Coronary angioplasty and COVID-19: are heparin requirements and thrombotic complications increasing?

Funding Acknowledgements

Type of funding sources: None.

Background

Covid-19 infection is associated with coagulopathy and possible heparin resistance, raising concerns that routine heparin during percutaneous coronary intervention (PCI) is failing to achieve adequate anticoagulation. We examined heparin requirements and efficacy in patients treated by PCI before and after the first reported UK case of Covid-19 (January 31st 2020).

Methods

We retrospectively compared heparin dose, Activated Clotting Time (ACT) and coronary flow (TIMI grade) for PCI procedures at a London cardiac centre in the 3 months before the UK pandemic and the three months afterwards. Testing for COVID was not routinely performed. Pre-specified analyses in patients with STEMI, NSTEMI and Stable angina were undertaken.

Results

Of 1227 PCI procedures performed over the period of observation, 690 were pre-pandemic and 537 were afterwards. Overall median heparin dose per case was 11000units versus 11500units (p = 0.137) and maximum ACTs were 291s versus 305s, respectively (p = 0.135). Pre-PCI TIMI 3 flow was lower during the pandemic than before (60% v 65%, p = 0.005) but Post-PCI flow was similar (96% versus 96%, p = 0.839). There were no statistically significant differences in heparin dose or achieved ACT among patients with STEMI, NSTEMI or Stable presentations.

Conclusion

In spite of the increasing evidence that COVID-19 infection causes thrombosis, it appears that standard heparin management during PCI is sufficient to achieve effective anticoagulation and avoid peri-procedural thrombotic complications.

	Group 1 Pre Pandemic	Group 2 Pandemic	P value
Number of doses given	3 (3 to 4)	3 (3 to 4)	0.952
Total Heparin dose (units)	11000 (8000 to 14000)	11500 (9000 to 14000)	0.137
Number of ACTs measured	2 (1 to 2)	2 (1 to 2)	0.194
First ACT (seconds)	240 (199 to 318)	248 (206 to 326)	0.256
Maximum ACT (seconds)	291 (230 to 368)	305 (239 to 369)	0.135

Heparin dose and Activated Clotting Times (ACT) in patients undergoing PCI before Covid-19 pandemic (Group 1) and during pandemic (Group 2); median and interquartile ranges

CYP1A2, 2A13, and 3A4 network and interaction with aflatoxin B1

Aspergillus fungi are known to produce aflatoxins, among which aflatoxin B1 (AFB1) is the most potent carcinogen that is metabolised by cytochrome P450 (CYP450). In the liver, AFB1 is metabolised into exo-8,9-epoxide by the CYP1A2 enzymes. The resulting epoxide can react with guanine to cause DNA damage. Natural inhibitors are being identified. However, the modes of action are poorly understood. In the current study, we have investigated the mode of action of AFB1 with CYP1A2, CYP3A4 and CYP2A13 using molecular dynamic simulation (MD simulation) approaches. The interaction network and paths among CYP1A2, CYP3A4, and CYP2A13 have been investigated using the STRING database and PathLinker plugin of Cytoscape. CYP3A4 is the most active protein involved in interactions with AFB1 during its metabolism. Residues 362ARG, 445SER, 450LEU and 451PHE of CYP1A2 are important, interacting with AFB1 and converting it to toxic exo-AFB1-8,9-epoxide (AFBEX). The pathway shows that microsomal epoxide hydrolase (EPHX1) may acts as initiator in the signalling pathway where CYP1A2, CYP3A4 and CYP2A13 interact in a sequential order. The interaction network shows there to be a strong association in expression among CYP1A2, CYP3A4 and CYP2A13 along with other metabolising enzymes. The complex of AFB1 and CYP1A2 was found to be stable during the MD simulation. This study provides a better understanding of the mode of action between AFB1 and CYP1A2, CYP3A4 and CYP2A13 which relates to the effective management of AFB1 toxicity. EPHX1 in the protein network may be an ideal target when designing inhibitors to prevent the toxin’s activation. Peptide inhibitors may be designed to block the substrate site residues of CYP1A2 in order to prevent the conversion from AFB1 into AFBEX. This would either neutralise or reduce its toxicity.

Social media use and information-sharing behaviour of university students

Social media has evolved over the last decade as a key driver for sharing and acquiring information in various domains of life. The increasing popularity of social media raises a number of questions regarding the extent of its use and the types of information shared. This study is designed to answer these questions by investigating university students’ use of social media in terms of commonly used social media platforms, frequency of use and the types of information shared. It also looks at differences of opinion based on gender, academic discipline and programme of study. The study is based on a cross-sectional survey; a structured questionnaire was developed and data was collected from 400 students at four universities in Faisalabad, Pakistan. The findings indicate that the majority of the students were frequent users of social media and visited platforms daily or several times a day. WhatsApp, Facebook and YouTube were the most widely used social media platforms. Male students tended to use social media more frequently than their female counterparts. This study will serve as a guideline for further research as it addresses an untouched area from a local perspective and reports original research.

In vitro Assessment of Tris Egg Yolk and Soybean Lecithin Based Extenders for Cryopreservation of Crossbred Ram Semen

BACKGROUND

The replacement of egg yolk with alternative plant-derived soybean lecithin is gaining interest in both animal and human sperm cryopreservation owing to biosecurity issues with egg yolk based extenders.

OBJECTIVE

To evaluate the comparative effect of egg yolk and soyabean lecithin based extenders on the quality of cryopreserved crossbred ram semen.

METHODS

Pooled ejaculates (total ejaculates = 36) were divided into two aliquots and extended with Tris egg yolk extender (Tris extender) and soybean lecithin based commercial extender (Ovixcell) RESULTS: Among the two extenders, Ovixcell showed better sperm quality both at the pre-freeze (Sperm motility) and post-thaw stages. Lower malondialdehyde (MDA) level (nmol/mL) was observed in Ovixcell as compared to Tris extender. Both sperm quality and MDA level decreased significantly (P < 0.05) from pre-freeze to post-thaw in both the extenders.

CONCLUSION

The findings of the present study indicate that Ovixcell is a comparable alternative to Tris extender for the cryopreservation of crossbred ram semen.

Academic use of smartphones among medical students in Pakistan

This study examined the use of smartphones as an academic tool amongst medical students from a developing country context. The study also aimed at identifying the perceived benefits and barriers to using smartphones in medical education. A cross sectional survey was administered to the students from nine medical institutes in Pakistan. A structured questionnaire was self-administered to 270 students from MBBS program. Data were analyzed using SPSS 23. All the respondents owned a smartphone. They used smartphones to browse the Internet to find medical information (100%), to share educational material (90%), and to take notes (79%). Easy and speedy access to information and improvement in study skills were the major benefits, while limited wireless access, small screen, and lack of awareness about medical resources were the main barriers. The students had a positive attitude towards smartphone as an academic tool. Smartphones use is likely to increase with the emergence of new developments in terms of design, medical apps and educational resources.

Information sources, practices and barriers: a situated and context-bound model of Pakistani electronic media reporters

Purpose

This study presents a situated and context-bound model of electronic media reports by exploring their detailed information practices within the workplace actions. It further investigates the information sources they usually consult for news or story-making process and barriers that hinder them to acquire required information.

Design/methodology/approach

The data were collected through semistructured, face-to-face interviews of electronic media reporters from the top news channels of Pakistan. These reporters had international exposure while having 7–20 years of work experience with different news channels.

Findings

In relation to information practices, the model also highlights the seven steps involved in news-making process of electronic media. Initially inspired from Mckenzie's (2003) model of information practice, which was developed within the everyday life context, this model attempts to see the information practices of electronic media reporters situated at their workplaces and might be seen as an extension of previous works.

Originality/value

This study is a unique attempt to find patterns of information practices situated in their workplace actions. The results of this study would be helpful for librarians and information specialists, who are working in media house libraries for the planning and designing of library services.

Peer review

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-07-2020-0308

Research practices of LIS professionals in Pakistan: A study of attitudes, involvement and competencies

This study analyses the attitudes, involvement and competencies of Pakistani Library Information Science (LIS) professionals towards research. An online survey was carried out by using a questionnaire to collect data from LIS professionals working in various types of libraries in Pakistan. The findings reveal that the overall attitude of the Pakistani LIS professionals towards research is positive. A vast majority of them read research literature, albeit occasionally, while a small majority read the full-text articles. Two local journals, Pakistan Library & Information Science Journal (PLISJ) and Pakistan Journal of Information Management & Libraries (PJIML), are the top read titles. Though research contributions counted towards promotion of LIS professionals, a very small majority of them were currently engaged in research project/s. They do not feel very confident about their research expertise, yet aspire to increase their knowledge of research. Some of the factors that deter LIS professionals from engaging in research are: a lack of time, little support from their organisation, lack of research ideas and lack of research skills. Institutional support in terms of time, money and educational training would enhance opportunities for LIS professionals to produce more research and publication.

Relationship between country income, socioeconomic factors and control of cardiovascular disease risk factors in patients with type 2 Diabetes: insights from the global DISCOVER registry

Background

In patients with type 2 diabetes (T2D), optimal management of cardiovascular (CV) risk factors is critical for primary prevention of CV disease.

Purpose

To describe the association of country income and patient socioeconomic factors with risk factor control in patients with T2D.

Methods

DISCOVER is a 37-country, prospective, observational study of 15,983 patients with T2D enrolled between January 2016 and December 2018 at initiation of 2nd-line glucose-lowering therapy and followed for 3 years. In patients without known CV disease with sub-optimally controlled risk factors at baseline, we examined achievement of risk factor control (HbA1c &lt;7%, BP &lt;140/90 mmHg, appropriate statin) at the 3 year follow-up. Countries were stratified by gross national income (GNI)/capita, per World Bank report. We explored variability across countries in risk factor control achievement using hierarchical logistic regression models and examined the association of country- and patient-level economic factors with risk factor control.

Results

Among 9,613 patients with T2D but without CV disease (mean age 57.2 years, 47.9% women), 83.1%, 37.5%, and 66.3% did not have optimal control of glucose, BP, and statins, respectively, at baseline. Of these, 40.8%, 55.5%, and 28.6% achieved optimal control at 3 years of follow-up. There was substantial variability in achievement of risk factor control across countries (Figure) but no association of country GNI/capita on achievement of risk factor control (Table). Insurance status, which differed substantially by GNI group, was strongly associated with glycemic control, with no insurance and public insurance associated with lower odds of patients achieving HbA1c &lt;7%.

Conclusions

In a global cohort of patients with T2D, a substantial proportion do not achieve risk factor control even after 3 years of follow-up. The variability across countries in risk factor control is not explained by the GNI/capita of the country.

Proportion of patients at goal

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): The DISCOVER study is funded by AstraZeneca

Design of a closed-loop gastric pacemaker for modulating dysrhythmic conduction patterns via extracellular potentials

A potential treatment option for chronic and severe motility disorders such as gastroparesis is the implantation of a Gastric Electrical Stimulator (GES), which is designed to modulate the bio-electric slow waves. However, the effectiveness of current GESs remains uncertain since they do not work in a closed-loop by sensing, processing, and modulating the dysrhythmic patterns. This work presents the design of a GES model working in closed-loop with the network of the Interstitial Cells of Cajal (ICC). A pre-existing two-dimensional ICC network is enhanced by proposing an extracellular potential generation model, which can precisely capture the timing behaviour of slow wave propagation pattern of the simulated ICC network. The GES senses the extracellular potential, detects bradygastric patterns and finally modulates the activity to ensure normal conduction. The GES is designed to be practical for ease of validation and implementation.

GW190521: A Binary Black Hole Merger with a Total Mass of 150 M_{⊙}

On May 21, 2019 at 03:02:29 UTC Advanced LIGO and Advanced Virgo observed a short duration gravitational-wave signal, GW190521, with a three-detector network signal-to-noise ratio of 14.7, and an estimated false-alarm rate of 1 in 4900 yr using a search sensitive to generic transients. If GW190521 is from a quasicircular binary inspiral, then the detected signal is consistent with the merger of two black holes with masses of 85_{-14}^{+21}  M_{⊙} and 66_{-18}^{+17}  M_{⊙} (90% credible intervals). We infer that the primary black hole mass lies within the gap produced by (pulsational) pair-instability supernova processes, with only a 0.32% probability of being below 65  M_{⊙}. We calculate the mass of the remnant to be 142_{-16}^{+28}  M_{⊙}, which can be considered an intermediate mass black hole (IMBH). The luminosity distance of the source is 5.3_{-2.6}^{+2.4}  Gpc, corresponding to a redshift of 0.82_{-0.34}^{+0.28}. The inferred rate of mergers similar to GW190521 is 0.13_{-0.11}^{+0.30}  Gpc^{-3} yr^{-1}.

Usage of and learning from Wikipedia: a study of university students in Pakistan

Purpose

This study aims to explore the university students’ usage pattern of Wikipedia information and its effect on their learning.

Design/methodology/approach

A structured questionnaire was designed to collect data from the students of master programmes at University of the Punjab, Lahore. Proportionate stratified sampling technique was used to select the sample from the population of “Faculty of Behavioural and Social Sciences”. In total, 225 masters’ students from eight departments participated voluntarily in the study.

Findings

Findings revealed that the majority of the respondents used Wikipedia information regularly for both academic and leisure purposes. They usually did not edit/add content in Wikipedia entries though they observed incomplete contents in it. Overall, the respondents perceived Wikipedia as an easy and understandable source of information that enhanced their understanding about a topic and enabled them to accomplish tasks more quickly.

Research limitations/implications

The sample of this study was social sciences students from one university. The findings may not be generalizable across other groups of students and universities.

Practical implications

These findings suggest that students have a positive behaviour towards Wikipedia and regarded it as a good source of information. They use Wikipedia information for academic and leisure purposes. So, the academics and librarians need to provide better guidelines for using Wikipedia, rather than prohibiting its use altogether.

Originality/value

This paper provides useful information on the use of Wikipedia among university students from a developing country’s perspective and thus contributes to the tendency of increasing acceptance of Wikipedia in academia. Furthermore, understanding how gender plays a role in differentiating the using behaviour of Wikipedia information could benefit both academics and library practitioners.

Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation

BACKGROUND AND PURPOSE

The safety of early initiation of anticoagulant therapy in patients with ischaemic stroke related to atrial fibrillation (AF) is unknown. We investigated the safety of early initiation of direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs) or no anticoagulation.

METHODS

This observational, retrospective, single-centre study included consecutive patients with recent (<4 weeks) ischaemic stroke and AF. The primary outcome was the rate of major (intracranial and extracranial) bleeding in patients on different treatment schemes, i.e. DOACs, VKAs and not anticoagulated. We also investigated the rate of ischaemic cerebrovascular events and mortality.

RESULTS

We included 959 consecutive patients with AF and ischaemic stroke followed up for an average of 16.1 days after the index event. A total of 559 out of 959 patients (58.3%) were anticoagulated with either VKAs (n = 259) or DOACs (n = 300). Anticoagulation was started after a mean of 7 ± 9.4 days in the DOAC group and 11.9 ± 19.7 days in the VKA group. Early initiation of any anticoagulant was not associated with an increased risk of any major bleeding [odds ratio (OR), 0.49; 95% confidence intervals (CI), 0.21-1.16] and in particular of intracranial bleeding (OR, 0.47; 95% CI, 0.17-1.29; P = 0.143) compared with no anticoagulation. In contrast to VKAs (OR, 0.78; 95% CI, 0.28-2.13), treatment with DOACs (OR, 0.32; 95% CI, 0.10-0.96) reduced the rate of major bleeding compared with no anticoagulation. Early recurrences of ischaemic stroke did not differ significantly among the three groups.

CONCLUSIONS

Starting DOACs within a mean of 7 days after stroke appeared to be safe. Randomized controlled studies are needed to establish the added efficacy of starting anticoagulation early after stroke.

Patella dislocation: an online systematic video analysis of the mechanism of injury

Background

The mechanism of injury (MoI) for a patellar dislocation has not been fully established. The aim of this study was to use systematic video analysis to determine the MoI of a patella dislocation.

Methods

A systematic search was conducted of three video sharing websites and three popular search engines to identify videos demonstrating a patellar dislocation. Videos were reviewed by three surgeons trained in systematic video analysis, who commented on the position of the lower limb and the situation in which the injury occurred. The results were reviewed to build a consensus of the MoI for each video. Statistical analysis was conducted for interobserver agreement (p < 0.05).

Results

Initial search yielded 603 videos with 13 meeting the inclusion criteria. The injuries were sustained performing a sporting activity (n = 9) or whilst dancing (n = 4). The injury was predominantly sustained during a non-contact situation (n = 10). The most common mechanism was an unbalanced individual with a flexed hip sustaining a valgus force to their flexed knee with the tibia externally rotated.

Conclusions

This study provides some insight into the MoI for a patellar dislocation and the findings may assist in developing injury prevention programmes and rehabilitation protocols as well as guiding future research.

Prospects for observing and localizing gravitational-wave transients with Advanced LIGO, Advanced Virgo and KAGRA

We present our current best estimate of the plausible observing scenarios for the Advanced LIGO, Advanced Virgo and KAGRA gravitational-wave detectors over the next several years, with the intention of providing information to facilitate planning for multi-messenger astronomy with gravitational waves. We estimate the sensitivity of the network to transient gravitational-wave signals for the third (O3), fourth (O4) and fifth observing (O5) runs, including the planned upgrades of the Advanced LIGO and Advanced Virgo detectors. We study the capability of the network to determine the sky location of the source for gravitational-wave signals from the inspiral of binary systems of compact objects, that is binary neutron star, neutron star-black hole, and binary black hole systems. The ability to localize the sources is given as a sky-area probability, luminosity distance, and comoving volume. The median sky localization area (90% credible region) is expected to be a few hundreds of square degrees for all types of binary systems during O3 with the Advanced LIGO and Virgo (HLV) network. The median sky localization area will improve to a few tens of square degrees during O4 with the Advanced LIGO, Virgo, and KAGRA (HLVK) network. During O3, the median localization volume (90% credible region) is expected to be on the order of 10 5 , 10 6 , 10 7 Mpc 3 for binary neutron star, neutron star-black hole, and binary black hole systems, respectively. The localization volume in O4 is expected to be about a factor two smaller than in O3. We predict a detection count of 1 - 1 + 12 ( 10 - 10 + 52 ) for binary neutron star mergers, of 0 - 0 + 19 ( 1 - 1 + 91 ) for neutron star-black hole mergers, and 17 - 11 + 22 ( 79 - 44 + 89 ) for binary black hole mergers in a one-calendar-year observing run of the HLV network during O3 (HLVK network during O4). We evaluate sensitivity and localization expectations for unmodeled signal searches, including the search for intermediate mass black hole binary mergers.

Anti-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibody in necrotizing myopathy: treatment outcomes, cancer risk, and role of autoantibody level

Objective: To evaluate clinical associations of anti-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibody (Ab) and statin exposure in necrotizing myopathy (NM) patients. Methods: NM without a known myositis-specific autoantibody (MSA) was ascertained from a large single-centre myositis database between 1985 and 2012. A comparison NM cohort included 32 anti-SRP⁺ autoantibody patients, and other control groups included 74 non-NM myositis patients and 21 non-myositis controls. Sera from all cases and controls were tested using a validated anti-HMGCR enzyme-linked immunosorbent assay. Clinical features including statin use and anti-HMGCR Ab status were compared between cases and controls. Results: Of the 256 NM muscle biopsies reviewed, only 48 subjects with available sera were identified as traditional MSA-negative NM. Anti-HMGCR positivity was significantly (p < 0.001) associated with MSA-negative NM [48% (23/48)] compared to all of the myositis and non-myositis controls [5% (6/127)]. Most anti-HMGCR Ab-positive NM patients had high titres of anti-HMGCR (83%) and a history of statin exposure (78%), along with severe muscle weakness, high creatine kinase (CK) levels (90% ≥ 5000 IU/L), a paucity of other organ manifestations, and the need for immunosuppression with prednisone and methotrexate, but generally favourable outcomes. Anti-HMGCR serum levels were associated with baseline CK levels but not muscle weakness. Conclusion: HMGCR Ab-positive NM patients are associated with statin exposure, have severe muscle weakness and high CK at presentation, lack other organ manifestations, and generally have favourable outcomes from immunosuppression. Anti-HMGCR Abs should be assessed in MSA-negative NM patients, particularly those with a history of statin exposure.

When does the patella dislocate? A systematic review of biomechanical & kinematic studies

Background

Patellar dislocations are a significant injury with the potential for long term problems. Little work has been done on establishing the mechanism by which this injury occurs.

Objectives

To determine the mechanism of injury of a patella dislocation based on the available published literature and compare them to already proposed theories.

Methods

A systematic review of the literature was conducted following searches performed on MEDLINE, EMBASE and ProQuest from the earliest year of indexing using the following search terms in any combination: "patella", "dislocation", "mechanism of injury", "anatomy", "biomechanical" and "risk factor". A broad inclusion criteria was used that included studies that looked at patellar dislocations and instability with respect to the patellofemoral joint (PFJ) kinematics or altered kinematics of the PFJ. Studies that did not address the kinematics or biomechanics of the PFJ were excluded. Studies were appraised based on their methodology using a combination of the Critical Appraisal Skills Programme tool and the Quality Appraisal for Cadaveric Studies.

Results

113 studies were identified from a search of MEDLINE, EMBASE and ProQuest databases. Following application of our inclusion criteria, a total of 23 studies were included in our review. 18 of these studies were cadaveric biomechanical studies. The remaining studies were anatomical, imaging based, and a computer simulation based study.

Conclusions

These biomechanical and kinematic studies provide some evidence that a dislocation is likely to occur during early knee flexion with external rotation of the tibia and contraction of the quadriceps. There is limited evidence to support other elements of proposed mechanisms of dislocation.

Search for Subsolar Mass Ultracompact Binaries in Advanced LIGO's Second Observing Run

We present a search for subsolar mass ultracompact objects in data obtained during Advanced LIGO's second observing run. In contrast to a previous search of Advanced LIGO data from the first observing run, this search includes the effects of component spin on the gravitational waveform. We identify no viable gravitational-wave candidates consistent with subsolar mass ultracompact binaries with at least one component between 0.2  M_{⊙}-1.0  M_{⊙}. We use the null result to constrain the binary merger rate of (0.2  M_{⊙}, 0.2  M_{⊙}) binaries to be less than 3.7×10^{5}  Gpc^{-3} yr^{-1} and the binary merger rate of (1.0  M_{⊙}, 1.0  M_{⊙}) binaries to be less than 5.2×10^{3}  Gpc^{-3} yr^{-1}. Subsolar mass ultracompact objects are not expected to form via known stellar evolution channels, though it has been suggested that primordial density fluctuations or particle dark matter with cooling mechanisms and/or nuclear interactions could form black holes with subsolar masses. Assuming a particular primordial black hole (PBH) formation model, we constrain a population of merging 0.2  M_{⊙} black holes to account for less than 16% of the dark matter density and a population of merging 1.0  M_{⊙} black holes to account for less than 2% of the dark matter density. We discuss how constraints on the merger rate and dark matter fraction may be extended to arbitrary black hole population models that predict subsolar mass binaries.