The association of bariatric surgery with myocardial infarction and coronary revascularization: a propensity score match analysis of National Inpatient Sample

BACKGROUND

Metabolic bariatric surgery (MBS) not only leads to a durable weight loss but also lowers mortality, and reduces cardiovascular risks.

OBJECTIVES

The current study aims to investigate the association of bariatric metabolic surgery (BMS) with admissions for acute myocardial infarction (AMI), including ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), as well as, coronary revascularization procedures, including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and thrombolysis.

SETTING

The National Inpatient Sample (NIS) database.

METHODS

The NIS data from 2016 to 2020 were analyzed. A propensity score matching in a 1:1 ratio was performed to match patients with history of MBS with non-MBS group.

RESULTS

Two hundred thirty-three thousand seven hundred twenty-nine patients from the non-MBS group were matched with 233,729 patients with history of MBS. The MBS group had about 52% reduced odds of admission for AMI compared to the non-MBS group (adjusted odd ratio: .477, 95% confidence interval: .454-.502, P value <.001). In addition, the odds of STEMI and NSEMI were significantly lower in the MBS group in comparison to the non-MBS group. Also, the MBS group had significantly lower odds of CABG, PCI, and thrombolysis compared to the non-MBS group. In addition, in patients with AMI, MBS was associated with lower in-hospital mortality (adjusted odd ratio: .627, 95% confidence interval: .469-.839, P value = .004), length of hospital stays, and total charges.

CONCLUSIONS

History of MBS is significantly associated with reduced risk of admission for AMI including STEMI and NSTEMI, as well as the, need for coronary revascularization such as PCI and CABG.

Oral Nicorandil effectively attenuates the incidence of contrast-induced nephropathy in patients undergoing cardiac catheterization: a randomized, controlled, open-label clinical trial

PURPOSE

The contrast-induced nephropathy (CIN) rate is increasing globally and can increase the rate of mortality and long-term problems. This study aims to determine the effect of Nicorandil on preventing CIN among patients undergoing cardiac catheterization.

METHODS

In a controlled randomized open-labeled clinical trial, all included patients undergoing cardiac catheterization due to coronary problems and possessing at least two risk factors of contrast nephropathy were divided into two groups of intervention and control. The intervention group received oral Nicorandil and normal saline, while the control group was treated with intravenous normal saline. Serum creatinine was measured before and 48 h after the procedure, and patients were assessed regarding CIN.

RESULTS

In this study, 172 patients entered each group; 41.86% and 45.34% were male in the control and Nicorandil groups. We showed that the incidence of CIN was meaningfully lower in the Nicorandil group (12, 7%) than in the control group (34, 19.8%, P = 0.001). Additionally, the incidence of CIN was notably lower in the female patients in the Nicorandil (85.7%) than in the control group (14.3%, P = 0.001); however, these numbers were not significantly different among men (64.0% and 36.0%, respectively, P = 0.850). After the injection of the contrast agent, the serum levels of blood urea nitrogen (P = 0.248), creatinine (P = 0.081), and glomerular filtration rate (P = 0.386) showed no significant differences between the control and Nicorandil groups. Multivariate regression analysis showed that Nicorandil significantly lowered the odds of CIN [odds ratio (OR) = 0.299, 95% confidence interval (CI) 0.149-0.602; P = 0.001] after adjustment for baseline creatinine (OR = 1.404, 95% CI 0.431-4.572; P = 0.574).

CONCLUSION

Our results indicate that pre-procedural treatment with Nicorandil may be effective against CIN in contrast to agent-exposed patients.

[The Ludwigshafen Osteoporosis Screening Questionnaire (LOS Questionnaire): result of the evaluation of anamnestic risk factors in osteoporosis diagnostics]

BACKGROUND

Osteoporosis is a major health problem worldwide and is included in the WHO list of the top ten major diseases. However, it is often undiagnosed until the first fracture occurs, due to inadequate patient education and lack of insurance coverage for screening tests.

METHODS AND MATERIAL

In our study of 78 patients with metaphyseal long bone fractures, we searched for a correlation between anamnestic risk factors, bone-specific laboratory values, and the bone morphogenic density (BMD). Each indicator was examined as a possible diagnostic instrument for osteoporosis. The secondary aim of this study was to demonstrate the high prevalence of osteoporosis in patients with metaphyseal fractures.

RESULTS

Of our fracture patients 76.9% had decreased bone density and 43.6% showed manifest osteoporosis in DXA (densitometry) measurements. Our modified LOS Questionnaire, identifying anamnestic risk factors, correlated highly significantly (p=0.01) with reduced BMD, whereas seven bone-specific laboratory values (p=0.046) correlated significantly.

CONCLUSION

Anamnestic risk factors correlate with pathological BMD more than bone-specific laboratory values. The LOS Questionnaire used in this study would therefore function as a cost-effective primary diagnostic instrument for identification of osteoporosis patients.

Symptomatic and asymptomatic cryptosporidiosis in young children in Iran

The present study was conducted during the period May 2003 to October 2003 in 616 children less than three years of age with and without diarrheal disease presenting at the pediatric clinic of teaching hospitals in Kermanshah, Iran. Single stool specimens were collected from 515 diarrheic and 99 non-diarrheic children. Two smears were made from each stool samples and were stained by a modified Ziehl Neelsen technique. Cryptosporidium parvum (C. parvum) were detected in 10.4% of children. The C. parvum infection rate was significantly higher in diarrheic children (11.6%) than in non-diarrheic children (4.0%). C. parvum was observed more frequently in stool samples of children who lived in rural areas (15.2%) than those who lived in urban areas (7.2%). In regard to the presence of animals, the infection rate was 18.5% among children who lived in association with animals in comparison with 8.2% among those who lived in compounds with no animals. The majority of C. parvum cases occurred in children between the ages of 0-12 months (11.9%), followed by in children between the ages of 13-24 months (9.2%) and in children between the ages of 25-36 months (3.0%). The data suggest that C. parvum is relatively endemic in young children and that Cryptosporidium may be an important pathogen associated with diarrhea in young children.

Instant stem cell therapy: characterization and concentration of human mesenchymal stem cells in vitro

In regenerative medicine, there is an approach to avoid expansion of the mesenchymal stem cell (MSC) before implantation. The aim of this study was to compare methods for instant MSC therapy by use of a portable, automatic and closed system centrifuge that allows for the concentration of MSCs. The main outcome measures were the amount of MSCs per millilitre of bone marrow (BM), clusters of differentiation (CD), proliferation and differentiation capacities of the MSC. A volume reduction protocol was compared to the traditional laboratory methods of isolation using a Ficoll gradient and native BM. Fifty millilitres of BM were obtained from haematologically healthy male Caucasians (n=10, age 8 to 49 years). The number of colony forming units-fibroblast (CFU-F)/ml BM was highest in the centrifuge volume reduction protocol, followed by the native BM (not significant), the centrifuge Ficoll (p=0.042) and the manual Ficoll procedure (p=0.001). The MSC of all groups could differentiate into the mesenchymal lineages without significant differences between the groups. The CD pattern was identical for all groups: CD13+; CD 44+; CD73 +; CD90+; CD105+; HLA-A,B,C+; CD14-; CD34-; CD45-; CD271-; HLA-DR-. In a further clinical pilot study (n=5) with 297 ml BM (SD 18.6), the volume reduction protocol concentrated the MSC by a factor of 14: there were 1.08 x 10(2) MSC/ml BM (standard deviation (SD) 1.02 x 10(2)) before concentration, 14.8 x 10(2) MSC/ ml BM (SD 12.4 x 10(2)) after concentration, and on average 296 x 10(2) MSC (SD 248.9 x 10(2), range 86.4-691.5 x 10(2)) were available for MSC therapy. The volume reduction protocol of the closed centrifuge allows for the highest concentration of the MSC, and therefore, is a promising candidate for instant stem cell therapy.

Effects of breed and progestin source on estrus synchronization and rates of fertility and fecundity in Iranian Sanjabi and Lori ewes

A trial was conducted to evaluate the effects of FGA (Fluorogestone acetate) and CIDR (Controlled internal drug release) on the induction of estrus and pregnancy and fecundity rates of the Sanjabi and Lori sheep. A total of 360 Sanjabi and Lori sheep were randomly grouped into two treatments with intravaginal devices inserted for 13 days: Group FGA (40 mg FGA, n = 180) and Group CIDR (n = 180). All ewes received an i.m. injection of 400 IU eCG (equine chorionic gonadotrophin) at devices removal. Estrous was assessed by exposing all ewes to vasectomized rams at 12 h intervals. Cervical artificial insemination was performed 12 h after estrus onset. The overall estrus response was 72.5%. The source of progestin did not influence the efficiency of estrus response but a significant difference (p<0.05) was found between the breed groups (Lori: 88.6%, Sanjabi: 58.3%). Among the sheep that received either CIDR or FGA, estrus response was significantly (p<0.05) higher in the Lori (CIDR: 82.2%, FGA: 91.1%) than in the Sanjabi (CIDR: 64.4%, FGA: 52.2%) breed. The lambing and fecundity rates for all groups were 60.2% and 1.2 +/- 0.03, respectively. No significant differences in term of the lambing and fecundity rates were recorded between CIDR and FGA groups and among Lori and Sanjabi breed. The results of this study indicate the source of progestin or sheep breed did not influence the pregnancy and fecundity rates. The sheep breed influences the estrous response rate while the source of progestin did not affect the estrous response.