Current Landscape of Temporary Percutaneous Mechanical Circulatory Support Technology

Mechanical circulatory support devices provide hemodynamic support to patients who present with cardiogenic shock. These devices work using different mechanisms to provide univentricular or biventricular support. There is a growing body of evidence supporting use of these devices as a goal for cardiac recovery or as a bridge to definitive therapy, but definitive, well-powered studies are still needed. Mechanical circulatory support devices are increasingly used using shock team and protocols, which can help clinicians in decision making, balancing operator and institutional experience and expertise. The aim of this article is to review commercially available mechanical circulatory support devices, their profiles and mechanisms of action, and the evidence available regarding their use

Caracterización del aceite de Leucaena (Leucaena leucocephala) por análisis directo en tiempo real (DART) y cromatografía de gases

For the first time, we report the characterization of triacylglycerols and fatty acids in Leucaena (Leucaena leucephala) oil [LUCO], an unexplored nontraditional non-medicinal plant belonging to the family Fabaceae. LUCO was converted to fatty acid methyl esters (FAMEs). We analyzed the triacylglycerols (TAGs) of pure LUCO and their FAMEs by time-of-flight mass spectrometry (TOF-MS) followed by multivariate analysis for discrimination among the FAMEs. Our investigations for the analysis of LUCO samples represent noble features of glycerides. A new type of ion source, coupled with high-resolution TOF-MS was applied for the comprehensive analysis of triacylglycerols. The composition of fatty acid based LUCO oil was studied using Gas Chromatography (GC-FID). The major fatty acid components of LUCO oil are linoleic acid (52.08%) oleic acid (21.26%), palmitic acid (7.91%) and stearic acid (6.01%). A metal analysis in LUCO was done by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The structural elucidation and thermal stability of LUCO were studied by FT-IR, 1H NMR, 13C NMR spectroscopic techniques and TGA-DSC, respectively. We also measured the cytotoxicity of LUCO.Se presenta por primera vez la caracterización de triacilgliceroles y ácidos grasos del aceite de Leucaena (Leucaena leucephala) [LUCO], una planta no medicinal, no tradicional y no explorada, perteneciente a la familia Fabaceae. Se analizaron triacilgliceroles (TAGs) de LUCO y sus FAMEs por espectrometría de masas de tiempo de vuelo (TOF-MS) seguido de análisis multivariante para discriminación entre los FAME. Nuestras investigaciones para el análisis de muestras de LUCO presentaron características propias de los glicéridos. Un nuevo tipo de fuente de iones, junto con alta resolución TOF-MS se aplicó para el análisis exhaustivo de triacilgliceroles. La composición de aceite de LUCO basado en ácidos grasos se estudió usando Cromatografía de Gas (GC-FID). Los principales componentes de ácidos grasos del aceite LUCO fueron, linoleico (52,08%), oleico (21,26%), palmítico (7,91%) y esteárico 6,01%. El análisis de metales se realizó mediante Espectrometría de Plasma Acoplado Inductivamente a Masas (ICP-MS). La elucidación estructural y la estabilidad térmica de LUCO se estudiaron mediante FT-IR, 1H NMR, técnicas espectroscópicas de 13C NMR y TGA-DSC, respectivamente. También se midió la citotoxicidad de LUCO

A missense mutation in TRAPPC6A leads to build-up of the protein, in patients with a neurodevelopmental syndrome and dysmorphic features.

Childhood onset clinical syndromes involving intellectual disability and dysmorphic features, such as polydactyly, suggest common developmental pathways link seemingly unrelated phenotypes. We identified a consanguineous family of Saudi origin with varying complex features including intellectual disability, speech delay, facial dysmorphism and polydactyly. Combining, microarray based comparative genomic hybridisation (CGH) to identify regions of homozygosity, with exome sequencing, led to the identification of homozygous mutations in five candidate genes (RSPH6A, ANKK1, AMOTL1, ALKBH8, TRAPPC6A), all of which appear to be pathogenic as predicted by Proven, SIFT and PolyPhen2 and segregate perfectly with the disease phenotype. We therefore looked for differences in expression levels of each protein in HEK293 cells, expressing either the wild-type or mutant full-length cDNA construct. Unexpectedly, wild-type TRAPPC6A appeared to be unstable, but addition of the proteasome inhibitor MG132 stabilised its expression. Mutations have previously been reported in several members of the TRAPP complex of proteins, including TRAPPC2, TRAPPC9 and TRAPPC11, resulting in disorders involving skeletal abnormalities, intellectual disability, speech impairment and developmental delay. TRAPPC6A joins a growing list of proteins belonging to the TRAPP complex, implicated in clinical syndromes with neurodevelopmental abnormalities

TCT-175 Safety and Complications Associated With the Use of Protamine in Percutaneous Coronary Intervention

Background: There is a paucity of data on the use of protamine after percutaneous coronary intervention (PCI). Methods: We conducted a retrospective analysis of 168 patients who underwent PCI from 2015 to 2021. All patients received protamine intra- or immediately after index PCI. We evaluated baseline characteristics, intraprocedural characteristics including heparin dosing and protamine dosing, and complications such as acute stent thrombosis (ST), dissection, perforation, and access-site bleeding. The primary outcome was the incidence of acute ST, subacute ST, and other thrombotic complications. Secondary outcomes included mortality within 24 hours and within 28 days of the index procedure. Results: One hundred sixty-eight patients were included. The mean age of patients was 72 ± 12.1 years, and 36% were women. The majority of patients received antiplatelet therapy prior to the index procedure (90%), and the average ejection fraction (EF) was 50% ± 14.3%. Of the 33 insulin-dependent patients (20%), only 1 (0.5%) used neutral protamine Hagedorn insulin. One hundred fifteen of the procedures (68%) were elective, and the average procedure time was 3 hours 21 minutes (SD 1 hour 43 minutes). Fifty-nine patients underwent rotational, orbital, or laser atherectomy (27, 23, and 9 patients, respectively). An average of 2.59 ± 1.38 stents were deployed, and intravascular ultrasound was used in 96 patients (57%). An average protamine dose of 32 mg was administered. Seventy-three patients (43%) had coronary perforations, and 19 (11%) had pericardial effusions requiring pericardiocentesis. Twenty-one patients (13%) had coronary dissections following PCI, and 6 (4%) had access-site bleeding requiring transfusion. Three patients (2%) underwent urgent cardiac surgery. Eight (5%) died within 24 hours of PCI, and 6 (3.5%) died within 28 days of PCI. Four patients (2%) had acute ST, no patients experienced subacute ST, and 1 patient (0.5%) developed arterial thrombosis (common femoral artery). Conclusions: Use protamine in PCI typically occurred because of intraprocedural complications. In our series, protamine was tolerated well in the majority of patients, but 3% of patients experienced coronary or arterial thrombosis, warranting caution when using protamine in these challenging scenarios. Categories: CORONARY: Stents: Drug-Elutin

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Failed Manta Closure Device After High-Risk PCI

Although the collagen-based Manta closure device (Teleflex) is a safe and effective option to close large-bore arterial access sites, complications can occur in at-risk cohorts, as seen in this clinical scenario. It is important for clinicians to share these complications as new technology is introduced

Are dental care providers in Saudi Arabia prepared to treat patients with special needs?

Arwa Alumran, Luloah Almulhim, Bainah Almolhim, Shouq Bakodah, Hessa Aldossary, Saja A AlrayesHealth Information Management and Technology Department, College of Public Health, Imam Abdulrahman bin Faisal University, Alkhobar, Saudi ArabiaBackground: Equity in services accessibility is one of the major components of good quality healthcare. However, patients with special needs have limited access to dental care services, which could be due to the lack of training and experience of the dental care providers that might effect on their preparedness and willingness when it comes to caring for the patients with special needs.Objectives: The main objective of this study is to determine the factors influencing the preparedness and willingness of dental care providers at different Saudi Arabian universities to provide treatment to patients with special needs.Methods: A Cross-sectional study design targeting all dental care providers such as interns, residents, specialists, consultants, dental nurses and students from universities around Saudi Arabia. Two scales were adapted to determine the dental care providers’ perceived preparedness and willingness to treat patients with special needs.Results: A total of 243 participants from dental colleges around Saudi universities were included in the study. Males appeared to be more prepared and willing to treat patients with special needs compared to females. Dental care providers from King Saud University perceived more preparedness compared to other universities in the study. While graduates from King Abdulaziz University exhibit more preparedness to treat patients with special needs compared to graduates from other universities in the study. Also, dental care providers who have treated a patient with special needs perceived more preparedness to treat them again.Conclusion: When a dental care provider have treated a patient with special needs or just dealt with them in a daily life, this experience procured high preparedness score, however, did not influence on their willingness score in the treatment of these individuals. Good dental education programs are important to provide equity of dental care services to all parts of the community equally.Keywords: autism spectrum disorder, dental care, oral health, dental education, quality of healthcare, social determinants of healt

Transradial versus transfemoral approach for percutaneous coronary intervention of chronic total occlusions: A meta-analysis and meta-regression

Background: Efficacy and safety of transradial approach (TRA) versus transfemoral approach (TFA) in chronic total occlusion percutaneous coronary intervention (CTO PCI) have not yet been determined. We performed a meta-analysis to compare TRA and TFA in CTO PCI. Methods: We comprehensively searched EMBASE, PubMed, and Web of Science. The primary endpoint was procedural success. Secondary endpoints were access site-related complications and bleeding, all-cause mortality, myocardial infarction (MI), contrastinduced nephropathy (CIN), contrast volume, fluoroscopy time, procedure time, urgent surgery, and coronary artery complications. Difference in Means (DM), Odds Ratios (OR) and 95% Confidence Intervals (CI) were computed with the Mantel-Haenszel method. Random effects model was used with heterogeneity considered if I2 \u3e 25. Results: Eight observational studies (n = 10,420 patients) were included in the analysis. There was no significant difference in procedural success between TRA versus TFA cohorts (OR 1.02; 95% CI, 0.77-1.36). CTO-PCI performed via TRA had lower access site-related complications and bleeding (OR 0.41; 95% CI, 0.24-0.71) and MI (OR 0.45; 95% CI 0.21-0.94) compared to CTO-PCI performed via TFA. There were no significant differences in all-cause mortality (OR, 0.84; 95% CI, 0.60-1.02), urgent surgery (OR, 0.79; 95% CI, 0.29-2.11), coronary artery complications (OR, 0.72; 95% CI, 0.33-1.57), CIN (OR, 0.31; 95% CI, 0.06-1.73), contrast volume (DM, -18.35; 95% CI, -42.99 to 6.29), procedure time (DM, 1.29; 95% CI, -14.84 to 7.42), and fluoroscopy time (DM, -2.50; 95% CI, -7.77 to 2.77) between the two groups. No association was observed in the meta-regression analysis. Conclusions: CTO-PCI via TRA was associated with lower access site-related complications, bleeding, and MI while achieving similar procedural success and similar procedural and fluoroscopy times when compared to TFA