Impact of coronavirus disease 2019 (COVID-19) outbreak on outcome of myocardial infarction in Hong Kong, China.

OBJECTIVE: To determine whether COVID-19 may adversely affect outcome of myocardial infarction (MI) patients in Hong Kong, China. BACKGROUND: The COVID-19 pandemic has infected thousands of people and placed enormous stress on healthcare system. Apart from being an infectious disease, it may affect human behavior and healthcare resource allocation which potentially cause treatment delay in MI. METHODS: This was a single center cross-sectional observational study. From November 1, 2019 to March 31, 2020, we compared outcome of patients admitted for acute ST-elevation MI (STEMI) and non-ST elevation MI (NSTEMI) before (group 1) and after (group 2) January 25, 2020 which was the date when Hong Kong hospitals launched emergency response measures to combat COVID-19. RESULTS: There was a reduction in daily emergency room attendance since January 25, 2020 (group 1,327/day vs. group 2,231/day) and 149 patients with diagnosis of MI were included into analysis (group 1 N = 85 vs. group 2 N = 64). For STEMI, patients in group 2 tended to have longer symptom-to-first medical contact time and more presented out of revascularization window (group 1 27.8 vs. group 2 33%). The primary composite outcome of in-hospital death, cardiogenic shock, sustained ventricular tachycardia or fibrillation (VT/VF) and use of mechanical circulatory support (MCS) was significantly worse in group 2 (14.1 vs. 29.7%, p = .02). CONCLUSIONS: More MI patients during COVID-19 outbreak had complicated in-hospital course and worse outcomes. Besides direct infectious complications, cardiology community has to acknowledge the indirect effect of communicable disease on our patients and system of care.

Incidence of dual antiplatelet therapy interruption within 1 year after primary percutaneous coronary intervention in patients with acute ST elevation myocardial infarction.

BACKGROUND: After primary percutaneous coronary intervention (PPCI) in patients with acute ST elevation myocardial infarction (STEMI), dual antiplatelet therapy (DAPT) is recommended to continue for 1 year. Occasionally, DAPT interruption may be required due to bleeding issues or unplanned surgical procedures. OBJECTIVE: To systematically evaluate the incidence of DAPT interruption within 1 year after PPCI. METHODS AND RESULTS: This was a single-centre, retrospective registry study. Consecutive patients with STEMI who underwent PPCI from 2013 to 2017 (N=538) were recruited into the analysis. The primary outcome was the incidence of interruption of DAPT within 1 year from the index PPCI. Secondary outcomes included incidence of bleeding in 1 year and prevalence of high bleeding risk (HBR) criteria at index presentation. Within 1 year, 17.1% (84/490) of post-PPCI survivors needed DAPT interruption and 7.1% (35/490) had major bleeding (Bleeding Academic Research Consortium type 3 or 5). At index presentation, HBR criteria were present in 36.1% (194/538) of patients. On univariate analysis, age, female gender, anaemia, anticoagulation, diabetes, hypertension and being a non-smoker were associated with DAPT interruption. On multivariate analysis, age was the only independent factor to predict DAPT interruption. CONCLUSION: DAPT interruption was not uncommon after PPCI in patients with STEMI particularly in the elderly. This has implication on stent selection during PPCI, and further studies are required to investigate which type of stent may best suit our real-life patients with STEMI.

Enhanced mitigation of para-chlorophenol using stratified activated carbon adsorption columns.

The adsorptive removal of toxic para-chlorophenol using activated carbon adsorption columns is a proven effective engineering process. This paper examined the possibility to stratify an adsorbent bed into layers, in order to enhance the adsorption process performance in terms of increased column service time and adsorbent bed saturation. Four different types of fixed-bed adsorption columns are used and compared under the same operating conditions, but with the variation of column geometry and activated carbon particle size stratification. The Type 3 column - a cylindrical column with particle stratification packing, is found to be the most efficient choice, as the extent of column service time and adsorbent bed saturation are the largest. This could eventually decrease the frequency of adsorbent replacement/regeneration and hence reduce the operating cost of the fixed-bed adsorption process. The Homogeneous Surface Diffusion Model (HSDM) was applied successfully to describe the dynamic adsorption of para-chlorophenol onto Filtrasorb 400 (F400) activated carbon in different types of columns. The Redlich-Peterson isotherm model equation, an experimentally derived external mass transfer correlation and a constant surface diffusivity are used in the HSDM. The optimised surface diffusivity of para-chlorophenol is found to be 1.20E-8 cm(2)/s, which is in good agreement with other phenolics/F400 carbon diffusing systems in literature.

Reliability of vacuum phenomenon in the sacroiliac joint as a sign of traumatic injury.

OBJECTIVE: To determine whether a vacuum phenomenon in the sacroiliac joint is a reliable sign of pelvic injury in trauma patients. MATERIALS AND METHODS: Prospective data were collected over a 1-year period for 107 patients with pelvic trauma and 104 nontrauma patients. Age ranges were 13-93 years in the trauma group and 19-83 years in the nontrauma group. All the patients had pelvic CT scans. The cases were assessed with regard to gas in the sacroiliac joint, osseous pelvic injuries, and mechanism of injury, and demographic data were analyzed. Injuries were caused by motor vehicle accidents in 67 cases, pedestrians being struck by a motor vehicle in 20, falling from a height in 18, gunshot wound in 1, and crush injury in 1. The indications for CT scan in the nontrauma patients were pain in 33 cases, infection in 31, cancer in 29, transplant in 5, bleeding in 4, and abnormal liver function tests in 2. RESULTS: Gas in the sacroiliac joint was present in 11 out of 107 trauma patients (10%) and 12 out of 104 nontrauma patients (12%). There was no statistical difference in the incidence of the vacuum phenomenon between the two patient populations according to the Chi(2) test. Degenerative sacroiliac changes were evident in 18 out of 107 trauma patients (17%) and 32 out of 104 nontrauma patients (41%). CONCLUSION: Gas in the sacroiliac joint is not a reliable indicator of sacroiliac joint injury.