A Review of the Incidence Diagnosis and Treatment of Spontaneous Hemorrhage in Patients Treated with Direct Oral Anticoagulants

Anticoagulation carries a tremendous therapeutic advantage in reducing morbidity and mortality with venous thromboembolism and atrial fibrillation. For over six decades, traditional anticoagulants like low molecular weight heparin and vitamin K antagonists like warfarin have been used to achieve therapeutic anticoagulation. In the past decade, multiple new direct oral anticoagulants have emerged and been approved for clinical use. Since their introduction, direct oral anticoagulants have changed the landscape of anticoagulants. With increasing indications and use in various patients, they have become the mainstay of treatment in venous thromboembolic diseases. The safety profile of direct oral anticoagulants is better or at least similar to warfarin, but several recent reports are focusing on spontaneous hemorrhages with direct oral anticoagulants. This narrative review aims to summarize the incidence of spontaneous hemorrhage in patients treated with direct oral anticoagulants and also offers practical management strategies for clinicians when patients receiving direct oral anticoagulants present with bleeding complications

The Impact of Diabetes Mellitus in Patients with Chronic Obstructive Pulmonary Disease (COPD) Hospitalization

Background: Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide. Diabetes mellitus (DM) has been shown to have adverse inflammatory effects on lung anatomy and physiology. We investigated the impact of DM on COPD patient outcomes during inpatient hospitalization. Methods: We conducted a retrospective analysis using the Nationwide Inpatient Sample (NIS) over the years 2002-2014. Three groups, COPD without diabetes, COPD with diabetes but no complication, and COPD with DM and complication, were analyzed. Results: A total of 7,498,577 were COPD hospitalization; of those, 1,799,637 had DM without complications, and 483,467 had DM with complications. After adjusting for clinical, demographic, and comorbidities, the odds of increased LOS in the COPD/DM with complication were 1.37 (confidence interval (CI): 1.326-1.368), and those of DM without complication were 1.061 (1.052-1.070) when compared with COPD alone. The odds of pneumonia, respiratory failure, stroke, and acute kidney injury were also higher in COPD hospitalizations with DM. Both DM with complication (odds ratio (OR): 0.751 (CI 0.727-0.777)) and DM without complication (OR: 0.635 (CI: 0.596-0.675)) have lesser odds of mortality during hospitalization than with COPD alone. Conclusions: There is a considerable inpatient burden among COPD patients with DM in the United States

Anisotropic structure-property relations of FDM printed short glass fiber reinforced polyamide TPMS structures under quasi-static compression

Triply minimal surface structures of short glass fiber reinforced polyamide with different relative densities were prepared and the effects of induced anisotropy, cell topology, and relative density on the compressive properties were evaluated. Schwarz Diamond, Schoen Gyroid, and Schwarz Primitive structures were 3D printed with relative densities ranging from 0.2 to 0.4, and compression properties along the axial and lateral build directions were determined. Gipson-Ashby numerical parameters required to establish a relation between the cell topology and the compressive properties of the lattice structures were estimated. The plastic deformation and failure mechanisms were analyzed. Results revealed that the compression properties are dominated by the cell topology rather than the relative density. Besides, the present work confirmed that the compressive properties of the lattice structures fabricated with short fiber reinforcement are significantly affected by anisotropy. These structures exhibited a higher compressive modulus and lower peak compressive stress in the lateral direction, which can be attributed to the inline orientation of the short glass fibers. Schwarz Diamond proved to be the stiffest structure, followed by Schoen Gyroid and Schwarz Primitive under axial and lateral compression. Likewise, Schwarz Primitive generated low stresses compared to Schoen Gyroid and Schwarz Diamond. All cell topologies deformed in a controlled manner layer by layer, minimizing undulations in the load-bearing capacity of the structures. D and G structures compressed in the axial direction exhibited significant strain hardening and identical structures compressed in the lateral direction exhibited stable post-yield behavior with negligible undulations which is highly preferred for crashworthiness applications

Trends in Prevalence and Outcomes of Cannabis Use Among Chronic Obstructive Pulmonary Disease Hospitalizations: A Nationwide Population-Based Study 2005-2014

Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality in the United States. Due to the ongoing legalization of cannabis, its acceptance, availability, and use in the in-patient population are on the rise. In this retrospective study, we investigated the association of cannabis use with important outcomes in COPD hospitalizations. Methods: The National Inpatient Sample (NIS) data were analyzed from 2005 to 2014. The primary outcome of interest was the trends and outcomes of cannabis use among COPD hospitalizations, including in-hospital mortality, pneumonia, sepsis, and respiratory failure. Results: We identified 6,073,862 hospitalizations, 18 years of age or older, with COPD using hospital discharge codes. Of these, 6,049,316 (99.6%) were without cannabis use, and 24,546 (0.4%) were admitted with cannabis use. The majority of COPD hospitalizations with cannabis use were aged 50-64 (60%). Cannabis use was associated with lower odds of in-hospital mortality (odds ratio [OR] 0.624 [95% confidence interval (CI) 0.407-0.958]; p=0.0309) and pneumonia (OR 0.882 [95% CI 0.806-0.964]; p=0.0059) among COPD hospitalizations. Cannabis use also had lower odds of sepsis (OR 0.749 [95% CI 0.523-1.071]; p=0.1127) and acute respiratory failure (OR 0.995 [95% CI 0.877-1.13]; p=0.9411), but it was not statistically significant. Conclusions: Among hospitalized patients with a diagnosis of COPD, cannabis users had statistically significant lower odds of in-hospital mortality and pneumonia compared to noncannabis users. The association between cannabis use and these favorable outcomes deserves further study to understand the interaction between cannabis use and COPD

The Effects of Warfarin and Direct Oral Anticoagulants on Systemic Vascular Calcification: A Review

Warfarin has been utilized for decades as an effective anticoagulant in patients with a history of strong risk factors for venous thromboembolism (VTE). Established adverse effects include bleeding, skin necrosis, teratogenicity during pregnancy, cholesterol embolization, and nephropathy. One of the lesser-known long-term side effects of warfarin is an increase in systemic arterial calcification. This is significant due to the association between vascular calcification and cardiovascular morbidity and mortality. Direct oral anticoagulants (DOACs) have gained prominence in recent years, as they require less frequent monitoring and have a superior side effect profile to warfarin, specifically in relation to major bleeding. The cost and lack of data for DOACs in some disease processes have precluded universal use. Within the last four years, retrospective cohort studies, observational studies, and randomized trials have shown, through different imaging modalities, that multiple DOACs are associated with slower progression of vascular calcification than warfarin. This review highlights the pathophysiology and mechanisms behind vascular calcification due to warfarin and compares the effect of warfarin and DOACs on systemic vasculature

Drilling-Induced Damages in Hybrid Carbon and Glass Fiber-Reinforced Composite Laminate and Optimized Drilling Parameters

Hybrid carbon and glass fiber-reinforced composites have attracted significant research interest for primary load-bearing structural components in the field of aviation manufacturing owing to their low weight and high strength to weight ratio. However, the anisotropic and heterogenic nature of carbon and/or glass fiber-reinforced composite prevents high machining quality due to the directionality effect of fibers in the polymer matrix. As such, this study investigates the effect of drilling process for hybrid fiber-reinforced composite and reports optimal drilling parameters to improve the drill quality. Experimental studies indicate that an increased point angle (i.e., from 80° to 120°) resulted in low delamination upon entry due to reduced thrust force, which in turn produces better surface finish with minimal tool wear. The optimal feed rate (0.2 mm/min) ensures lower delamination at entry, since higher feed rates can increase the thrust force due to elevation in the shear area or raise the self-generated feed angle, which in turn reduces the effective clearance angle. To this end, drilling parameters were optimized using Dandelion optimizer (DO)—a cutting-edge metaheuristic search algorithm (MSA). We report the excellent consistency of DO to solve the proposed drilling optimization problem while achieving promising results as ascertained by the small standard deviation values

Trends in the Epidemiology and Outcomes of Pneumocystis Pneumonia among Human Immunodeficiency Virus (HIV) Hospitalizations

Introduction: Pneumocystis Pneumonia (PCP) is a common opportunistic infection among people living with the human immunodeficiency virus (HIV). This study’s objective was to assess temporal trends in PCP epidemiology among hospitalized patients with HIV/AIDS in the US and to compare data for hospitalizations with HIV with PCP to those without PCP. Methods: The national inpatient sample (NIS) data were analyzed from 2002–2014. The discharge coding identified hospitalized patients with HIV or AIDS and with or without PCP. Results: We identified 3,011,725 hospitalizations with HIV/AIDS during the study period; PCP was present in 5% of the patients with a diagnosis of HIV. The rates of PCP progressively declined from 6.7% in 2002 to 3.5 % in 2014 (p < 0.001). Overall mortality in patients with HIV was 3.3% and was significantly higher in those with PCP than without PCP (9.9% vs. 2.9%; p < 0.001). After adjusting for demographics and other comorbidities, PCP had higher odds of hospital mortality 3.082 (OR 3.082; 95% CI, 3.007 to 3.159; p < 0.001). Conclusion: From 2002 to 2014, the rate of PCP in HIV patients has decreased significantly in the United States but is associated with substantially higher mortality