The Genetic Architecture of Coronary Artery Disease: Current Knowledge and Future Opportunities

Purpose of reviewWe provide an overview of our current understanding of the genetic architecture of coronary artery disease (CAD) and discuss areas of research that provide excellent opportunities for further exploration.Recent findingsLarge-scale studies in human populations, coupled with rapid advances in genetic technologies over the last decade, have clearly established the association of common genetic variation with risk of CAD. However, the effect sizes of the susceptibility alleles are for the most part modest and collectively explain only a small fraction of the overall heritability. By comparison, evidence that rare variants make a substantial contribution to risk of CAD has been somewhat disappointing thus far, suggesting that other biological mechanisms have yet to be discovered. Emerging data suggests that novel pathways involved in the development of CAD can be identified through complementary and integrative systems genetics strategies in mice or humans. There is also convincing evidence that gut bacteria play a previously unrecognized role in the development of CAD, particularly through metabolism of certain dietary nutrients that lead to proatherogenic metabolites in the circulation. A major effort is now underway to functionally understand the newly discovered genetic and biological associations for CAD, which could lead to the development of potentially novel therapeutic strategies. Other important areas of investigation for understanding the pathophysiology of CAD, including epistatic interactions between genes or with either sex and environmental factors, have not been studied on a broad scope and represent additional opportunities for future studies

The efficacy of mouthwashes in reducing SARS-CoV-2 viral loads in human saliva: A systematic review

This systematic review aimed to evaluate existing randomized controlled trials (RCT) and cohort studies on the efficacy of mouthwashes in reducing SARS-CoV-2 viral loads in human saliva.Searches with pertinent search terms were conducted in PubMed, MEDLINE, Scopus, and Web of Science databases for relevant records published up to Oct 15, 2022. Google Scholar and ProQuest were searched for grey literature. Manual searches were conducted as well for any pertinent articles. The protocol was prospectively registered at PROSPERO (CRD42022324894). Eligible studies were critically appraised for risk of bias and quality of evidence to assess the efficacy of mouthwash in reducing the SARS-CoV-2 viral load in human saliva.Eleven studies were included. The effect on viral load using various types of mouthwash was observed, including chlorhexidine (CHX), povidone-iodine (PI), cetylpyridinium chloride (CPC), hydrogen peroxide (HP), ß-cyclodextrin-citrox mouthwash (CDCM), and Hypochlorous acid (HCIO). Eight articles discussed CHX use. Five were found to be significant and three did not show any significant decrease in viral loads. Eight studies reviewed the use of PI, with five articles identifying a significant decrease in viral load, and three not showing a significant decrease in viral load. HP was reviewed in four studies, two studies identified significant viral load reductions, and two did not. CPC was reviewed in four studies, two of which identified significant viral load reductions, and two did not. CDCM was reviewed in one article which found a significant decrease in viral load reduction. Also, HCIO which was evaluated in one study indicated no significant difference in CT value.The current systematic review indicates that based on these eleven studies, mouthwashes are effective at reducing the SARS-CoV-2 viral load in human saliva. However, further studies should be performed on larger populations with different mouthwashes. The overall quality of evidence was high

Using Forum Theatre to mobilise knowledge and improve NHS care: The Enhancing Post-injury psychological Intervention and Care (EPPIC) study

Background:Evidence regarding the impact of psychological problems on recovery from injury has limited influence on practice. Mindlines show effective practice requires diverse knowledge which is generally socially transmitted. Aims and Objectives: Develop and test a method blending patient, practitioner, and research evidence and using forum theatre to enable key stakeholders to interact with it.Assess: these methods; impact on contributing individuals/groups; on behaviour, practice, and research; mechanisms enabling these changes to occur.Methods: Stage-1: captured patient (n=53), practitioner (n=62), and research/expert (n=3) evidence using interviews, focus-groups, literature review; combined these strands using framework analysis and conveyed them in a play. Stage-2: patients (n=32), carers (n=3), practitioners (n=31) and researchers (n=16) attended Forum Theatre workshops where they shared experiences, watched the play, re-enacted elements, and co-produced service improvements. Stage-3: used the Social Impact Framework to analyse study outcome data and establish what changed, how and why.Findings: This approach enhanced individuals’/group knowledge of post-injury psychopathology, confidence in their knowledge, mutual understanding, creativity, attitudes towards knowledge mobilisation and research. These cognitive, attitudinal, and relational impacts led to multilevel changes in behaviour, practice, and research. Four key mechanisms enabled this research to occur and create impact: diverse knowledge, drama/storytelling, social interaction, actively altering outcomes. Discussion: Discourse about poor uptake of scientific evidence focusses on methods to aid translation and implementation, this study shows how mindlines can reframe this ‘problem’ and inform impactful research.Conclusions: EPPIC demonstrated how productive interaction between diverse stakeholders using creative means bridges gaps between evidence, knowledge, and action