222 research outputs found

    Does individualized guided selection of antiplatelet therapy improve outcomes after percutaneous coronary intervention? A systematic review and meta-analysis

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    Background: The potential benefits of individualized guided selection of antiplatelet therapy over standard antiplatelet therapy in improving outcomes in patients undergoing percutaneous coronary intervention (PCI) have not been established. Therefore, we pooled evidence from available clinical trials to assess the effectiveness by comparing the two regimens in patients undergoing PCI.Methods: We queried two electronic databases, MEDLINE and Cochrane CENTRAL, from their inception to April 20, 2021 for published randomized controlled trials in any language that compared guided antiplatelet therapy, using either genetic testing or platelet function testing, versus standard antiplatelet therapy in patients undergoing PCI. The results from trials were presented as risk ratios (RRs) with 95% confidence intervals (CIs) and were pooled using a random-effects model.Results: Eleven eligible studies consisting of 18,465 patients undergoing PCI were included. Pooled results indicated that guided antiplatelet therapy, compared to standard therapy, was associated with a significant reduction in the incidence of MACE [RR 0路78, 95% CI (0路62-0路99), P = 0路04], MI [RR 0路73, 95% CI (0路56-0.96), P = 0路03], ST [RR 0路66, 95% CI (0路47-0.94), P = 0路02], stroke [RR 0路71, 95% CI (0路50-1.00), P = 0路05], and minor bleeding [RR 0路78, 95% CI (0路66-0.91), P = 0路003].Conclusions: Individualized guided selection of antiplatelet therapy significantly reduced the incidence of MACE, MI, ST, stroke, and minor bleeding in adult patients when compared with standard antiplatelet therapy. Our findings support the implementation of genetic and platelet function testing to select the most beneficial antiplatelet agent

    Myocarditis following administration of COVID-19 Vaccine 鈥 Should we be worried?

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    The COVID-19 vaccines have raised scepticism surrounding their accelerated approval due to their suspected adverse side effects.(1) Recently emerging clinical cases such as flu, fever, tachycardia, Bell鈥檚 palsy, and swelling of the lymph nodes have further heightened public distrust. Interestingly, the United States Food and Drug Administration has recently announced an inflammatory heart disease, Myocarditis, as a potential risk of the Pfizer-BioNTech COVID-19 vaccine. 聽In efforts to find an association between the Pfizer vaccine and Myocarditis, researchers recently carried out extensive clinical trials; two new studies tracked cases having biomarker evidence of myocardial injury and Cardiac Magnetic Resonance Imaging.(2,3) Moreover, the United States Centers for Disease Control and Prevention (CDC) has recorded 323 confirmed cases of myocarditis, most documented within a week after each patient had received the Pfizer-BioNTech COVID-19 vaccine.(4) A recent emergent theory suggests a cytokine response as the leading cause of myocarditis; the immune system identifies the mRNA in the vaccine as an antigen, leading to the activation of proinflammatory cascades and immunological pathways. The expression of cytokines and activation markers is due to the exposure of the dendritic cells to mRNA, which eventually causes inflammation of the heart muscle.(4) Furthermore, according to the CDC, the myocarditis is mainly observed in male adolescents and young adults, more often after getting the second dose of the COVID-19 vaccine. A week after administrating 聽the vaccine, symptoms such as chest pain, shortness of breath, and tachycardia may appear, which tend to resolve following conservative treatment with nonsteroidal anti-inflammatory drugs.(3) Despite the previously mentioned occurrences of myocarditis after administration of the Pfizer-BioNtech vaccine, we would like to highlight the results of a large-scale cohort study in Israel with 2.5 million participants, where the estimated incidence of myocarditis after the administration of the Pfizer vaccine was only 2.13 cases per 100,000 persons.(5) These statistics allow us to draw the readers鈥 attention towards the benefits of the COVID-19 vaccination, which outweigh potential adverse risks such as Myocarditis. The Pfizer-BioNtech vaccine has proven to be 95% effective and to keep聽 track of other possible complications, patients are advised to report to the Vaccine Adverse Event Reporting System (VAERS) to document any unusual side effects.(4) Despite the few reported complications, we would further like to emphasize the importance of population- wide vaccination to overcome the COVID-19 pandemic with a minimum mortality rate

    Efficacy and safety of direct oral anticoagulants with and without aspirin: A systematic review and meta-analysis

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    Background: Various anticoagulant therapies are prescribed to patients under physicians\u27 discretion and recently Direct Oral Anticoagulants(DOAC) have been under trials to evaluate their safety and efficacy. In addition to this, the regimen of DOACs and Aspirin is of keen interest as researchers continue to find an optimal regimen to treat blood clots in patients. This study is a systematic review and meta-analysis of randomized controlled trials and observational studies that asses the safety and efficacy of DOAC with and without Aspirin. Methods: We queried MEDLINE and Cochrane CENTRAL from their inception to April 2021, for published and randomized controlled trials and observational studies in any language that compared dual (DOAC + ASA) therapy or mono (DOAC alone) therapy in patients with AF. The results from the studies were presented as risk ratios (RRs) with 95% confidence intervals (CIs) and were pooled using a random-effects model. Endpoints of interest included major bleeding, myocardial infarction (MI), major adverse cardiovascular events (MACEs), hospitalizations, all-cause mortality, and stroke. Results: The risk of major bleeding was significantly lower in the DOAC alone group compared with DOAC plus aspirin group. Non-significant results were obtained (P value greater than 0.05) for other outcomes establishing that DOAC monotherapy was not superior to the combined regimen in reducing the risk of MACE, Stroke, Hospitalization, Death. Conclusion: Among patients with NVAF (Non valvular Atrial Fibrillation) and VTE (Venous thromboembolism) receiving anticoagulation prophylaxis, in terms of safety profile our comparisons showed a statistically significant reduction in Major Bleeding in DOAC Alone group compared with DOAC Plus Aspirin

    Aduhelm's accelerated approval for the treatment of Alzheimer's Disease

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    Madam, despite the life-threatening manifestations that Alzheimer's disease (AD) possesses, to date, only five medical treatments have been approved for AD, which involve two classes of drugs that merely control the symptoms rather than altering the course of the disease. Moreover, in the last decade, relatively few clinical trials have been undertaken in AD, which have had a 99.6% failure rate.1 However, the United States Food and Drug Administration recently approved a drug, Aduhelm, a monoclonal antibody that directly targets the fundamental pathophysiology of the disease.2 With the advancing health care system, life expectancy in Pakistan has increased from 65.41 to 67.48 years in the past ten years, consequently raising diseases in the elderly population, such as AD.3 In efforts to find a treatment for AD, researchers carried out three trials that enrolled approximately three thousand patients who were given Aduhelm in a randomized, placebo-controlled study of different dosages. The patients who received Aduhelm showed reduced prevalence and impact of the manifestations of AD.2 The 鈥渁myloid cascade hypothesis鈥 suggests that the accumulation of the beta-amyloid plaques results from an imbalance between the plaque accumulation and clearance in the brain, which is the main cause of AD pathogenesis. Designed specifically in keeping with the above fact, Aduhelm selectively targets and clears aggregated forms of beta-amyloid plaques, including soluble oligomers and insoluble fibrils, thus promoting healthy brain aging.4 We want to draw the attention of the readers towards the alarming number of patients being diagnosed with AD and the importance of the role of this drug in managing the manifestations of this disease. This drug has been approved for everyone with AD but it is not yet available.5 Pakistan is a developing country and unfortunately, due to economic constraints, an expensive drug like Aduhelm is an unlikely choice, a situation that leaves very few viable options. However, to reduce the inequity in the accessibility of this drug, the government could make a review in policies to subsidize the price of the drug and make it more affordable and accessible to the masses. Continuous..

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    Not AvailableThe article explores the activities and demonstration units available at Krishi Vigyan Kendra, Hulkoti, Gadag District, Karnataka StateNot Availabl

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    Not AvailableThe article highlights on the importance, nutritional value and medicinal value of Jamun fruitNot Availabl

    Immune Modulation by Transplanted Calcium Phosphate Biomaterials and Human Mesenchymal Stromal Cells in Bone Regeneration

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    International audienceA wide variety of biomaterials have been developed as both stabilizing structures for the injured bone and inducers of bone neoformation. They differ in chemical composition, shape, porosity, and mechanical properties. The most extensively employed and studied subset of bioceramics are calcium phosphate materials (CaPs). These materials, when transplanted alongside mesenchymal stem cells (MSCs), lead to ectopic (intramuscular and subcutaneous) and orthotopic bone formation in preclinical studies, and effective fracture healing in clinical trials. Human MSC transplantation in pre-clinical and clinical trials reveals very low engraftment in spite of successful clinical outcomes and their therapeutic actions are thought to be primarily through paracrine mechanisms. The beneficial role of transplanted MSC could rely on their strong immunomodulatory effect since, even without long-term engraftment, they have the ability to alter both the innate and adaptive immune response which is critical to facilitate new bone formation. This study presents the current knowledge of the immune response to the implantation of CaP biomaterials alone or in combination with MSC. In particular the central role of monocyte-derived cells, both macrophages and osteoclasts, in MSC-CaP mediated bone formation is emphasized. Biomaterial properties, such as macroporosity and surface microstructure, dictate the host response, and the ultimate bone healing cascade. Understanding intercellular communications throughout the inflammation, its resolution and the bone regeneration phase, is crucial to improve the current therapeutic strategies or develop new approaches

    Factors Determining Pakistani Medical Students\u27 Career Preference for General Practice Residency Training.

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    Background Few studies have explored factors affecting preference of medical students towards general practice as a career choice. We conducted a survey in Karachi across various public and private sector medical colleges to examine factors associated with students鈥 general practice career aspirations in Karachi, Pakistan. Methods From January to March 2018, we distributed a 21-item questionnaire to final year medical students in eight medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. Results A total of 1400 responses were obtained. The top five specialty fields chosen by students with their numbers were: internal medicine, 898 (64.2%); general practice, 337 (24.1%); pediatrics, 449 (32.1%); surgery, 380 (27.2%); and emergency medicine, 243 (17.4%). The 鈥渋ntent to inherit existing practice鈥 and 鈥渙ther academic or professional experiences prior to medical school鈥 had a positive association with choosing general practice while 鈥渉aving a physician parent鈥欌 had a negative association among the medical students demographics after adjusting for other covariates in the multivariable logistic regression. Medical students who ranked 鈥渃linical diagnostic reasoning鈥, 鈥渃ommunity-oriented practice鈥, 鈥渋nvolvement in preventive medicine鈥, and 鈥渇requent patient communication鈥 as highly important were more likely to choose general practice, whereas, 鈥渁ccess to advanced medical fields鈥, 鈥渕astering advanced procedures鈥, and 鈥渄epth rather than breadth of practice鈥 were less likely to be associated with general practice aspiration. Conclusion The study鈥檚 results depicted limited interest of family medicine as a career option in graduating students, and pointed out the factors that likely influence the choice of general practice as a career are clinical diagnostic reasoning, community-oriented practice and preventive medicine
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