Cholesterol-Lowering Drugs and Therapies in Cardiovascular Disease

Dyslipidemia is a major risk factor for cardiovascular disease (CVD). The relationship between low-density lipoprotein concentration and cardiovascular (CV) risk has been well established in numerous epidemiological studies. The benefit of cholesterol-lowering agents has been demonstrated in patients with known CVD. On the other hand, in patients without known CVD the decision to start therapy depends on their 10-year risk prediction of CV events. 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (“statins”), a mainstay of cholesterol-lowering therapy, have been shown to reduce both CV events and all-cause mortality. Other lipid-lowering measures (both pharmacological and nonpharmacological) have also been demonstrated in clinical trials to reduce CV outcomes. In this chapter, we review contemporary therapies used to treat dyslipidemia and discuss future directions including novel agents on the horizon

Diagnosis and Surveillance of Aortic Root Dilation

Aortic root dilation (AoD) imparts increased risk of aortic complications such as dissection, rupture, and valvular regurgitation. Multiple etiologies of AoD exist, such as Marfan syndrome, bicuspid aortic valve, Ehler-Danlos syndrome, infections, and idiopathic conditions. Due to the variety of clinical conditions that can result in AoD, and the risks associated with worsening AoD, a thorough understanding of the pathophysiology of AoD, noninvasive imaging modalities, and pharmacologic therapies is critical. This chapter will review the various etiologies of AoD, pathophysiological basis of each disease entity, overview of the diagnosis of AoD, noninvasive imaging modalities employed for detection and surveillance, pharmacological therapies used in the prevention and management, and the factors that guide intervention such as surgical repair

The Implications and Flow Behavior of the Hydraulically Fractured Wells in Shale Gas Formation

Shale gas formations are known to have low permeability. This low permeability can be as low as 100 nano darcies. Without stimulating wells drilled in the shale gas formations, it is hard to produce them at an economic rate. One of the stimulating approaches is by drilling horizontal wells and hydraulically fracturing the formation. Once the formation is fractured, different flow patterns will occur. The dominant flow regime observed in the shale gas formation is the linear flow or the transient drainage from the formation matrix toward the hydraulic fracture. This flow could extend up to years of production and it can be identified by half slop on the log-log plot of the gas rate against time. It could be utilized to evaluate the hydraulic fracture surface area and eventually evaluate the effectiveness of the completion job. Different models from the literature can be used to evaluate the completion job. One of the models used in this work assumes a rectangular reservoir with a slab shaped matrix between each two hydraulic fractures. From this model, there are at least five flow regions and the two regions discussed are the Region 2 in which bilinear flow occurs as a result of simultaneous drainage form the matrix and hydraulic fracture. The other is Region 4 which results from transient matrix drainage which could extend up to many years. The Barnett shale production data will be utilized throughout this work to show sample of the calculations. This first part of this work will evaluate the field data used in this study following a systematic procedure explained in Chapter III. This part reviews the historical production, reservoir and fluid data and well completion records available for the wells being analyzed. It will also check for data correlations from the data available and explain abnormal flow behaviors that might occur utilizing the field production data. It will explain why some wells might not fit into each model. This will be followed by a preliminary diagnosis, in which flow regimes will be identified, unclear data will be filtered, and interference and liquid loading data will be pointed. After completing the data evaluation, this work will evaluate and compare the different methods available in the literature in order to decide which method will best fit to analyze the production data from the Barnett shale. Formation properties and the original gas in place will be evaluated and compared for different methods

Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain

Purpose Perianal fistula is one of the most common anorectal diseases in adult patients, especially men. A relationship between pyogenic perianal abscess and fistula formation is established in multiple domains. This is the first exploration of such association among patients in the country as no related study has been published in Bahrain. We expect this study to be a foundation for future protocols and evidence-based practice. Methods A retrospective study was conducted in Salmaniya Medical Complex of Bahrain. A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018. Data were collected from the electronic files database used in Salmaniya Medical Complex (iSeha) as well as phone calls to the patients. Collected data were analyzed using statistical software. Results The most predominant presentation of perianal abscess was pain. Over 50% of abscesses were classified as perianal (56.9%) and among those, left-sided abscesses were more common, followed by right-, posterior-, and anterior-sited, respectively. No recurrence of abscess was recorded among 80% of patients. A fistula developed following abscess drainage in 33.9% of patients. Most fistulas (37.8%) were diagnosed within 6 months or less from abscess drainage. Posterior fistulas were the most common, followed by anterior and left-sided fistulas. Conclusion The incidence of anal fistula in Bahrain after perianal abscess was 33.9%. Most of the patients who developed a fistula following pyogenic abscess drainage were males and above the age of 40 years. The most common site for fistula was posterior

Novel alternatively-spliced exons of the VRK2 gene in mouse brain and microglial cells

Common sequence variations in the VRK2 gene contribute to genetic risk for various psychiatric diseases including schizophrenia and major depressive disorder. Despite the clear importance of studying the regulation and function of VRK2 for understanding the causes of these diseases, the organisation and expression of the gene remain poorly characterised. Using reverse-transcriptase-PCR, we have amplifed exons of Vrk2 mRNA from regions of mouse brain, and from different cell classes comprising neurones, astrocytes and microglial cells. We find that Vrk2 mRNA is expressed in all cell types, and that the splicing of the mouse Vrk2 gene is much more complex than previously appreciated. In addition to the predicted alternative splicing (absence/presence) of the penultimate 3 prime exon, we also detected a variety of 5 prime structures, including two novel exons spanning the first characterised exon (exon 1), which we term exons 1a and 1b. While expressed in neurones and astrocytes, exon 1b was not expressed in microglial cells. Expression of transcripts containing exon 1a in microglia was increased by immune stimulation. An additional truncated transcript lacking 7 central exons was also identified. As with the human gene, the results confirm complex patterns of alternative splicing which are likely to be relevant for understanding the physiological and pathological function of the gene in the CNS

Transforming ophthalmic education into virtual learning during COVID-19 pandemic : a global perspective

Objective: The coronavirus disease 2019 (COVID-19) pandemic has imposed measures of social distancing and barriers in delivery of "in person" education. Institutions, involved in training the next generation of ophthalmologists, are using alternative teaching methods to maintain the standard of education. Methods: We conducted a worldwide survey among physicians, who are actively involved in Ophthalmology-related education, between 3 and 14 April 2020. The expert survey, developed on the basis of literature search and focus group discussions, comprised 23 questions addressing the use of e-learning in Ophthalmology during the COVID-19 pandemic. Results: A total of 321 participants from both academic and non-academic institutions worldwide, with variable practice experience and expertise, completed the survey. Before the pandemic, the majority of participants used traditional training modalities, including lectures, grand rounds and journal clubs, and 48% did not use any e-learning. There was a statistically significant increase in the use of all e-learning alternatives during the pandemic (p < 0.001), associated mainly with the availability of e-learning facilities (p < 0.001) and the academic character of institutions (p < 0.001). Zoom\uae was recognized as the mostly used platform for virtual teaching. Although theoretical teaching may take place, the surgical training of residents/fellows was dramatically reduced. The latter was significantly associated with participants' perspectives about teaching practices (p < 0.001). Conclusion: COVID-19 pandemic imposed great challenges in the educational field of Ophthalmology. The experience related to virtual training in Ophthalmology, gained during the pandemic, may change the traditional teaching practices in the world and provide new educational opportunities

Patterns of antibiotic prescriptions and appropriateness in the emergency room in a major secondary care hospital in Bahrain

Objective: To describe the pattern and appropriateness of antibiotics prescribed in the emergency room in a major secondary care hospital in Bahrain.Methods: Patients aged more than or equal to 14 years old that attended emergency room and was prescribed antibiotics from 1 to 31 July 2014 were included. Data were obtained from patients’ emergency records. Antibiotic treatment was classified to appropriate, inappropriate or unjustified use according to the local or international guidelines. Chi Square was performed to evaluate the variables associated to appropriateness antibiotic treatment.Results: A total of 1313 patients were included (52.6% males), mostly in the age group 14-30 years old (45.3%). The most frequent diseases attended were upper respiratory and urinary tract infections (27.3% and 22.1%,respectively). Cefuroxime was the most prescribed antibiotic (37.5%) followed by ciprofloxacin (20.8%). Percentage of inappropriate antibiotics prescription was 81.9% mostly due to unjustified use. Inappropriate antibiotic treatment was significantly more common in males (87.1%; P-value <0.001), in patients without mentioned diagnosis, then upper respiratory tract infection (100%, 96.9%. P-value <0.001) and prescriptions written by emergency physicians (85.5%; P- value <0.001).Conclusion: The study concludes that high rate of inappropriate antibiotics use mostly among patients treated by emergency doctors

Overview on Epidemiology and Management of Myxedema Coma or Crisis

The most severe type of hypothyroidism is known as myxedema coma, which can quickly lead to death if not identified and treated aggressively. The condition known as hypothyroidism is easily detected and treated. But if ignored, it might eventually progress to myxedema coma, the most serious form of hypothyroidism. Since the majority of patients do not initially appear in a coma, the term "myxedema coma" is usually regarded as misleading. Lethargy usually progresses to stupor, which then becomes a coma with hypothermia and respiratory failure. only clinical criteria are used for diagnosis because thyroid hormone assays are unable to distinguish between simple hyperthyroidism and thyroid storm. Apart from essential medical interventions, the treatment focuses on preventing thyroid hormone production and secretion as antithyroid medications, and preventing the peripheral effects of thyroid hormone as β-blocker, glucocorticoids. The diagnosis of thyroid-stimulating hormone (TSH) in the blood is the same as that of simple hypothyroidism. As soon as a diagnosis is obtained, treatment should start right away. The majority of hospital and commercial laboratories can turnaround a TSH test in a matter of hours

Fracture parameter inversion from passive seismic shear-wave splitting: A validation study using full-waveform numerical synthetics

Fractures are pervasive features within the Earth's crust and they have a significant influence on the multi-physical response of the subsurface. The presence of coherent fracture sets often leads to observable seismic anisotropy enabling seismic techniques to remotely locate and characterise fracture systems. Since fractures play a critical role in the geomechanical and fluid-flow response, there has been significant interest in quantitatively imaging in situ fractures for improved hydro-mechanical modelling. In this study we assess the robustness of inverting for fracture properties using shear-wave splitting measurements. We show that it is feasible to invert shear-wave splitting measurements to quantitatively estimate fracture strike and fracture density assuming an effective medium fracture model. Although the SWS results themselves are diagnostic of fracturing, the fracture inversion allows placing constraints on the physical properties of the fracture system. For the single seismic source case and optimum receiver array geometry, the inversion for strike has average errors of between 11° and 25°, whereas for density has average errors between 65% and 80% for the single fracture set and 30% and 90% for the double fracture sets. For real microseismic datasets, the range in magnitude of microseismicity (i.e., frequency content), spatial distribution and variable source mechanisms suggests that the inversion of fracture properties from SWS measurements is feasible

Major Cardiovascular Events After COVID-19, Event Rates Post-vaccination, Antiviral or Anti-inflammatory Therapy, and Temporal Trends: Rationale and Methodology of the Corona-VTE-Network Study

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with excess risk of cardiovascular and thrombotic events in the early post-infection period and during convalescence. Despite the progress in our understanding of cardiovascular complications, uncertainty persists with respect to more recent event rates, temporal trends, association between vaccination status and outcomes, and findings within vulnerable subgroups such as older adults (aged 65 years or older), or those undergoing hemodialysis. Sex-informed findings, including results among pregnant and breastfeeding women, as well as adjusted comparisons between male and female adults are similarly understudied. METHODS: Adult patients, aged ≥18 years, with polymerase chain reaction-confirmed COVID-19 who received inpatient or outpatient care at the participating centers of the registry are eligible for inclusion. A total of 10,000 patients have been included in this multicenter study, with Brigham and Women\u27s Hospital (Boston, MA) serving as the coordinating center. Other sites include Beth Israel Deaconess Medical Center, Anne Arundel Medical Center, University of Virginia Medical Center, University of Colorado Health System, and Thomas Jefferson University Health System. Data elements will be ascertained manually for accuracy. The two main outcomes are 1) a composite of venous or arterial thrombotic events, and 2) a composite of major cardiovascular events, defined as venous or arterial thrombosis, myocarditis or heart failure with inpatient treatment, new atrial fibrillation/flutter, or cardiovascular death. Clinical outcomes are adjudicated by independent physicians. Vaccination status and time of inclusion in the study will be ascertained for subgroup-specific analyses. Outcomes are pre-specified to be reported separately for hospitalized patients versus those who were initially receiving outpatient care. Outcomes will be reported at 30-day and 90-day follow-up. Data cleaning at the sites and the data coordinating center and outcomes adjudication process are in-progress. CONCLUSIONS: The CORONA-VTE-Network study will share contemporary information related to rates of cardiovascular and thrombotic events in patients with COVID-19 overall, as well as within key subgroups, including by time of inclusion, vaccination status, patients undergoing hemodialysis, the elderly, and sex-informed analyses such as comparison of women and men, or among pregnant and breastfeeding women