Catheter ablation versus medical therapy in atrial fibrillation: an umbrella review of meta-analyses of randomized clinical trials

This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.

Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non-ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis

Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) is indicated in complex interventions. There is a paucity of evidence for outcomes with large studies on using IVUS during PCI in non-ST-elevation myocardial infarction (NSTEMI). Our objective was to compare the in-hospital outcome of IVUS-guided with that of nonguided PCI among NSTEMI hospitalizations. The National Inpatient Sample (2016 to 2019) was queried to identify all hospitalizations with a principal diagnosis of NSTEMI. In our study, we compared outcomes of PCI with and without IVUS guidance using a multivariate logistic regression model after propensity score matching, with the primary outcome being in-hospital mortality. A total of 671,280 NSTEMI-related hospitalizations were identified, of whom 48,285 (7.2%) underwent IVUS-guided PCI compared with 622,995 (92.8%) who underwent non-IVUS PCI. After adjusted analysis on matched pairs, we found that IVUS-guided PCI had a lower risk of in-hospital mortality than that of non-IVUS PCI (adjusted odds ratio [aOR] 0.736, confidence interval (CI) 0.578 to 0.937, p = 0.013). However, there was a higher use of mechanical circulatory support in the IVUS-guided PCI (aOR 2.138, CI 1.84 to 2.47, p <0.001) than in non-IVUS PCI. The odds of cardiogenic shock (aOR 1.11, CI 0.93 to 1.32, p = 0.233) and procedural complications (aOR 0.794, CI 0.549 to 1.14, p = 0.22) were similar between the cohorts. Hence, we conclude that patients with NSTEMIs who underwent IVUS-guided PCI had less risk of in-hospital mortality and a greater requirement of mechanical circulatory support than did those who underwent non-IVUS PCI, with no difference in procedural complications. Large prospective trials are essential to validate these findings.

Polychlorinated biphenyls in compost amended soil of a landfill site

The soil receives enormous quantities of pesticides and PCBs as a waste product each year due to their wide application. The degradation and eventual fate of these chemicals in the soil largely determine ultimate environmental impact. A survey of an abandoned landfill site has been conducted in a fast developing industrial city Nagpur (India) to assess the degree of environmental contamination with PCBs. The purpose was to determine if any of the mixture of PCBs, Aroclor 1254 and Aroclor 1260 are retained in the compost amended soil of the site despite atmospheric losses possible due the peak summer (100-117 degrees F) in the city. The accuracy and precision for Aroclor 1254 and Aroclor 1260 determinations in the soil samples have been calculated as 76.5 and +/- 0.92 and 83.3 and +/- 1.13 respectively. The samples analysis showed the presence of Aroclor 1254 and Aroclor 1254 and Aroclor 1260 up to the levels of 0.55 and 0.80 mg/g respectively. The maximum total PCBs on dry weight basis are found as 1.2 mg/g.

Isolation and characterisation of organochlorine pesticides residues from landfill sites

Organochlorine pesticides (OClPs) have been analysed in the soil samples collected from landfill site, which was abandoned for more than ten years. The most commonly used OClPs of the region were identified and analysed in the soil samples collected at various depths. The method involves extraction of OClPs by soxhlet assembly, concentration cleanup by alumina and florisil columns and gas chromatographic analysis. Among OClPs analysed, g-HCH concentration was found maximum at 5 m layer and minimum at the bottom layer. p,p'-DDT was not found in any of the layers, this could be due to its degradation into its metabolites like p,p'-DDE and p,p'-DDD. p,p'-DDE was detected in 2 m, 5 m and bottom (7 m) layer while p,p'-DDD was found only at 2 m level.

Thiopurine methyltransferase activity in a sample population of black subjects in Florida

Thiopurine methyltransferase (TPMT), is an enzyme detected in the human red blood cell that catalyzes the S-methylation of thiopurine drugs and is known to exist as a genetic polymorphism in white subjects. Investigations in this laboratory of red blood cell TPMT showed interethnic differences also existed in North American black subjects. A sample group of black subjects in Florida had a mean activity of 8.64 +/- 3.47 U/ml red blood cells and an antimode of 6.5 units, which represented values significantly lower than those obtained for both the mean activity and the antimode in other populations. The findings of this study suggest the possibility that TPMT activity may be under genetic control in North American black subjects and that this ethnic group may be at greater risk of experiencing thiopurine-induced toxicity caused by the lower overall mean activity of the enzyme.