Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Cardiovascular disease risk in women with hyperandrogenism, oligomenorrhea/menstrual irregularity or polycystic ovaries (components of polycystic ovary syndrome): a systematic review and meta-analysis.

AIMS: Prior meta-analyses indicate polycystic ovary syndrome (PCOS) is associated with cardiovascular diseases (CVDs), but have high statistical heterogeneity, likely because PCOS is a heterogenous syndrome diagnosed by having any two of the three components: hyperandrogenism, oligomenorrhea/menstrual irregularity or polycystic ovaries. Several studies report higher risk of CVDs from individual PCOS components, but a comprehensive assessment of how each component contributes to CVD risk is lacking. This study aims to assess CVD risk for women with one of the PCOS components. METHODS AND RESULTS: A systematic review and meta-analysis of observational studies was conducted. PubMed, Scopus, and Web of Science were searched without restrictions in July 2022. Studies meeting inclusion criteria examined the association between PCOS components and risk of a CVD. Two reviewers independently assessed abstracts and full-text articles, and extracted data from eligible studies. Where appropriate, relative risk (RR) and 95% confidence interval (CI) were estimated by random-effects meta-analysis. Statistical heterogeneity was assessed using the I2 statistic. Twenty-three studies, including 346 486 women, were identified. Oligo-amenorrhea/menstrual irregularity was associated with overall CVD (RR = 1.29, 95%CI = 1.09-1.53), coronary heart disease (CHD) (RR = 1.22, 95%CI = 1.06-1.41), and myocardial infarction (MI) (RR = 1.37, 95%CI = 1.01-1.88) but not cerebrovascular disease. These results were broadly consistent even after further adjustment for obesity. There was mixed evidence for the role of hyperandrogenism in CVDs. No studies examined polycystic ovaries as an independent exposure for CVD risk. CONCLUSION: Oligo-amenorrhea/menstrual irregularity is associated with greater risk of overall CVD, CHD, and MI. More research is needed to assess the risks associated with hyperandrogenism or polycystic ovaries

Study of the effects of mergers and acquisitions in the banking.

Case study on 3 mergers and acquisitions in the banking industry in Singapore: DBS-POS Bank, UOB-OUB, and OCBC-Keppel TatLee. To analyze the effects of the mergers and acquisitions in the banking industry in Singapor

A marketing plan presented to San Miguel Brewery, Inc.

Beer, being a sin product, is mostly associated with guilt and is restricted from the lifestyles of health conscious individuals. San Miguel Brewery, Inc. saw a potential market among these people, and hence decided to create San Mig Zero to address the underlying need of this possibly new market segment. San Mig Zero was launched with the intention of targeting lapsed beer drinkers aged 35 and above belonging to the Socio-Economic Class A, B, and C1, many of which who have lessened beer consumption due to health consciousness, medical restrictions, and age. The main goal of the paper is to be the brand of choice among the previously mentioned target market as the lowest calorie, lowest ABV1, and lowest carbohydrate beer option through a plan of action with the support of primary (UAI2) and secondary research. It was discovered from the UAI that San Mig Zero has not yet fully reached out to the target market, and there seems to be some miscommunication especially regarding its nutrition facts. This marketing plan thus focuses on increasing awareness, inducing more trial, correcting present misconceptions about the brand and finally generating more sales and profits through implementing brand activations and utilizing varying forms of media for advertisements. Along with this, computations for costing and pricing, investment plans and estimates of profitability were also done in order to provide a comprehensive perspective of the plan. This paper aims to convince the target market that beer can be good, and that San Mig Zero is the better beer option that complements healthy lifestyles. Furthermore, this research also intends to hike up San Mig Zero from its current state, and ultimately spearhead its growth and development in the beer industry in the next couple of years

Do COVID-19 Infections Result in a Different Form of Secondary Hemophagocytic Lymphohistiocytosis

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality across the world, with no current effective treatments available. Recent studies suggest the possibility of a cytokine storm associated with severe COVID-19, similar to the biochemical profile seen in hemophagocytic lymphohistiocytosis (HLH), raising the question of possible benefits that could be derived from targeted immunosuppression in severe COVID-19 patients. We reviewed the literature regarding the diagnosis and features of HLH, particularly secondary HLH, and aimed to identify gaps in the literature to truly clarify the existence of a COVID-19 associated HLH. Diagnostic criteria such as HScore or HLH-2004 may have suboptimal performance in identifying COVID-19 HLH-like presentations, and criteria such as soluble CD163, NK cell activity, or other novel biomarkers may be more useful in identifying this entity

Future Cardiovascular Disease Risk for Women With Gestational Hypertension: A Systematic Review and Meta-Analysis.

Background Inconsistent findings have been found among studies evaluating the risk of cardiovascular disease for women who have had pregnancies complicated by gestational hypertension (the new onset of high blood pressure without proteinuria during pregnancy). We provide a comprehensive review of studies to quantify the association between gestational hypertension and cardiovascular events in women. Methods and Results We conducted a systematic search of PubMed, Embase and Web of Science in March 2019 for studies examining the association between gestational hypertension and any cardiovascular event. Two reviewers independently assessed the abstracts and full-text articles. Study characteristics and the relative risk of cardiovascular events associated with gestational hypertension were extracted from the eligible studies. Where appropriate, estimates were pooled with inverse variance weighted random-effects meta-analysis. Twenty-one studies involving 3,601,192 women (127,913 with gestational hypertension) were identified. Gestational hypertension in the first pregnancy was associated with an increased risk of overall cardiovascular disease (relative risk 1.45, 95% confidence interval, 1.17-1.80), and coronary heart disease (1.46, 1.23-1.73), but not stroke (1.26, 0.96-1.65) or thromboembolic events (0.88, 0.73-1.07). Women with one or more pregnancies affected by gestational hypertension were at greater risk of cardiovascular disease (1.81, 1.42-2.31), coronary heart disease (1.83, 1.33-2.51) and heart failure (1.77, 1.47-2.13), but not stroke (1.50, 0.75-2.99). Conclusions Gestational hypertension is associated with an increased risk of overall cardiovascular disease, coronary heart disease and heart failure. More research is needed to assess the presence of a dose-response relationship between gestational hypertension and subsequent cardiovascular disease. Study registration PROSPERO registration number: CRD42018119031. Key Words: Pregnancy, Gestational Hypertension, Cardiovascular Disease, Women, ReviewCO is was supported by a British Heart Foundation Cambridge Centre of Excellence (RE/13/6/30180) and an early career fellowship from Homerton College, University of Cambridge. AF is supported by a UK MRC fellowship (MR/M009351/1). The funding source had no role in the design or conduct of the study; collection or analysis of the data; or the decision to submit the manuscript for publicatio

Future Cardiovascular Disease Risk for Women With Gestational Hypertension: A Systematic Review and Meta-Analysis.

Background Inconsistent findings have been found among studies evaluating the risk of cardiovascular disease for women who have had pregnancies complicated by gestational hypertension (the new onset of high blood pressure without proteinuria during pregnancy). We provide a comprehensive review of studies to quantify the association between gestational hypertension and cardiovascular events in women. Methods and Results We conducted a systematic search of PubMed, Embase, and Web of Science in March 2019 for studies examining the association between gestational hypertension and any cardiovascular event. Two reviewers independently assessed the abstracts and full-text articles. Study characteristics and the relative risk (RR) of cardiovascular events associated with gestational hypertension were extracted from the eligible studies. Where appropriate, the estimates were pooled with inverse variance weighted random-effects meta-analysis. A total of 21 studies involving 3 60 1192 women (127 913 with gestational hypertension) were identified. Gestational hypertension in the first pregnancy was associated with a greater risk of overall cardiovascular disease (RR, 1.45; 95% CI, 1.17-1.80) and coronary heart disease (RR, 1.46; 95% CI, 1.23-1.73), but not stroke (RR, 1.26; 95% CI, 0.96-1.65) or thromboembolic events (RR, 0.88; 95% CI, 0.73-1.07). Women with 1 or more pregnancies affected by gestational hypertension were at greater risk of cardiovascular disease (RR, 1.81; 95% CI, 1.42-2.31), coronary heart disease (RR, 1.83; 95% CI, 1.33-2.51), and heart failure (RR, 1.77; 95% CI, 1.47-2.13), but not stroke (RR, 1.50; 95% CI, 0.75-2.99). Conclusions Gestational hypertension is associated with a greater risk of overall cardiovascular disease, coronary heart disease, and heart failure. More research is needed to assess the presence of a dose-response relationship between gestational hypertension and subsequent cardiovascular disease. Registration URL: https://www.crd.york.ac.uk/prosp​ero/; Unique identifier: CRD42018119031.CO is was supported by a British Heart Foundation Cambridge Centre of Excellence (RE/13/6/30180) and an early career fellowship from Homerton College, University of Cambridge. AF is supported by a UK MRC fellowship (MR/M009351/1). The funding source had no role in the design or conduct of the study; collection or analysis of the data; or the decision to submit the manuscript for publicatio