Factors determining the frequency of optical coherence tomography and intravascular ultrasound use in patients treated with percutaneous coronary interventions in recent years: Analysis based on a large national registry

Background: Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have demonstrated improvement in the clinical outcome of patients undergoing percutaneous coronary intervention (PCI). Aims: To examine the frequency of implementing OCT and IVUS during coronary angiography (CA) and PCI in every day practice in Poland. Factors related to the more common choice of these techniques for imaging were determined. Methods: Data from the national registry of percutaneous coronary interventions (ORPKI) were procured for analysis. Between January 2014 and December 2021, 1 452 135 CAs, 11 710 using IVUS (0.8%) and 1471 with OCT (0.1%) were extracted, 838297 comprised PCIs, 15 436 with IVUS (1.8%), while 1680 were OCT (0.2%). The determining factors for applying IVUS and OCT via multiple regression logistics models were assessed. Results: The occurrence of applying IVUS during CAs and PCIs experienced a significant increase between the years 2014 and 2021. In 2021, its level achieved 1.54% for CAs and 4.42% for PCIs, while for OCT, there was a rise regarding the CA group — reaching 0.13% in 2021 and in the PCI group, 0.43%. Age was among a number of factors significantly associated with the frequency of using IVUS/OCT during CA/PCI confirmed by multivariate analysis (Odds ratio: 0.981 for IVUS and 0.973 for OCT use with PCI). Conclusion: The frequency at which IVUS and OCT were used has undergone a significant increase in previous years. This increase can be largely attributed to present reimbursement policies. Further improvement is required for it to be at a satisfactory level

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Sztuczna inteligencja w służbie kardiologii inwazyjnej

Zwapnienia w naczyniach wieńcowych zwiększają istotnie złożoność zabiegów angioplastyki wieńcowej. Zwapniałe zmiany miażdżycowe niepodatne na inflację cewnikami balonowymi stanowią wyzwanie dla kardiologii interwencyjnej w związku z dużym ryzykiem zabiegowym oraz suboptymalnymi wynikami angiograficznymi skutkującymi gorszymi wynikami odległymi. Optyczna tomografia koherencyjna (OCT) stosuje światło z zakresu bliskiej podczerwieni do tworzenia obrazów o wysokiej rozdzielczości zarówno światła, jak i ściany naczynia wieńcowego. OCT pozwala na zautomatyzowane, dokładne pomiary umożliwiające wymiarowanie naczynia wieńcowego oraz optymalizację implantacji stentów w trakcie zabiegów PCI. Wykazano, że użycie OCT wiąże się z polepszeniem odległych wyników klinicznych. Przedstawiamy przypadek pacjenta, u którego wykonano zabieg PCI pod kontrolą OCT w zakresie pnia głównego oraz gałęzi zstępującej lewej tętnicy wieńcowej w obrębie zmiany nie poddającej się poszerzeniu cewnikami balonowymi (wysokociśnieniowymi oraz tnącymi), a także zastosowaniu rotablacji wieńcowej. Zastosowanie obrazowania wewnątrzwieńcowego OCT zmieniło początkową strategię zabiegu. Użycie wewnątrzwieńcowej litotrypsji (IVL) pozwoliło na modyfikację uwapnionej zmiany miażdżycowej, co pozwoliło uzyskać optymalne rozprężenie stentów i dobry wynik bezpośredni zabiegu. System hemodynamicznego wspomagania krążenia Impella CP zastosowany podczas PCI pozwolił na bezpieczne przeprowadzenie złożonej procedury, pomimo znacznie obniżonej frakcji wyrzutowej lewej komory. Uzyskano dobry wynik bezpośredni zabiegu PCI, a przebieg wewnątrzszpitalny był niepowikłany.Zwapnienia w naczyniach wieńcowych zwiększają istotnie złożoność zabiegów angioplastyki wieńcowej. Zwapniałe zmiany miażdżycowe niepodatne na inflację cewnikami balonowymi stanowią wyzwanie dla kardiologii interwencyjnej w związku z dużym ryzykiem zabiegowym oraz suboptymalnymi wynikami angiograficznymi skutkującymi gorszymi wynikami odległymi. Optyczna tomografia koherencyjna (OCT) stosuje światło z zakresu bliskiej podczerwieni do tworzenia obrazów o wysokiej rozdzielczości zarówno światła, jak i ściany naczynia wieńcowego. OCT pozwala na zautomatyzowane, dokładne pomiary umożliwiające wymiarowanie naczynia wieńcowego oraz optymalizację implantacji stentów w trakcie zabiegów PCI. Wykazano, że użycie OCT wiąże się z polepszeniem odległych wyników klinicznych. Przedstawiamy przypadek pacjenta, u którego wykonano zabieg PCI pod kontrolą OCT w zakresie pnia głównego oraz gałęzi zstępującej lewej tętnicy wieńcowej w obrębie zmiany nie poddającej się poszerzeniu cewnikami balonowymi (wysokociśnieniowymi oraz tnącymi), a także zastosowaniu rotablacji wieńcowej. Zastosowanie obrazowania wewnątrzwieńcowego OCT zmieniło początkową strategię zabiegu. Użycie wewnątrzwieńcowej litotrypsji (IVL) pozwoliło na modyfikację uwapnionej zmiany miażdżycowej, co pozwoliło uzyskać optymalne rozprężenie stentów i dobry wynik bezpośredni zabiegu. System hemodynamicznego wspomagania krążenia Impella CP zastosowany podczas PCI pozwolił na bezpieczne przeprowadzenie złożonej procedury, pomimo znacznie obniżonej frakcji wyrzutowej lewej komory. Uzyskano dobry wynik bezpośredni zabiegu PCI, a przebieg wewnątrzszpitalny był niepowikłany

Niestabilna dusznica bolesna. Aagresywne leczenie statyną oraz inhibitorem COX-2 zmniejsza stężenie CRP już po trzech dniach

Background and aim: Elevated levels of C-reactive protein (CRP) are associated with an increased risk of coronary events. The levels of CRP and other inflammatory markers are significantly elevated in patients with unstable angina. We hypothesised that a high-dose statin therapy alone or with cyclooxygenase-2 (COX-2) inhibitors, administered before coronary diagnostic or invasive procedures, can attenuate CRP elevation after the procedure and, consequently, more effectively reduce the rate of coronary events.Methods: All patients with unstable angina in class III and IIB according to Braunwald classification were considered for inclusion in the present study. Finally, 60 patients with elevated CRP level (>3 mg/l) were randomised to three groups of pharmacological treatment before coronary angiography and subsequent angioplasty. Patients from group A received placebo, patients from group B - 80 mg of atorvastatin, and patients from group C - 80 mg of atorvastatin and 25 mg of rofecoxib. The levels of CRP were measured at baseline, after 3 days of therapy and 48 hours after invasive coronary procedure.Results: The mean baseline CRP level in group A was 5.67&#177;2.82 mg/l, in group B - 4.7&#177;1.32 mg/l, and in group C - 6.78&#177;2.56 mg/l (NS). After three days of pharmacological treatment, the mean CRP level was 5.82&#177;2.69 mg/l in group A (NS compared with baseline) and was significantly reduced in group B to 2.5&#177;1.37 mg/l and in group C to 3.01&#177;1.57 mg/l (

Inter-individual variability in response to clopidogrel in patients with coronary artery disease

Background: Clopidogrel, especially when combined with aspirin, reduces the rate of ischaemic events in patients with coronary artery disease (CAD). There are scare data in literature on the inter-individual variability in response to clopidogrel.Aim: To assess the incidence of clopidogrel resistance using rapid whole blood platelet function assessment, and to examine the possibility of early identification of non-responders.Methods: In 31 consecutive patients with stable angina treated with aspirin, the degree of platelet aggregation inhibition (DPAI) in the whole blood was assessed at baseline and 3, 6, 12 as well as 24 hours after administration of loading dose of clopidogrel (300 mg). Response to clopidogrel was measured by calculating the absolute difference between the baseline DPAI and DPAI obtained at the investigated time-points (&#8710;DPAI).Results: After 24 hours from clopidogrel administration, seven (22.6%) patients were identified as non-responders (&#8710;DPAI &#8804;10%). Demographic and clinical variables as well as baseline DPAI were similar in responders and non-responders (DPAI: 5.8&#177;3.7% vs 7.1&#177;5.3%, p=NS). Out of the patients who were found to be resistant to clopidogrel at the six-hour time-point, 87.5% remained resistant to this agent 24 hours after drug administration. &#8710;DPAI calculated at the 24-hour time-point highly correlated with the six-hour &#8710;DPAI (r=0.74). No differences in the rate of ischaemic or bleeding complications between responders and non-responders were noted.Conclusions: The assessment of the degree of platelet aggregation inhibition allows early (six hours from the initiation of treatment) identification of patients who are resistant to clopidogrel. The method of the rapid whole blood platelet function assessment is feasible in every-day clinical practice