Association between Lipoprotein(a) concentration and adverse cardiac events in patients with coronary artery disease: An observational cohort study.

This prospective study investigated the association between lipoprotein (a) [Lp(a)] levels and adverse cardiac events in patients undergoing percutaneous coronary intervention (PCI) for coronary artery disease. Among 600 patients, 79.16 % were male. Kaplan Meier analysis revealed significantly higher incidence rates of cardiac death, major adverse cardiac events, myocardial infarction, revascularization and stroke in patients with elevated Lp(a) (≥30 mg/dL). The Cox Regression model identified Lp(a) ≥30 mg/dL as a significant risk factor for adverse events (HR: 4.2920; 95%CI: 2.58-7.120; p < 0.05). Elevated Lp(a) levels were associated with an increased risk of adverse cardiac events in coronary artery disease patients undergoing PCI.

Confounding Factors Responsible for Elevated Lp(a) Levels in Patients with Coronary Artery Disease.

BACKGROUND: Cardiovascular diseases (CVDs) are a leading cause of global mortality, motivating research into novel approaches for their management. Lipoprotein(a) (Lp(a)), a unique lipoprotein particle, has been implicated in atherosclerosis and thrombosis, suggesting its potential as a therapeutic target for CVDs. AIM: This study aimed to investigate the association of Lp(a) levels with various cardiovascular parameters and events among patients with confirmed cardiovascular disease. METHODOLOGY: A prospective study was conducted, enrolling 600 participants, predominantly comprising males (79%), with a mean age of 52.78 ± 0.412 years diagnosed with cardiovascular disease. The follow-up was done for 18 months. Patient demographics, blood investigations, and occurrence of major adverse cardiac events (MACE) were collected. SPSS version 21 was used to statistically analyze the relationships between elevated Lp(a) levels and factors such as age, glycated hemoglobin, mortality, MACE, cardiac death, target vessel revascularization, and stroke. RESULTS: The study revealed significant (P < 0.05) associations between elevated Lp(a) levels and advanced age, increased glycated hemoglobin levels, as well as occurrences of all-cause mortality, MACE, cardiac death, target vessel revascularization, and stroke. Notably, a significant (P < 0.05), association between high Lp(a) levels and acute coronary syndrome (ACS) emerged, suggesting Lp(a)'s role in advanced cardiac events. CONCLUSION: The findings highlight the potential significance of Lp(a) as a notable risk factor in cardiovascular health. The observed associations between elevated Lp(a) and adverse cardiovascular events, including ACS, underscore its pathogenic role. Consequently, this study supports the rationale for further research into Lp(a)-specific therapeutic interventions, offering substantial promise in refining the management strategies for cardiovascular diseases.

Protein Adsorption on Solid Surfaces: Data Mining, Database, Molecular Surface-Derived Properties, and Semiempirical Relationships.

Protein adsorption on solid surfaces is a process relevant to biological, medical, industrial, and environmental applications. Despite this wide interest and advancement in measurement techniques, the complexity of protein adsorption has frustrated its accurate prediction. To address this challenge, here, data regarding protein adsorption reported in the last four decades was collected, checked for completeness and correctness, organized, and archived in an upgraded, freely accessible Biomolecular Adsorption Database, which is equivalent to a large-scale, ad hoc, crowd-sourced multifactorial experiment. The shape and physicochemical properties of the proteins present in the database were quantified on their molecular surfaces using an in-house program (ProMS) operating as an add-on to the PyMol software. Machine learning-based analysis indicated that protein adsorption on hydrophobic and hydrophilic surfaces is modulated by different sets of operational, structural, and molecular surface-based physicochemical parameters. Separately, the adsorption data regarding four "benchmark" proteins, i.e., lysozyme, albumin, IgG, and fibrinogen, was processed by piecewise linear regression with the protein monolayer acting as breakpoint, using the linearization of the Langmuir isotherm formalism, resulting in semiempirical relationships predicting protein adsorption. These relationships, derived separately for hydrophilic and hydrophobic surfaces, described well the protein concentration on the surface as a function of the protein concentration in solution, adsorbing surface contact angle, ionic strength, pH, and temperature of the carrying fluid, and the difference between pH and the isoelectric point of the protein. When applying the semiempirical relationships derived for benchmark proteins to two other "test" proteins with known PDB structure, i.e., ß-lactoglobulin and α-lactalbumin, the errors of this extrapolation were found to be in a linear relationship with the dissimilarity between the benchmark and the test proteins. The work presented here can be used for the estimation of operational parameters modulating protein adsorption for various applications such as diagnostic devices, pharmaceuticals, biomaterials, or the food industry.

Fluorescence Interference Contrast-enabled structures improve the microarrays performance.

Continuous improvements of the fluorescence-based sensitivity and specificity, required for high throughput screening, diagnostics, and molecular biology studies, are usually addressed by better readout systems, or better reporting elements. However, while Fluorescence Interference Contrast (FLIC), which modulates the fluorescence by materials-based parameters, has been used for decades to measure biomolecular interactions at nanometer-precision, e.g., for the study of molecular motors and membrane processes, it has been seldom used for high throughput or diagnostic microdevices. Moreover, the amplification of both the fluorescence signal, modulated by vertically-nano-calibrated structures, and the signal/background, modulated by laterally-micro-calibrated structures, has not been explored. To address this synergy, structures comprising optically transparent silicon oxide, tens of micrometers-wide and with thicknesses in the low hundreds of nanometers, which are able to promote the formation of standing waves if patterned on a reflective material, have been designed, fabricated and tested, for the use in DNA- and protein arrays. The light emitted by a fluorophore placed on top of the structures and reflected by a bottom mirror surface, e.g., silicon, platinum, is physically constrained to a region defined lithographically, both vertically and laterally, i.e., micro-pillars and -wells, resulting in an accurate identification and quantification of fluorescence. The signal/noise ratio on micro-/nano-structured substrates is comparable to that measured on planar substrates, but the physical confinement of the microarray spots results in a considerable increase of the intra-feature uniformity.

Protein microarray spots are modulated by patterning method, surface chemistry and processing conditions.

The uniformity of the protein patterns, their shape, and the contrast between the fluorescence signal of the pattern and the background, critically modulate the quantitative accuracy of the microarray-derived data. While significant research focused of the identification of the factors that impact the protein microarray patterns, these studies usually have focused on the optimization of one set of these factors, e.g., how the spot uniformity is affected by different additives, or by different surfaces. However, the complex interaction between proteins, carrier fluids, surfaces, and patterning methodologies used would suggest a systematic and more comprehensive study that considers all these parameters, as well as their inter-relationship. The present work compared the patterning of two fluorescently-tagged proteins, i.e., IgG, BSA, on surfaces with different hydrophobicity and chemistry, and printed by inkjet, pin, and microcontact printing (µCP). The quantification of the spot size regularity, its morphology, the signal intensity and its distribution within spots were used to assess the quality of a specific printing method, on a specific surface, with a specific solute of the printed protein. It was found that the optimal uniformity for both droplet-based methods depend on surface chemistry, with glass slides modified with 3-Glycidoxypropyl-dimethoxymethyl silane (GPS) and 3-(Aminopropyl)-triethoxy silane (APTES) exhibiting the greatest uniformity, while uniformity of the µCP patterns was relatively independent of the surface chemistry. For the inkjet and pin printing, the largest fluorescence signal and contrast with the background was found on APTES modified glass slides, whereas for the µCP the fluorescence signal increased with increasing hydrophilicity.

Impact of socioeconomic status on adverse cardiac events after coronary angioplasty: a cohort study.

BACKGROUND: Socioeconomic status (SES) has been associated with adverse cardiovascular events in coronary atherosclerotic disease. However, it is unclear how SES impacts adverse cardiac events in patients treated with percutaneous coronary intervention (PCI). METHODS: We determined SES based on educational, economic and occupational parameters for 630 consecutive patients who underwent PCI at our centre between 01 June 2015 and 01 June 2016. The patients were divided into low and high SES groups, and they were followed up for 12 months. Patients were matched at baseline for demographic and procedural characteristics; multivariate analysis was used to adjust for baseline and procedural variables. Postprocedure compliance to medications was analysed. At 12 months, the primary composite end point of major adverse cardiac events (MACE) - consisting of death, non-fatal myocardial infarction, target lesion revascularisation, target vessel revascularisation - was compared between the groups. RESULTS: The high SES group had a higher prevalence of diabetes mellitus (p=0.03; OR 0.74%, 95% CI 0.53% to 1.03%) and a stronger family history of ischaemic heart disease (p=0.003; OR 0.53%, 95% CI 0.33% to 0.84%). Low SES was associated with lower compliance with medication (p=0.01; OR 2.22%, 95% CI 1.19% to 4.15%). At 12 months, the primary composite end point of MACE was found to be higher in the low SES group (p=0.01); higher MACE was primarily driven by cardiac mortality (p<0.001). Low SES was found to be an independent predictor of MACE (HR 1.84%, 95% CI 1.16% to 2.96%). CONCLUSION: Low SES was associated with a higher incidence of major adverse cardiac events in patients undergoing PCI and was an independent predictor of MACE at 12 months.

Understanding masked depression: A Clinical scenario.

BACKGROUND: Masked depression is often misdiagnosed due to the predominance of somatic symptoms and is further complicated by lack of awareness among doctors. AIM: The present survey was conducted to gather the views of psychiatrists and nonpsychiatrists regarding presentation and management aspects of masked depression. This may help in unmasking this condition and facilitate early identification and appropriate management of patients presenting with this condition. MATERIALS AND METHODS: This questionnaire-based survey was conducted as an interview through computer-aided telephonic interview among 300 doctors (150 psychiatrists and 150 nonpsychiatrists) across India. RESULTS: Both psychiatrists and nonpsychiatrists reported a high prevalence of somatic symptoms among patients with masked depression. Nonpsychiatrists (44%) more often than psychiatrists (20%) noted chronic pain in the majority of patients with masked depression. Psychiatrists (31%) more often than nonpsychiatrists (9%) noted lack of concentration in the majority of patients with masked depression. Sexual dysfunction among young patients and noncompliance to therapy for chronic illness were considered as potential predictors of masked depression. There was a general agreement among psychiatrists and nonpsychiatrists that medical liaising is beneficial for the management of patients with masked depression. CONCLUSION: Both psychiatrists and nonpsychiatrists agree that somatic symptoms are commonly encountered in patients with masked depression. However, these somatic symptoms are often interpreted as physical illness rather than as an entity of depression which creates an unmet need in terms of managing masked depression, especially by nonpsychiatrists.

Manipal lifestyle modification score to predict major adverse cardiac events in postcoronary angioplasty patients.

BACKGROUND: Lifestyle modification (LSM) such as prudent diet, physical activity, avoidance of smoking, and maintaining a healthy weight may considerably decrease the risk for coronary artery disease. OBJECTIVE: The primary objective of this study was to develop a new LSM scoring system and investigate the correlation between adherence to LSM and incidence of major adverse cardiac events (MACEs) at 12-month follow-up. METHOD: A total of 1000 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA) were included in this prospective single-center study. Manipal lifestyle modification score (MLSMS) was developed by using five lifestyle-related factors. Adherence to LSM at the baseline and subsequent follow-ups was determined by using MLSMS. The MACE at 1-, 6-, and 12-month follow-up were analyzed. RESULTS: There was a significant reduction in overall adherence to LSM (p < 0.001) at 12-month follow-up. Nonadherence to LSM [hazard ratio (HR) 0.575; 95% confidence interval (CI) 0.334-0.990; p < 0.046] and noncompliance to medication (HR 2.09; 95% CI 1.425-3.072; p < 0.001) were independent predictors of MACEs after PTCA. The cumulative MACE was 15.4%, which includes 4.9% of all-cause death, 5.2% of nonfatal myocardial infarction, 2.0% of target lesion revascularization, 1.8% of target vessel revascularization, and 1.3% of stroke at 12 months. The incidence of MACEs at 12 months was significantly (p = 0.03) higher in LSM nonadherent compared with LSM adherent patients. CONCLUSION: There is an overall reduction in adherence to LSM on successive follow-ups and a significant association between the incidence of MACEs and the lack of adherence to LSM. MLSMS is a simple and effective evaluation tool in predicting MACEs in this group of patients.

Thermal lysis and isothermal amplification of Mycobacterium tuberculosis H37Rv in one tube.

Tuberculosis (TB) is a leading cause of high mortality rates in developing countries. Sample preparation is one of the major challenges in developing an inexpensive point-of-care device for rapid and confirmed detection of tuberculosis. Existing chemical and mechanical lysis methods are unsuitable for field applications, as they require intermediate wash steps, manual intervention or separate lysis equipment. We report a one-step reaction protocol (65°C and 60min) for the H37Rv strain of Mycobacterium tuberculosis that (i) completely disinfects the mycobacteria culture, (ii) lyses the cells and (iii) performs helicase dependent amplification on the extracted DNA. Our assay combines multiple functions in a single step, uses a dry heat bath and does not require any intermediate user intervention, which makes it suitable for use by minimally trained health workers at the point of care.

Multiple Drugs Causing Severe Anemia in Infective Endocarditis.

Ceftriaxone and linezolid are commonly used antibiotics in infective endocarditis. Here we present a rare case of severe anemia caused by both the drugs via different mechanisms. Drugs have shown significant contribution in inducing anemia via hemolysis and bone marrow suppression in an infective endocarditis patient.

Malignant triton tumor: a rare case.

Malignant triton tumor (MTT) is a malignant peripheral nerve sheath tumor (MPNST) with rhabdomyoblastic differentiation. This rare tumor, with fewer than 100 cases reported in the literature, generally affects adult patients with neurofibromatosis 1 (NF-1). We report such a case in a 34-year-old man with NF-1 who presented with a mass over the medial side of the arm. Histopathologically finding of rhabdomyoblasts among malignant Schwann cells in a tumor arising from a peripheral nerve supported by immunostaining with S-100 protein and myogenin confirmed the diagnosis. MTT has a poor prognosis owing to its aggressive biological behavior. The fact that this tumor is extremely rare has prompted us to report this case.

Primary hepatic neuroendocrine tumor: an unusual cystic presentation.

Primary neuroendocrine tumors of the liver are exceedingly rare and unlike metastatic neuroendocrine tumor rarely cause carcinoid syndrome. There are only about 60 such cases reported in the current literature. We present a case of a 57-year-old male with a primary hepatic neuroendocrine tumor which presented as cystic mass and successfully resected. The case presented required meticulous radiological, histopathological, and immunohistochemical work-up to rule out an occult extrahepatic malignancy with hepatic metastasis to confirm the primary nature of hepatic tumors. Here we intend to put forward a review of the current literature regarding the diagnosis, pathology, and management of this disease.