0014 : Implications of myocardial reperfusion on survival in women versus men with acute myocardial infarction undergoing primary coronary intervention

BackgroundThe in hospital mortality rate after myocardial infarction is higher among women than men. PCI is recommended treatment for ST -segment elevation myocardial infarction (STEMI) in patients of both genders. It is used in women without a clear demonstration of their efficiency in this population. It is only extrapolations of studies enrolling a large majority of males (more than 85%). It is very important to improve our therapeutic stratégies in women, to perform dedicated studies.AimOf our study was to compare clinical and angiographic features in men and women and to determine wether gender influenced in – hospital prognosis of primary percutaneous coronary intervention.MethodsWe conducted a retrospective study including 282 patients admitted in the University hospital of Blida (Alegria). Between April 2009 and January 2011. All these patients had an ST segment elevation myocardial infarction and underwent primary PCI within 12 hours after symptom onset.ResultsOur population counted 239men and 43women. Females were significantly older (p<0.05). They had a higher prevalence of diabetes 32.6% (P<0.05), hypertension 55.8% (P=0.01), dyslipemia16.3% (P<0.05). They were more likely to consult late (Mean time from symptom onset was 299.7±93.9min in women vs 296±97.9mn in men (p<0.001). In our study, angiographic success was achieved in 76.7% of the cases in women and in 92.1% of the cases in men (p=0.005). The in hospital mortality rate was 7% in women and 5% in men (p=NS).ConclusionThere is no gender descrepancy in – hospital mortality in patients who undergo emergency PCI for treatment of STEMI. These data suggest that gender should not affect the decision to offer PCI but further gender specific studies are warranted

Effect of Pre-Hospital Ticagrelor During the First 24 Hours After Primary PCI in Patients With ST-Segment Elevation Myocardial Infarction: The ATLANTIC-H Analysis

OBJECTIVES: The aim of this landmark exploratory analysis, ATLANTIC-H24, was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery study). BACKGROUND: The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). METHODS: The ATLANTIC-H24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction grade 3 flow, >/=70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. RESULTS: Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%, p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%, p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%, p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. CONCLUSIONS: The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580])

Характеристика фосфатних відходів гірничого комплексу «Джебель Онк» для стійкого управління навколишнім середовищем

The objects of the research are phosphate ore rejections – industrial waste resulting from the treatment of phosphate ore by different processes (particle size separation, calcination, physicochemical process, electrostatically process, etc.). These discharges are generally stored in specially constructed sedimentation ponds. However, its storage for a long period leads to serious environmental problems because they contain heavy and radioactive metals that affect nearby communities. They contaminate groundwater and surface water through the infiltration of caustic solution laden with rare metals. To remedy these environmental disasters and manage these concerns, it is necessary to upgrade the discharges from the Djebel Onk complex and give an added value to the national economy. The start-up of the Djebel El Onk phosphate complex, in the province of Tebessa was in 1965, since that date, all the waste resulting from the beneficiation process has been dumped in the valley adjacent to the complex without any treatment or recycling, it should be noted that the Djebel Onk phosphate complex generates huge quantities of phosphate sludge (more than 4000 tons per day). This waste is relatively rich in useful substance. The results of chemical analyzes reveal that these sludge’s contain around 20.2 % of phosphate (P2O5) with the presence of different heavy metals such as Uranium, Cadmium, Zinc, Copper, and Arsenic et. Those metals threaten life of local residents and affects vegetation, livestock in nearby populated areas. However, this work systematically reviews the mineralogical and chemical characterization of the phosphate sludge rejected by the Djebel Onk treatment complex to develop a suitable method for their revaluation. In our work, in this viable environmental perspective, we try to highlight the use of wastes as an alternative raw material in building materials. The impact of heavy metals on the environment and health is determined by the chemical species, concentration, bioavailability and transport through food chains, unless they are released into nature due to the consequences harm they create. Certain elements, such as mercury, lead, cadmium, zinc, copper, etc., have no function in maintaining body balance and are immediately dangerous.Об'єктом дослідження є відходи фосфоритного виробництва – промислові відходи, що утворюються в результаті переробки фосфатної руди за допомогою різних процесів (гранулометричного розділення, прожарювання, фізико-хімічного процесу, електростатичного процесу та ін.). Ці скиди, як правило, зберігаються у спеціально побудованих відстійниках. Однак їх тривале зберігання призводить до серйозних екологічних проблем, оскільки вони містять важкі та радіоактивні метали, які впливають на довколишні громади. Вони забруднюють підземні та поверхневі води через інфільтрацію їдкого розчину, насиченого рідкісними металами. Щоб усунути ці екологічні катастрофи та вирішити ці проблеми, необхідно модернізувати скиди з комплексу «Джебель Онк» і створити додаткову вартість для національної економіки. Запуск фосфатного комплексу Джебель-Ель-Онк в провінції Тебеса відбувся в 1965&nbsp;р. З того часу всі відходи, що утворюються в процесі збагачення, скидалися в прилеглу до комплексу долину без будь-якої обробки або переробки, слід зазначити, що фосфатний комплекс Джебель-Онк генерує величезну кількість фосфатного шламу (понад 4000 тонн на добу). Ці відходи відносно багаті на корисні речовини, результати хімічних аналізів показують, що ці шлами містять близько 20,2&nbsp;% фосфатів (P2O5) з присутністю різних важких металів, таких як уран, кадмій, цинк, мідь, миш'як та ін. Ці метали загрожують життю місцевих жителів і впливають на рослинність, худобу в прилеглих населених районах. Однак у цій роботі систематично розглядаються мінералогічні та хімічні характеристики фосфатних шламів, відкинутих очисним комплексом Джебель-Онк, для розробки відповідного методу їх переоцінки. В нашій роботі, в цій життєздатній екологічній перспективі, ми намагаємося висвітлити використання відходів як альтернативної сировини в будівельних матеріалах. Вплив важких металів на навколишнє середовище та здоров'я визначається хімічним видом, концентрацією, біодоступністю та транспортуванням по харчових ланцюгах, якщо тільки вони не вивільняються в природу через створювані ними наслідки. Деякі елементи, такі як ртуть, свинець, кадмій, цинк, мідь тощо, не виконують жодної функції у підтримці балансу в організмі та становлять безпосередню небезпеку

[14] A prospective study of transurethral bipolar resection and vaporisation of large prostate adenomas

Objective: To report our experience following the introduction of transurethral bipolar vapo-resection of large prostate adenomas and to evaluate it to the traditional techniques used to date in Algeria in the surgical treatment of large prostates. Methods: This was a prospective longitudinal study, conducted in our department, between December 2015 and September 2016, including 40 patients with a surgical indication for benign prostatic hyperplasia (BPH) with prostate volumes of >70 mL, consenting to the procedure. We evaluated functional parameters [International Prostate Symptom Score (IPSS)/quality of life (QoL) score, maximum urinary flow rate (Qmax)] pre- and postoperatively according to a quarterly schedule, surgical data (resection time, resected volume), as well as the duration of catheterisation and bleeding complications. Results: The mean (range) prostate volume in our series was 118.72 (70–254) mL and the indications were dominated by medical treatment failure and urinary retention, at 55% and 35%, respectively. The evaluation of the IPSS and QoL score showed a constant decrease from a median of 26 and 6 preoperatively to 1 and 0 at 15 months postoperatively, respectively. The median Qmax increased from 5.1 mL/s preoperatively to 14.9 mL/s at 15 months postoperatively. In all, 10% of the patients had postoperative clotting and two patients required surgical haemostasis. The average time to removal of the urinary catheter was 3 days. The average resection speed increased from 0.5 mL/min to 1.6 mL/min at maturity. Conclusion: The combination of resection and vaporisation in large adenomas seems to be effective according to our data, it does not require any particular training for an already established urologist and the investment seems reasonable and compatible in an economic context

At least seven days delayed stenting using minimalist immediate mechanical intervention (MIMI) in ST-segment elevation myocardial infarction: the SUPER-MIMI study

International audienc

Association between gender and short-term outcome in patients with ST elevation myocardial infraction participating in the international, prospective, randomised administration of ticagrelor in the catheterisation laboratory or in the ambulance for new ST elevation myocardial infarction to open the coronary artery (ATLANTIC) trial: a prespecified analysis

Objectives: to evaluate gender differences in outcomes in patents with ST-segment elevation myocardial infarction (STEMI) planned for primary percutaneous coronary intervention (PPCI). Settings: a prespecified gender analysis of the multicentre, randomised, double-blind Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery. Participants: between September 2011 and October 2013, 1862 patients with STEMI and symptom duration <6 hours were included. Interventions: patients were assigned to prehospital versus in-hospital administration of 180 mg ticagrelor. Outcomes: the main objective was to study the association between gender and primary and secondary outcomes of the main study with a focus on the clinical efficacy and safety outcomes. Primary outcome: the proportion of patients who did not have 70% resolution of ST-segment elevation and did not meet the criteria for Thrombolysis In Myocardial Infarction (TIMI) flow 3 at initial angiography. Secondary outcome: the composite of death, MI, stent thrombosis, stroke or urgent revascularisation and major or minor bleeding at 30 days. Results: women were older, had higher TIMI risk score, longer prehospital delays and better TIMI flow in the infarct-related artery. Women had a threefold higher risk for all-cause mortality compared with men (5.7% vs 1.9%, HR 3.13, 95% CI 1.78 to 5.51). After adjustment, the difference was attenuated but remained statistically significant (HR 2.08, 95% CI 1.03 to 4.20). The incidence of major bleeding events was twofold to threefold higher in women compared with men. In the multivariable model, female gender was not an independent predictor of bleeding (Platelet Inhibition and Patient Outcomes major HR 1.45, 95% CI 0.73 to 2.86, TIMI major HR 1.28, 95% CI 0.47 to 3.48, Bleeding Academic Research Consortium type 3-5 HR 1.45, 95% CI 0.72 to 2.91). There was no interaction between gender and efficacy or safety of randomised treatment. Conclusions: in patients with STEMI planned for PPCI and treated with modern antiplatelet therapy, female gender was an independent predictor of short-term mortality. In contrast, the higher incidence of bleeding complications in women could mainly be explained by older age and clustering of comorbidities