The Association between Myocardial Perfusion Scan and Electrocardiographic Findings among Patients with Myocardial Ischemia

Introduction: The aim of this study was to determine the consistency of Electrocardiography (ECG) and myocardial perfusion scan findings of patients with myocardial ischemia at Firoozgar and Hazrat-Rasool hospitals.Methods: Electrocardiogram of 80 patients undergoing myocardial perfusion scans was analyzed. All patients had a stable angina. All patients with bundle branch blocks and history of MI and coronary bypass or angiography were excluded. Overall, 120 patients were evaluated with single photon emission tomography/myocardial perfusion imaging for ischemia and 80 patients had a positive test.Results: Forty-five percent of patients were female and 55% were male. The average age of patients was 61.48 years. Sixty-one patients (76.25%) had normal ECG and 19 patients (23.75) had pathological changes in their ECG. Eleven patients had ST segment depression and 6 patients had T wave inversion. Furthermore, 21 patients (26.25%) had lateral wall ischemia in their myocardial perfusion scan and 13 (16.25%) patients had septal wall ischemia. The ECG changes in male patients and hypertensive cases were more prominent.Conclusions: This study showed that ST-T changes (ST depression and T inversion) in the ECG are more suggestive of accuracy of myocardial ischemia and ECG

The Association of Serum Vitamin D Levels and Short Term and 6-month Outcomes among Patients with Acute Coronary Syndrome

Introduction: vitamin D affects the function of most of the cells in the body, including myocytes and endothelial cells, and also affects platelet function. This study aims to evaluate the relation between vitamin D deficiency and in-hospital and 6-month outcomes of patients with the acute coronary syndrome.Methods: This was a prospective cohort study of patients admitted to Mousavi hospital with the diagnosis of acute coronary syndrome. A venous blood sample obtained from patients at the time of admission and 25-hydroxyvitamin D, lipid profile, and hs-troponin-I levels were measured. After coronary angiography, the severity of the coronary artery stenosis was calculated by the syntax score. Patients also evaluated in-hospital outcomes and even followed up for 6-month results.Results: Totally, 204 patients were included in the study. The mean ± SD of age was 60 ± 11.6-year-old. The overall vitamin D deficiency was 80.9%. There was no association between vitamin D deficiency and in-hospital and 6-month mortality in patients with acute coronary syndrome (P = 0.824). There was a direct and statistically significant association between vitamin D levels and HDL cholesterol (P = 0.011). Twenty-eight percent of patients with negative hs-troponin-I and 14% with positive hs-troponin-I had normal vitamin D levels, which was statistically significant (P = 0.045).Conclusion: This study does not demonstrate an association between vitamin D levels and in-hospital and 6-month outcomes in patients with the acute coronary syndrome

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality among Patients with COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis. Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU). Design, Setting, and Participants: Multicenter randomized trial with a 2 � 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020. Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up. Main Outcomes and Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 �103/µL). All outcomes were blindly adjudicated. Results: Among 600 randomized patients, 562 (93.7) were included in the primary analysis (median interquartile range age, 62 50-71 years; 237 42.2% women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% 95% CI,-6.6% to 9.8%; odds ratio, 1.06 95% CI, 0.76-1.48; P =.70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% 1-sided 97.5% CI,-� to 3.4%; odds ratio, 1.83 1-sided 97.5% CI, 0.00-5.93), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% 95% CI, 0.4%-3.8%; P =.01). Conclusions and Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19. Trial Registration: ClinicalTrials.gov Identifier: NCT04486508. © 2021 American Medical Association. All rights reserved

The effect of sodium-glucose co-transporter-2 (SGLT2) inhibitors on blood interleukin-6 concentration: a systematic review and meta-analysis of randomized controlled trials

Abstract Background The low-grade chronic inflammation in diabetes plays an important role in development of cardiovascular and renal complications. Sodium-glucose co-transporter-2 (SGLT2) inhibitors are recognized as protective agents for cardio-renal complications. Interleukin-6 (IL-6) is positively associated with the pathophysiology of metabolic-related pathologies. The aim of this meta-analysis is to investigate the effect of SGLT2 inhibitors on blood IL-6 concentration in randomized controlled trials (RCTs). Methods Embase, PubMed, and Scopus were systematically searched up to 1st of November 2023. The eligible studies were RCTs with adult population that had provided blood IL-6 for both control and intervention groups. Cochrane risk-of-bias tool were for study quality assessment. Data were analyzed using random effect model via Stata statistical software. Results Eighteen studies with a total of 5311 patients were included. Of which 3222 and 2052 patients were in intervention and control arm, respectively. Of the total population, 49.7% were men. The study durations ranged from 8 to 52 weeks. The pooled analysis showed a significant association between the use of SGLT2 inhibitors and lower IL-6 levels (standardized mean difference (SMD) = -1.04, Confidence Interval (CI): -1.48; -0.60, I2 = 96.93%). Dapagliflozin was observed to have a higher IL-6-lowering effect (SMD = -1.30, CI: -1.89; -0.71, I2 = 92.52) than empagliflozin or canagliflozin. Sub-group analysis of control groups (SMD = -0.58 (-1.01, -0.15) and -1.35 (-2.00, -0.70 for the placebo and active control sub-groups, respectively) and duration of interventions (SMD = -0.78 (-1.28, -0.28) and -1.20 (-1.86, -0.55) for study duration of ≤ 12 and > 12 weeks, respectively) did not change the results. Meta-regression analysis showed a significant correlation between the level of HbA1c and IL-6-lowering efficacy of SGLT2 inhibitors. Conclusion IL-6 levels are significantly reduced with the use of SGLT2 inhibitors with HbA1c as the only marker influencing such reductions, and dapagliflozin had the highest potency. The anti-inflammatory effect of SGLT2 inhibitors supports their broader use to address diabetic complications related to inflammatory responses

Additional file 1 of Fatal overdose from injection of human growth hormone; a case report and review of the literature

Additional file 1: Supplementary Figure 1: The electrocardiogram of patient. Left atrial abnormality is visible. According to Romhilt-Estes criteria, the second part of P wave deflection in lead V1 represents the duration of ≥ 40 msec and the depth of ≥ 1 mm

Additional file 1 of The effect of sodium-glucose co-transporter-2 (SGLT2) inhibitors on blood interleukin-6 concentration: a systematic review and meta-analysis of randomized controlled trials

Additional file 1: Table S1. We have searched PubMed, Embase, and Scopus databases using the terms below, PubMed for example (Updated to November 2023). Table S1. PICO inclusion criteria. Table S1. Meta-regression analysis of demographic and clinical variables on IL-6 lowering effect of SGLT2 inhibitors. Figure S1. Forest plot of the effect of SGLT2 inhibitor drugs on interleukin-6 based on the trial duration. Figure S2. Forest plot of the effect of SGLT2 inhibitor drugs on interleukin-6 based on the level of HbA1c. Figure S3. Relationship between level of HbA1c and interleukin-6 lowering effect of SGLT2 inhibitors. SGLT2 inhibitor: Sodium-glucose co-transporter-2 inhibitors. Figure S4. Relationship between male sex and interleukin-6 lowering effect of SGLT2 inhibitors. SGLT2 inhibitor: Sodium-glucose co-transporter-2 inhibitors. Figure S5. Relationship between age and interleukin-6 lowering effect of SGLT2 inhibitors. SGLT2 inhibitor: Sodium-glucose co-transporter-2 inhibitors. Figure S1. Risk of bias quality assessment results using ROB-2 tool. Figure S2. Funnel plot with pseudo 95% confidence limits demonstrating the SMD of interlukin-6 for each trial against their corresponding SEs. SMD: Standardized mean difference, SE: Standard error. Egger regression test had the p-value of 0.061. Figure S3. Galbraith plot to assess heterogeneity of the effects of SGLT2 inhibitor drugs on interleukin-6. SGLT2 inhibitor: Sodium-glucose co-transporter-2 inhibitors. Figure S4. The sensitivity analysis of the included studies using the leave-one-out (Left) and cumulative (Right) approaches. Table S1. Sensitivity analyses to assess the effect of different correlation coefficients on the main results

Atorvastatin versus Placebo in ICU Patients with COVID-19: Ninety-day Results of the INSPIRATION-S Trial

BACKGROUND: In the INSPIRATION-S trial, atorvastatin versus placebo was associated with a nonsignificant 16% reduction in 30-day composite of venous/arterial thrombosis or death in intensive care unit (ICU) patients with COVID-19. Thrombo-inflammatory response in coronavirus disease 2019 (COVID-19) may last beyond the first 30 days. METHODS: This article reports the effects of atorvastatin 20 mg daily versus placebo on 90-day clinical and functional outcomes from INSPIRATION-S, a double-blind multicenter randomized trial of adult ICU patients with COVID-19. The main outcome for this prespecified study was a composite of adjudicated venous/arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause mortality. Functional status was assessed with the Post-COVID-19 Functional Scale. RESULTS: In the primary analysis, 587 patients were included (age: 57 [Q1-Q3: 45-68] years; 44% women). By 90-day follow-up, the main outcome occurred in 96 (33.1%) patients assigned to atorvastatin and 113 (38.0%) assigned to placebo (hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.60-1.05, p = 0.11). Atorvastatin in patients who presented within 7 days of symptom onset was associated with reduced 90-day hazard for the main outcome (HR: 0.60, 95% CI: 0.42-0.86, p $_{interaction}$ = 0.02). Atorvastatin use was associated with improved 90-day functional status, although the upper bound CI crossed 1.0 (OR$_{ordinal}$: 0.64, 95% CI: 0.41-1.01, p = 0.05). CONCLUSION: Atorvastatin 20 mg compared with placebo did not significantly reduce the 90-day composite of death, treatment with ECMO, or venous/arterial thrombosis. However, the point estimates do not exclude a potential clinically meaningful treatment effect, especially among patients who presented within 7 days of symptom onset (NCT04486508)