Debate: PCI or CABG for multivessel disease? Viewpoint: No clear winner in an unfair fight

The Arterial Revascularization Therapy Study (ARTS) and the Stent or Surgery (SoS) trial each randomized patients with multivessel disease to either stenting or bypass surgery. The ARTS showed no difference in mortality between the two strategies, other than in diabetic patients, who fared better with surgery. The SoS trial demonstrated increased mortality in the stent arm, a difference that was not attributable to diabetes. Both trials found that the rates of repeat revascularization were lower with surgery, although the rate with stenting was much lower than had been seen in previous trials of angioplasty. Use of antiplatelet therapy such as intravenous glycoprotein IIb/IIIa inhibitors, especially with their pronounced effects in diabetics and in those with multivessel disease, could potentially equalize the playing field or perhaps even tip the balance in favor of percutaneous intervention

FORMULATION AND EVALUATION OF ALLOPURINOL LOADED CHITOSAN NANOPARTICLES

Objective: The objective of the present investigation was to fabricate and characterize allopurinol loaded chitosan nanoparticles (A-CNPs) for sustained release of drug. Methods: The allopurinol loaded chitosan nanoparticles were successfully prepared by employing the ionotropic gelation method. Further, particle size (PS), polydispersity index (PDI), zeta potential (ZP), Differential Scanning Calorimetry (DSC), entrapment efficiency (EE), Transmission Electron Microscopy (TEM), in vitro drug release, X-Ray Diffraction (XRD) and Fourier transform infrared (FTIR) were used for evaluating formulated A-CNPs Results: A-CNPs was successfully prepared and the particle size, polydispersity index, ZP and entrapment efficiency were found to be 375.3±10.1 nm, 0.362±0.01 and 32.5±2.7 mV and 52.56±0.10% respectively. In vitro release profile of A-CNPs showed sustained release and Higuchi model was found to be best fit for drug release kinetics. FTIR study depicted no chemical interaction between pure drug allopurinol (AL) and other excipients. Conclusion: The sustained release formulation of allopurinol was successfully prepared using HMW chitosan and evaluated for different parameters

Dark secrets behind the shimmer of contact lens: the Indian scenario

<p>Abstract</p> <p>Background</p> <p>We studied the bacteriological profile of soft contact lens and its accessories among the asymptomatic subjects and monitored the compliance level with the lens use and its cleaning protocol.</p> <p>Findings</p> <p>A total of 115 (104 daily wear and 11 extended wear) subjects using contact lens were studied. Data regarding the duration of use and frequency and method of cleaning were recorded. Contact lens, lens cases, preserving solutions and tips of solution bottles were the samples collected. The isolates were identified on the basis of their phenotypic characters. Samples from 24 subjects (21 daily wear and 3 extended wear) were found contaminated. Of the 24 contaminated cases, 23 showed medium adherence to the cleaning protocol. Contamination rate was higher among the 56 daily wear lens users who used same lens for 2 years and more, than the 48 users who used their lenses for less than 2 years. Lens case contamination was found in all the 24 cases. The bacteria isolated were <it>Citrobacter freundii, Escherichia coli</it>, <it>Klebsiella pneumoniae, Pseudomonas aeruginosa</it>, <it>Staphylococcus epidermidis </it>and <it>Streptococcus pneumoniae</it>. In extended wear lens users, there was no change in microbial flora on repeating the cultures on day 7 and 14.</p> <p>Conclusion</p> <p>Non-compliance with contact lens use may lead to invitation of microbial flora. The accumulation of these bacteria may act as a precursor to biofilm formation, thus colonizing the lens accessories as well. The bacteria isolated in this study were similar to the ones causing microbial keratitis thus, predisposing the otherwise asymptomatic subjects to permanent visual damage.</p

Gaschromatography/mass spectrometry analysis of degradation of ethylacetoacetate achieved in shake flask culture using a previously characterized yeast strain Tichosporon dermatis.

Public and regulatory interest regarding the presence of pharmaceutically active compounds in the environment its increasing adverse impact has increased in the recent years. Detection of a wide variety of pharmaceutical compounds in water environment has been a serious and growing concern in the last few decades. Understanding the biological degradation of pharmaceutical compounds is essential for accurately determining their ultimate environmental fate, conducting accurate risk assessments, and improving removal of such micro pollutants.  Present investigation was designed to accomplish biodegradation of ethylacetoacetate in shake flask culture using whole cells of previously isolated and identified yeast strain Trichosporon dermatis, from pharmaceutical effluents using enrichment culture technique. The strain was cultivated for two generations on an orbital shaker at 120 rpm at 28 ± 20C and the biomass was separated by centrifugation at 10,000 rpm for 20 mts. Normal saline washed cells were used in degradation carried out in Erlenmeyer flasks containing 500 ml of mineral medium containing ethylacetoacetate at standard conditions; wet cell weight= 20g/l; ethylacetoacetate concentration = 0.5% in mineral medium (w/v); time of biodegradation= 72 hrs; temperature= 28 ± 20C. Gas chromatography/mass spectrometry (GC-MS) analysis of microbially degraded product revealed that complete degradation of ethylacetoacetate in mineral medium was achieved in 72 hours using whole cells of Trichosporon dermatis yeast strain. Degradation of ethylacetoacetate by this yeast strain has not been reported before the present investigation. Keywords: ethyl acetoacetate, biodegradation, Gass chromatography/mass spectrometry and effluents

Antibody-Based Ticagrelor Reversal Agent in Healthy Volunteers.

BACKGROUND: Ticagrelor is an oral P2Y12 inhibitor that is used with aspirin to reduce the risk of ischemic events among patients with acute coronary syndromes or previous myocardial infarction. Spontaneous major bleeding and bleeding associated with urgent invasive procedures are concerns with ticagrelor, as with other antiplatelet drugs. The antiplatelet effects of ticagrelor cannot be reversed with platelet transfusion. A rapid-acting reversal agent would be useful. METHODS: In this randomized, double-blind, placebo-controlled, phase 1 trial, we evaluated intravenous PB2452, a monoclonal antibody fragment that binds ticagrelor with high affinity, as a ticagrelor reversal agent. We assessed platelet function in healthy volunteers before and after 48 hours of ticagrelor pretreatment and again after the administration of PB2452 or placebo. Platelet function was assessed with the use of light transmission aggregometry, a point-of-care P2Y12 platelet-reactivity test, and a vasodilator-stimulated phosphoprotein assay. RESULTS: Of the 64 volunteers who underwent randomization, 48 were assigned to receive PB2452 and 16 to receive placebo. After 48 hours of ticagrelor pretreatment, platelet aggregation was suppressed by approximately 80%. PB2452 administered as an initial intravenous bolus followed by a prolonged infusion (8, 12, or 16 hours) was associated with a significantly greater increase in platelet function than placebo, as measured by multiple assays. Ticagrelor reversal occurred within 5 minutes after the initiation of PB2452 and was sustained for more than 20 hours (P\u3c0.001 after Bonferroni adjustment across all time points for all assays). There was no evidence of a rebound in platelet activity after drug cessation. Adverse events related to the trial drug were limited mainly to issues involving the infusion site. CONCLUSIONS: In healthy volunteers, the administration of PB2452, a specific reversal agent for ticagrelor, provided immediate and sustained reversal of the antiplatelet effects of ticagrelor, as measured by multiple assays. (Funded by PhaseBio Pharmaceuticals; ClinicalTrials.gov number, NCT03492385.)

Relationships between components of blood pressure and cardiovascular events in patients with stable coronary artery disease and hypertension

Observational studies have shown a J-shaped relationship between diastolic blood pressure (BP) and cardiovascular events in hypertensive patients with coronary artery disease. We investigated whether the increased risk associated with low diastolic BP reflects elevated pulse pressure (PP). In 22 672 hypertensive patients with coronary artery disease from the CLARIFY registry (Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease), followed for a median of 5.0 years, BP was measured annually and averaged. The relationships between PP and diastolic BP, alone or combined, and the primary composite outcome (cardiovascular death or myocardial infarction) were analyzed using multivariable Cox proportional hazards models. Adjusted hazard ratios for the primary outcome were 1.62 (95% confidence interval [CI], 1.40–1.87), 1.00 (ref), 1.07 (95% CI, 0.94–1.21), 1.54 (95% CI, 1.32–1.79), and 2.34 (95% CI, 1.95–2.81) for PP&lt;45, 45 to 54 (reference), 55 to 64, 65 to 74, and ≥75 mm Hg, respectively, and 1.50 (95% CI, 1.31–1.72), 1.00 (reference), and 1.58 (95% CI, 1.42–1.77) for diastolic BPs of &lt;70, 70 to 79 (ref), and ≥80 mm Hg, respectively. In a cross-classification analysis between diastolic BP and PP, the relationship between diastolic BP and the primary outcome remained J-shaped when the analysis was restricted to patients with the lowest-risk PP (45–64 mm Hg), with adjusted hazard ratios of 1.53 (95% CI, 1.27–1.83), 1.00 (ref), and 1.54 (95% CI, 1.34–1.75) in the &lt;70, 70 to 79 (reference), and ≥80 mm Hg subgroups, respectively. The J-shaped relationship between diastolic BP and cardiovascular events in hypertensive patients with coronary artery disease persists in patients within the lowest-risk PP range and is therefore unlikely to be solely the consequence of an increased PP reflecting advanced vascular disease

Paradoxical Association of Smoking With In‐Hospital Mortality Among Patients Admitted With Acute Ischemic Stroke

Background: Compared to those who never smoked, a paradoxical effect of smoking on reducing mortality in patients admitted with myocardial ischemia has been reported. We sought to determine if this effect was present in patients hospitalized with ischemic stroke. Methods and Results: Using the local Get with the Guidelines‐Stroke registry, we analyzed 4305 consecutively admitted ischemic stroke patients (March 2002–December 2011). The sample was divided into smokers versus nonsmokers. The main outcome of interest was the overall inpatient mortality. Compared to nonsmokers, tobacco smokers were younger, more frequently male and presented with fewer stroke risk factors such as hypertension, hyperlipidemia, diabetes, coronary artery disease, and atrial fibrillation. Smokers also had a lower average NIH Stroke Scale (NIHSS) and fewer received tissue plasminogen activator (tPA). Patients in both groups had similar adherence to early antithrombotics, dysphagia screening prior to oral intake, and deep vein thrombosis (DVT) prophylaxis. Smoking was associated with lower all‐cause in‐hospital mortality (6.6% versus 12.4%; unadjusted OR 0.46; CI [0.34 to 0.63]; P<0.001). In multivariable analysis, adjusted for age, gender, ethnicity, hypertension, diabetes mellitus, hyperlipidemia, CAD, atrial fibrillation, NIHSS, and tPA, smoking remained independently associated with lower mortality (adjusted OR 0.64; CI [0.42 to 0.96]; P=0.03). Conclusions: Similar to myocardial ischemia, smoking was independently associated with lower inpatient mortality in acute ischemic stroke. This effect may be due to tobacco‐induced changes in cerebrovascular vasoreactivity, or may be due in part to residual confounding. Larger, multicenter studies are needed to confirm the finding and the effect on 30‐day and 1‐year mortality

Underwater Acoustic Sensor Network Data Optimization with Enhanced Void Avoidance and Routing Protocol

Deployment of a multi-hop underwater acoustic sensor network (UASN) in a larger region presents innovative challenges in reliable data communications and survivability of network because of the limited underwater interaction range or bandwidth and the limited energy of underwater sensor nodes. UASNs are becoming very significant in ocean exploration applications, like underwater device maintenance, ocean monitoring, ocean resource management, pollution detection, and so on. To overcome those difficulties and attains the purpose of maximizing data delivery ratio and minimizing energy consumption of underwater SNs, routing becomes necessary. In UASN, as the routing protocol will guarantee effective and reliable data communication from the source node to the destination, routing protocol model was an alluring topic for researchers. There were several routing techniques devised recently. This manuscript presents an underwater acoustic sensor network data optimization with enhanced void avoidance and routing (UASN-DAEVAR) protocol. The presented UASN-DAEVAR technique aims to present an effective data transmission process using proficient routing protocols. In the presented UASN-DAEVAR technique, a red deer algorithm (RDA) is employed in this study. In addition, the UASN-DAEVAR technique computes optimal routes in the UASN. To exhibit the effectual results of the UASN-DAEVAR technique, a wide spread experimental analysis is made. The experimental outcomes represented the enhancements of the UASN-DAEVAR model