSSA is appropriate for irrigation, whereas TCA is inappropriate due to potential salinity and magnesium risks. The best way to manage water resources in Siwa Oasis could be to use underground drip irrigation and combine water with TCA and NSSA.

Management strategy for children with ovarian immature teratoma: results from a tertiary pediatric oncology center.

OBJECTIVES: We present an Egyptian study on pediatric ovarian immature teratomas (ITs), aiming to clarify our treatment strategy selection. METHODS: A retrospective review of all children with pure ovarian ITs who were treated at our institution between 2008 and 2023. The analysis included clinical characteristics, tumor staging according to Children's Oncology Group (COG), grading based on the Norris system, management, and outcomes. RESULTS: Thirty-two patients were included, with a median age of 9 years. All patients underwent primary surgery. Unilateral salpingo-oophorectomy was performed in 31 patients. Surgical staging was completed in all patients. Based on COG staging, there were 28 patients (87.5%) stage I, 1 (3%) stage II, and 3 (9.5%) stage III. According to Norris classification, 16 patients (50%) were classified as grade I, 9 (28%) grade II, and 7 (22%) grade III. All patients in stage I were treated using surgery-alone approach, whereas the remaining four (12.5%) received adjuvant chemotherapy. Five patients in stage I had gliomatosis peritonei (GP), and none of them underwent extensive surgery. At a median follow-up of 86 months, two patients had events. The first patient (stage III/grade I) developed IT relapse on the operative bed, and the second (stage I/grade I) had a metachronous IT on the contralateral ovary. Both patients were successfully managed with surgery followed by second-line chemotherapy. Five-year overall survival and event-free survival for all patients were 100% and 93.4%, respectively. CONCLUSIONS: Surgery-alone strategy with close follow-up achieves excellent outcomes for localized ovarian ITs in children, irrespective of the Norris grading or the presence of GP. However, adjuvant chemotherapy is questionable for patients with incompletely resected or locally advanced tumors, and its role requires further evaluation through prospective multicentric studies with a larger sample size.

Hydrogeochemical characteristics and air quality risks associated with gold mining operations in Egypt using geochemical modeling and risk indices.

The success of industrial operations depends on the effective identification, appraisal, and mitigation of possible hazards and associated environmental concerns. This report provides a complete review of environmental management techniques at the Sukari Gold Mine (SGM), located in the southeastern desert of Egypt. Extensive environmental measurements were taken to assess air and water quality, identify hazards, and analyze risks on the SGM premises. Air quality and noise intensity levels were measured at 39 places around the mine's working region. The findings found noncompliance with the Egyptian Environmental Law's (EEL4/94) noise exposure limitations, with the Power Generator House having the maximum noise levels at 107 dB. Remedial measures such as personal protective equipment (PPE) and exposure limit reduction strategies are being considered to address elevated noise levels. Measurements of particulate matter (PM10) and noxious gases (e.g., CO, SO2, NO2, HCN, and NH3) were conducted in workplace and ambient environments. Elevated PM10 concentrations were particularly concerning in underground regions, forcing the deployment of water depression techniques and improved PPE measures. While gas emissions from most activities remained under regulatory limits, select zones showed hydrogen cyanide (HCN) levels that exceeded permitted thresholds, necessitating specific control actions. Using hazard index (HI) and risk rating assessments, this study found different risk profiles across SGM's workplaces, focusing on high-risk regions for focused intervention. Additionally, a water assessment near a Tailing Storage Facility (TSF) was conducted to monitor the impact of mining activities on groundwater quality. The study revealed that groundwater in the region belongs to the Na-K-Cl-SO4 and Ca-Mg-Cl-SO4 water classes, with potential degradation attributed to high mineralization processes induced by aquifer materials and seawater intrusion. The findings underscore the importance of ongoing monitoring, control measures, and implementation of programs to ensure environmental sustainability and minimize risks associated with mining activities in the Sukari Gold Mines. This research highlights the imperative of continuous monitoring, proactive control measures, and the implementation of environmental initiatives to ensure the sustainability of mining operations within the Sukari Gold Mines.

Evaluation of platelet-rich fibrin versus collagen membrane for enhancing healing of secondary grafted alveolar cleft: a randomised controlled trial.

The purpose of this study was to compare the efficiency of using autologous platelet-rich fibrin versus a resorbable collagen membrane in secondary alveolar bone grafting. Patients were randomly allocated to the three treatment groups: Group 1 - twelve children in whom the nasal layers of the alveolar clefts were repaired using autologous platelet-rich fibrin with autogenous chin bone; Group 2 - twelve children in whom the nasal layers of the alveolar clefts were repaired using bovine collagen membrane type I (Colla-D) with autogenous chin bone; and Group 3 - twelve children in whom the bony alveolar clefts were grafted with autogenous chin bone after construction of a watertight nasal floor had been completed. The study population comprised 36 patients with alveolar clefts, ranging in age from seven to 12 years. At the last follow-up period all groups had stable healing conditions and good radiological outcomes in terms of the alveolar bone height bordering the teeth (both mesially and distally) and the incorporation of grafting material with the surrounding bone. The use of either a PRF membrane and a collagen membrane as an interpositional layer between the nasal layer and the autogenous chin bone graft enhanced bone formation and density in alveolar clefts compared with the control group.

Dual encapsulation and sequential release of cisplatin and vitamin E from soy polysaccharides and ß-cyclodextrin bioadhesive hydrogel nanoparticles.

Chemically cross-linked hydrogel nanoparticles (HGNPs) offer enhanced properties over their physical counterparts, particularly in drug delivery and cell encapsulation. This study applied pH-thermal dual responsive bio-adhesive HGNPs for dual complexation and enhanced the controlled release and bioavailability of cisplatin (CDDP) and Vitamin E (VE) drugs. The CDDP was loaded into the HGNPs via chemical conjugation with the carboxyl groups in the HGNPs surface by soy polysaccharides (SSPS). At the same time, the host-guest interaction complexed the VE through the ß-cyclodextrin (ß-CD). The HGNPs showed a uniform HGNPs size distribution of 90.77 ± 14.77 nm and 81.425 ± 13.21 nm before and after complexation, respectively. The FTIR, XRD, XPS, and zeta potential confirmed the conjugation. The cumulative release percent of CDDP reached 98 % at pH 1.2, while <45 % was released at pH 7.4. Our HGNPs enhance the incorporation of CDDP by substituting its chlorides with carboxyl groups of the SSPS; the loading of CDDP and VE was 15 ± 0.33 and 11.32 ± 0.25 wt%, respectively. Moreover, the CDDP and VE also released slower from the HGNPs at 25 °C than at 37 °C and 42 °C. The (VE/CDDP)-loaded HGNPs exhibited longer circulation time in vivo than free CDDP and free VE suspension.

Molecular Diversity and Combining Ability in Newly Developed Maize Inbred Lines under Low-Nitrogen Conditions.

Nitrogen is an essential element for maize growth, but excessive application can lead to various environmental and ecological issues, including water pollution, air pollution, greenhouse gas emissions, and biodiversity loss. Hence, developing maize hybrids resilient to low-N conditions is vital for sustainable agriculture, particularly in nitrogen-deficient soils. Combining ability and genetic relationships among parental lines is crucial for breeding superior hybrids under diverse nitrogen levels. This study aimed to assess the genetic diversity of maize inbred lines using simple sequence repeat (SSR) markers and evaluate their combining ability to identify superior hybrids under low-N and recommended conditions. Local and exotic inbred lines were genotyped using SSR markers, revealing substantial genetic variation with high gene diversity (He = 0.60), moderate polymorphism information content (PIC = 0.54), and an average of 3.64 alleles per locus. Twenty-one F1 hybrids were generated through a diallel mating design using these diverse lines. These hybrids and a high yielding commercial check (SC-131) were field-tested under low-N and recommended N conditions. Significant variations (p < 0.01) were observed among nitrogen levels, hybrids, and their interaction for all recorded traits. Additive genetic variances predominated over non-additive genetic variances for grain yield and most traits. Inbred IL3 emerged as an effective combiner for developing early maturing genotypes with lower ear placement. Additionally, inbreds IL1, IL2, and IL3 showed promise as superior combiners for enhancing grain yield and related traits under both low-N and recommended conditions. Notably, hybrids IL1×IL4, IL2×IL5, IL2×IL6, and IL5×IL7 exhibited specific combining abilities for increasing grain yield and associated traits under low-N stress conditions. Furthermore, strong positive associations were identified between grain yield and specific traits like plant height, ear length, number of rows per ear, and number of kernels per row. Due to their straightforward measurability, these relationships underscore the potential of using these traits as proxies for indirect selection in early breeding generations, particularly under low-N stress. This research contributes to breeding nitrogen-efficient maize hybrids and advances our understanding of the genetic foundations for tolerance to nitrogen limitations.

Does volumetric measurement of ADC values achieve higher diagnostic performance in bladder cancer MRI?

BACKGROUND: Apparent diffusion coefficient (ADC) value is an important part of bladder cancer magnetic resonance imaging (MRI) assessment and can predict the aggressive and invasive potentials. There is growing interest in whole tumor volume measurements. PURPOSE: To investigate if the volumetric ADC measurement method will significantly exceed the diagnostic performance of the selected region of interest (ROI) method in everyday practice. MATERIAL AND METHODS: A prospective evaluation was carried out of 50 patients with bladder cancer by two radiologists. The mean and the minimum ADC values were measured using both methods. The inter-reader agreement was determined by the intraclass correlation coefficient. The ADC values were compared between different grades, states of muscle invasion, and lympho-vascular invasion (LVI); then, validity was evaluated using receiver operating characteristic (ROC) curves. Areas under the curve (AUC) were then compared for the level of statistical significance. RESULTS: The inter-observer agreement was excellent for the ADC values using both methods. The volumetric measurement provides higher mean and lower minimum ADC values with statistically significant differences (P <0.00001). The highest diagnostic accuracy for differentiating tumor grade and predicting muscle invasion was for the minimum ADC by a selected ROI. However, the differences between the achieved AUCs were of no statistical significance. None of the ADC values predicted LVI with statistical significance. CONCLUSION: The selected ROI and volumetric measurement methods of mean and minimum ADC in bladder cancer yield different values, still having comparable diagnostic performance with accurate ROI sampling. The minimum ADC value by ROI is preferred in everyday clinical practice.

Percutaneous Intervention of LVAD Outflow Graft Obstruction and Thrombosis.

Left ventricular assist devices serve as a salvage therapy for patients with advanced heart failure. Complications such as thrombosis and obstruction can lead to acute device malfunction, posing significant clinical risks. A multidisciplinary approach is crucial for management. Few cases in the literature have demonstrated the safety and efficacy of percutaneous intervention, which holds significant value due to its less invasive nature and minimal risk of morbidity, especially in high-risk surgical patients.

FNDC5 genetic polymorphism in patients with peripartum cardiomyopathy.

Background: Late in pregnancy or soon after delivery, peripartum cardiomyopathy (PPCM) which is an uncommon type of cardiomyopathy, can develop. To assess the association between the level of irisin expression and (FNDC5) (rs3480) gene polymorphism with peripartum cardiomyopathy. Methods: This is a case control study included a thirty female patients with new-onset PPCM and sixty healthy females at the at the peripartum period in same time window for PPCM as a control. For each patient, comprehensive medical history was taken, full clinical assessment was done, ECHO., FNDC5 (rs3480) & Irisin assay. Results: The left ventricle end diastolic dimensions &left atrium diameters were statistically significant higher in patients' group than controls' group (P=0.000 for all), Also left ventricular ejection fraction (%) was statistically significant lower in patients than controls and as regards irisin, its Mean ±SD was lower in patient group than control group (8.44±1.1 vs 10.65±2.31) with (p <0.001) which is considered a significant difference statistically. Conclusion: Irisin level was lower in peripartum cardiomyopathic patients when compared with normal individuals and regarding its genotype, the homotype A/A was higher than homotype G/G.

New approach into human health risk assessment associated with heavy metals in surface water and groundwater using Monte Carlo Method.

This study assessed the environmental and health risks associated with heavy metals in the water resources of Egypt's northwestern desert. The current approaches included the Spearman correlation matrix, principal component analysis, and cluster analysis to identify pollution sources and quality-controlling factors. Various indices (HPI, MI, HQ, HI, and CR) were applied to evaluate environmental and human health risks. Additionally, the Monte Carlo method was employed for probabilistic carcinogenic and non-carcinogenic risk assessment via oral and dermal exposure routes in adults and children. Notably, all water resources exhibited high pollution risks with HPI and MI values exceeding permissible limits (HPI > 100 and MI > 6), respectively. Furthermore, HI oral values indicated significant non-carcinogenic risks to both adults and children, while dermal contact posed a high risk to 19.4% of samples for adults and 77.6% of samples for children (HI > 1). Most water samples exhibited CR values exceeding 1 × 10-4 for Cd, Cr, and Pb, suggesting vulnerability to carcinogenic effects in both age groups. Monte Carlo simulations reinforced these findings, indicating a significant carcinogenic impact on children and adults. Consequently, comprehensive water treatment measures are urgently needed to mitigate carcinogenic and non-carcinogenic health risks in Siwa Oasis.

Outcomes and Readmissions after Left Atrial Appendage Occlusion in Octogenarians: A Contemporary Analysis.

INTRODUCTION AND OBJECTIVES: The outcomes of left atrial appendage occlusion (LAAO) with the Watchman device in octogenarians are unknown as this population was underrepresented in major clinical trials. This study aims at examining the causes and outcomes of readmission after LAAO. DESIGN: A retrospective cohort study based on the National Readmission Database in the United States. SETTINGS AND PARTICIPANT: Patients aged ≥80 years, admitted between January 2016 and December 2018, with the primary diagnosis of atrial fibrillation or flutter or who had LAAO were included in the study. Patients who died during index admission were excluded. METHODS: We used the National Readmission Database and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify study participants. Data analysis was performed through Stata, version 17. Univariate and multivariate aggression analysis was used to adjust for confounders using Student t tests and χ2 tests. RESULTS: We identified 491,329 patients on anticoagulation (AC) and 2030 patients who underwent LAA closure. Neither group differed regarding hypertension, previous myocardial infarction, or valvular heart disease. All-cause readmissions were lower in the LAAO group at 45 days (adjusted P < .01). All-cause readmissions at 45 and 90 days were similar in both groups. There was an increase in gastrointestinal bleeding (GIB) readmissions in the LAAO at 45 (P < .01), 90 (P < .01), and 180 (P < .01) days. There was no difference in GIB readmission between the 2 groups. There was no also difference in stroke or intracranial hemorrhage rates between the 2 groups throughout the follow-up period. CONCLUSION AND IMPLICATIONS: In octogenarians who received LAAO, the rate of GIB increased during the first 6 months after the procedure; however, it was not different from that of AC after that. Special attention should be given to the antithrombotic regimens after LAAO to avoid bleeding in this vulnerable patient population.

Short duration of dual antiplatelet therapy following complex percutaneous coronary intervention: A systematic review and meta-analysis.

INTRODUCTION AND AIM: The optimal composition and duration of antiplatelet therapy after complex percutaneous coronary intervention (PCI) remains unclear. We conducted a meta-analysis to compare 1-3 months of dual antiplatelet therapy (DAPT) followed by monotherapy vs. 12 months of DAPT. METHOD: MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for studies comparing 1-3 months of DAPT followed by monotherapy vs. 12 months of DAPT in the outcomes of complex PCI from inception through January 2023. Outcomes of interest included major bleeding, all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stent thrombosis, target vessel revascularization, and stroke. RESULTS: Compared to 12 months, 1-3 months of dual antiplatelet therapy had a weak association with less major bleeding (OR 0.67; 95 % CI, 0.44-1.00; p = 0.05; I2 = 28 %). There were no significant differences between the shorter and longer antiplatelet therapy in terms of all-cause mortality (OR 0.83; 95 % CI, 0.59-1.16; p = 0.21; I2 = 17 %), cardiovascular mortality (OR 0.87; 95 % CI, 0.53-0.42; p = 0.50; I2 = 0), MI (OR 0.97; 95 % CI, 0.69-1.35; p = 0.82; I2 = 32 %), stent thrombosis (OR 1.17, 95 % CI, 0.77-1.76; p = 0.38; I2 = 0 %), target vessel revascularization (OR 1.05, 95 % CI, 0.58-1.89; p = 0.82; I2 = 64 %), or stroke (OR 1.10, 95 % CI, 0.55-2.17; p = 0.37; I2 = 7 %);. CONCLUSION: Among patients undergoing complex PCI, DAPT for 1-3 months may be associated with less major bleeding but similar rates of cardiovascular events (death, MI, stroke, stent thrombosis, and revascularization) compared to DAPT for 12 months.