Short- and long-term cost-effectiveness analysis of CYP2C19 genotype-guided therapy, universal clopidogrel, versus universal ticagrelor in post-percutaneous coronary intervention patients in Qatar

BackgroundPatients having CYP2C19 loss-of-function alleles and receiving clopidogrel are at higher risk of adverse cardiovascular outcomes. Ticagrelor is an effective antiplatelet that is unaffected by the CYP2C19 polymorphism. The main aim of the current research is to evaluate the cost-effectiveness among CYP2C19 genotype-guided therapy, universal ticagrelor, and universal clopidogrel after a percutaneous coronary intervention (PCI). MethodsA two-part decision-analytic model, including a one-year model and a 20-year follow-up Markov model, was created to follow the use of (i) universal clopidogrel, (ii) universal ticagrelor, and (iii) genotype-guided antiplatelet therapy. Outcome measures were the incremental cost-effectiveness ratio (ICER, cost/success) and incremental cost-utility ratio (ICUR, cost/quality-adjusted life years [QALY]). Therapy success was defined as survival without myocardial infarction, stroke, cardiovascular death, stent thrombosis, and no therapy discontinuation because of adverse events, i.e. major bleeding and dyspnea. The model was based on a multivariate analysis, and a sensitivity analysis confirmed the robustness of the model outcomes, including against variations in drug acquisition costs. ResultsAgainst universal clopidogrel, genotype-guided therapy was cost-effective over the one-year duration (ICER, USD 6102 /success), and dominant over the long-term. Genotype-guided therapy was dominant against universal ticagrelor over the one-year duration, and cost-effective over the long term (ICUR, USD 1383 /QALY). Universal clopidogrel was dominant over ticagrelor for the short term, and cost-effective over the long-term (ICUR, USD 10,616 /QALY). ConclusionCYP2C19 genotype-guided therapy appears to be the preferred antiplatelet strategy, followed by universal clopidogrel, and then universal ticagrelor for post-PCI patients in Qatar.This research is supported by award# GRA5-2-0521-18060 from Qatar National Research Fund, Qatar Foundation, Qatar

Optimum Mix for Pervious Geopolymer Concrete (GEOCRETE) Based on Water Permeability and Compressive Strength

The production of ordinary Portland cement (OPC) consumes considerable natural resources and energy, and it also affects the emission of a significant quantity of CO2 in the atmosphere. This pervious geopolymer concrete study aims to explore an alternative binder without OPC. Pervious geopolymer concretes were prepared from fly ash (FA), sodium silicate (NaSiO3), sodium hydroxide (NaOH) solution, and coarse aggregate (CA). The effects of pervious geopolymer concrete parameters that affect water permeability and compressive strength are evaluated. The FA to CA ratios of 1:6, 1:7,1:8, and 1:9 by weight, CA sizes of 5–10, 10–14, and 14–20 mm, constant NaSiO3/NaOH ratio of 2.5, alkaline liquid to fly ash (AL/FA) ratios of 0.4, 0.5, and 0.6, and NaOH concentrations of 8, 10, and 12 M were the pervious geopolymer concrete mix proportions. The curing temperature of 80 °C for 24 h was used. The results showed that a pervious geopolymer concrete with CA of 10 mm achieved water permeability of 2.3 cm/s and compressive strength of 20 MPa with AL/FA ratio of 0.5, NaOH concentration of 10 M, and FA:CA of 1:7. GEOCRETE is indicated to have better engineering properties than does pervious concrete that is made of ordinary Portland cement

Idiopathic fascicular left ventricular tachycardia

Idiopathic left fascicular ventricular tachycardia (ILFVT) is characterized by right bundle branch block morphology and left axis deviation. We report a case of idiopathic left ventricular fascicular tachycardia in a young 31-year-old male patient presenting with a narrow complex tachycardia

Optimum Mix for Pervious Geopolymer Concrete (GEOCRETE) Based on Water Permeability and Compressive Strength

The production of ordinary Portland cement (OPC) consumes considerable natural resources and energy, and it also affects the emission of a significant quantity of CO2 in the atmosphere. This pervious geopolymer concrete study aims to explore an alternative binder without OPC. Pervious geopolymer concretes were prepared from fly ash (FA), sodium silicate (NaSiO3), sodium hydroxide (NaOH) solution, and coarse aggregate (CA). The effects of pervious geopolymer concrete parameters that affect water permeability and compressive strength are evaluated. The FA to CA ratios of 1:6, 1:7,1:8, and 1:9 by weight, CA sizes of 5–10, 10–14, and 14–20 mm, constant NaSiO3/NaOH ratio of 2.5, alkaline liquid to fly ash (AL/FA) ratios of 0.4, 0.5, and 0.6, and NaOH concentrations of 8, 10, and 12 M were the pervious geopolymer concrete mix proportions. The curing temperature of 80 °C for 24 h was used. The results showed that a pervious geopolymer concrete with CA of 10 mm achieved water permeability of 2.3 cm/s and compressive strength of 20 MPa with AL/FA ratio of 0.5, NaOH concentration of 10 M, and FA:CA of 1:7. GEOCRETE is indicated to have better engineering properties than does pervious concrete that is made of ordinary Portland cement

Investigation into the permeability and strength of pervious geopolymer concrete containing coated biomass aggregate material

Waste palm oil products can be recycled in the production of pervious geopolymer concrete (PGC) for long-term sustainable development. PGC is a non-slip porous pavement concrete that allows water to pass through. Biomass aggregate (BA) is produced by burning palm oil biomass and is introduced as a replacement for natural aggregate (NA). BA is mixed with fly ash (FA) and alkaline liquid (AL) and heated in an oven at 80 °C for 24 h to produce coated biomass aggregate (CBA). PGC containing CBA is commonly used as a cement substitute in concrete. This study aims to develop and evaluate the effect of rainfall intensity on the ability of PGC to reduce stormwater runoff. Coating BA with geopolymer paste resulted in improved properties, better Aggregate crushing value (ACV), Aggregate impact value (AIV), water absorption and higher compressive strength compared with BA. Results indicated, a PGC with a FA/CBA ratio of 1:7, CBA of 5–10 mm, NaOH molarity of 10 M, Na2SiO3/NaOH ratio of 2.5, and AL/FA ratio of 0.5 when cured in an oven for 24 h at 80 °C, gave the optimum ratio for compressive strength of 13.7 MPa and water permeability of 2.1 cm/s. Both BA and CBA revealed a viable alternative aggregates for producing PGC and that the compressive strength of PGC made with CBA was 51% greater than cement pervious concrete containing NA. The results also showed that the reduction in runoff was due to the permeable concrete and decreased runoff with the increased rainfall intensity.Validerad;2021;Nivå 2;2021-10-01 (alebob)</p

Utilisation of Waste-Based Geopolymer in Asphalt Pavement Modification and Construction—A Review

The use of geopolymer in pavement constructions is strongly encouraged. Many studies have demonstrated the vast potential of using industrial-by-products-based geopolymers. This paper discusses the modification of asphalt binders with geopolymers, namely geopolymer-modified asphalt (GMA) and geopolymer-modified asphalt mixture (GMAM). In addition, curing geopolymer materials, engineering properties, production techniques, and prospective utilisation in the pavement construction, such as durability and sustainability, are also discussed. The literature review showed that many industrial by-products, including red mud, blast furnace slag, fly ash, and mine waste, are used to produce geopolymers because of the metal components such as silicon and aluminium in these materials. The geopolymers from these materials influence the rheological and physical properties of asphalt binders. Geopolymers can enhance asphalt mixture performance, such as stability, fatigue, rutting, and low-temperature cracking. The use of geopolymers in asphalt pavement has beneficial impacts on sustainability and economic and environmental benefits

Effect of CYP2C19 genetic variants on bleeding and major adverse cardiovascular events in a cohort of Arab patients undergoing percutaneous coronary intervention and stent implantation

Introduction One-third of patients have clopidogrel resistance that may lead to major adverse cardiac events (MACEs). By contrast, it was found that some clopidogrel-treated patients have hyperresponsive platelets that are associated with higher bleeding risk. Several studies have shown that polymorphisms in the gene encoding the CYP2C19 contribute to the variability in response to clopidogrel. Data on genetic and nongenetic factors affecting clopidogrel response in the Arab population are scarce. In this prospective cohort study, we sought to assess the association between the increased function allele (CYP2C19?17) and bleeding events, and validate the effect of the CYP2C19 genetic variants and nongenetic factors on the incidence of MACEs. Methods Blood samples were collected from patients that were undergoing percutaneous coronary intervention and receiving clopidogrel at the Heart Hospital, a specialist tertiary hospital in Doha, Qatar. Patients were followed for 12 months. Genotyping was performed for CYP2C19?2, ?3, and ?17 using TaqMan assays. Results In 254 patients, the minor allele frequencies were 0.13, 0.004, and 0.21 for ?2, ?3, and ?17, respectively. Over a 12-month follow-up period, there were 21 bleeding events (8.5 events/100 patient-year). CYP2C19?17 carriers were found to be associated with increased risk of bleeding (OR, 21.6; 95% CI, 4.8-96.8; P < 0.0001). CYP2C19?2 or ?3 carriers were found to be associated with increased risk of baseline and incident MACE combined (OR, 8.4; 95% CI, 3.2-23.9; P < 0.0001). Conclusion This study showed a significant association between CYP2C19?17 allele and the increased risk of bleeding, and CYP2C19?2 or ?3 with MACE outcomes. 2022 Lippincott Williams and Wilkins. All rights reserved.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by Hamad Medical Corporation, Doha, Qatar (grant number: IRGC-02-NI-052). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Scopu