Transit time flow measurement (TTFM) as a predictor of graft failure and major adverse cardiac events following coronary artery bypass grafting (CABG)

Funding Acknowledgements

Type of funding sources: None.

Introduction

Post coronary artery bypass grafting (CABG), coronary angiography (CAG) is the gold standard for graft assessment to check the presence of occlusion or stenosis. Despite this, CAGs after a CABG in the nation are only conducted if patients show ischemic signs. Alternative to CAG, transit time flow measurement (TTFM) can be utilized to determine overall quality of blood flow in grafts. TTFM has yet been utilized to assess graft patency despite its availability in the nation.

Purpose

This study aims to provide TTFM profiles from CABG surgeries, including characterizing the differences in TTFM parameters between failed and normal grafts, as well as determining the association of TTFM parameters and related clinical factors to the likelihood of graft failure and major adverse cardiac events (MACE).

Methods

279 patients were admitted to the cardiology centre from 1 January 2017 to 31 December 2019. Mann-Whitney test was used to compare the differences in TTFM parameters across different graft types, as well as between failed and normal grafts. To determine the likelihood of a graft being normal or failed based on established TTFM parameter cutoffs, χ² test was used. Lastly, multivariate logistic regression was used to determine the association between TTFM parameters and MACE, specifically angina, myocardial infarction, and death.

Results

Different graft types exhibited significant differences in TTFM parameters, particularly pulsatility index (PI) and diastolic filling (%DF). Arterial grafts presented with higher quality of blood flow compared to venous grafts, with left-sided grafts (especially LIMA-LAD) being the graft type of highest quality (Refer to Fig.1).

However, there were no differences in TTFM parameters between failed and normal grafts (PI P = 0.893; DF% P = 0.143). Despite this, there was a greater number of failed grafts with PI > 5 (6.6%) compared to PI < 5 (2.6%) (χ²=4.021, P = 0.045).

Multivariate analysis showed no significant association between TTFM parameters and prevalence of MACE. Instead, an increased risk of graft failure is associated with the female gender (P = 0.031), history of congestive heart failure (P = 0.025) and poor renal function (P = 0.034). Also, an increased risk of MACE is associated with a history of coronary intervention (P = 0.041), left coronary dominance (P = 0.018) and renal function (P = 0.009).

Conclusion

This study provides an overview of the TTFM profiles among different graft types used in CABG surgeries. While TTFM are not indicative of failed grafts upon ischemic signs, patient comorbidities were informative. Follow-up studies should include a larger sample size of patients from an earlier timeframe to assess correlation of graft failure over a 5-to-10-year span post-CABG. Regardless of ischemic signs, routine CAG for all patients should be considered to determine the true prevalence of graft failure among CABG patients in the nation. Abstract Figure. Fig1.Median comparison TTFM Parameters  Abstract Figure. Fig2. Multivariate analysis models

The association between serum prealbumin and poor outcome in COVID-19 - Systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the association between the prealbumin and severity and mortality in COVID-19.

MATERIALS AND METHODS

We performed a systematic literature search from PubMed, Embase, and Scopus databases up until 2 February 2021. The primary outcome was the poor outcome, a composite of mortality and severity. Severe COVID-19 was defined as COVID-19 that fulfill the criteria for severe pneumonia or patients with acute respiratory distress syndrome/disease progression/need for intensive care unit or mechanical ventilation. The effect estimates were a mean difference between patients with and without a poor outcome in mg/dL and odds ratio (OR) per 1 mg/dL decrease in prealbumin level. The effect estimates were reported with their 95% confidence interval (95% CI).

RESULTS

Nine studies comprising of 2104 patients were included in this systematic review and meta-analysis. Patients with poor outcome have lower prealbumin level (mean difference -71.48 mg/dL [95% CI -93.74, -49.22], p<0.001; I2: 85.9%). Every 1 mg/dL decrease in prealbumin level was associated with 1% increase in poor outcome (OR 0.992 [0.987, 0.997], p=0.004, I2: 81.7%). Meta-regression analysis showed that the association between the prealbumin level and poor outcome varies with gender (male) (coefficient: 3.50, R2: 100%, p<0.001), but not age, diabetes, hypertension, and chronic kidney disease.

CONCLUSIONS

Low serum prealbumin was associated with poor outcomes in patients with COVID-19.

Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19

OBJECTIVE: To investigate the association between chronic obstructive pulmonary disease (COPD) and smoking with outcome in patients with COVID-19.METHODS: A systematic literature search was performed using PubMed, EuropePMC, SCOPUS and the Cochrane Central Database. A composite of poor outcome, mortality, severe COVID-19, the need for treatment in an intensive care unit (ICU) and disease progression were the outcomes of interest.RESULTS: Data on 4603 patients were pooled from 21 studies. COPD was associated with an increased risk for composite poor outcome (OR 5.01, 95%CI 3.06-8.22; P < 0.001; I² 0%), mortality (OR 4.36, 95%CI 1.45-13.10; P = 0.009; I² 0%), severe COVID-19 (OR 4.62, 95%CI 2.49-8.56; P < 0.001; I² 0%), ICU care (OR 8.33, 95%CI 1.27-54.56; P = 0.03; I² 0%), and disease progression (OR 8.42, 95%CI 1.60-44.27; P = 0.01; I² 0%). Smoking was found to increase the risk of composite poor outcome (OR 1.52, 95%CI 1.16-2.00; P = 0.005; I² 12%), and subgroup analysis showed that smoking was significant for increased risk of severe COVID-19 (OR 1.65, 95%CI 1.17-2.34; P = 0.004; I² 11%). Current smokers were at higher risk of composite poor outcomes (OR 1.58, 95%CI 1.10-2.27; P = 0.01; I² 0%) than former/non-smokers.CONCLUSION: Our systematic review and meta-analysis revealed that COPD and smoking were associated with poor outcomes in patients with COVID-19.

Body mass index and outcome in patients with COVID-19: A dose-response meta-analysis

Background

There is mounting evidence related to the association between obesity and severity of COVID-19. However, the direct relationship of the increase in the severe COVID-19 risk factors, with an increase in body mass index (BMI), has not yet been evaluated.

Aim

This meta-analysis aims to evaluate the dose–response relationship between body mass index (BMI) and poor outcome in patients with COVID-19.

Methods

A systematic literature search was conducted using PubMed, Europe PMC, ProQuest, and the Cochrane Central Database. The primary outcome was composite poor outcome composed of mortality and severity. The secondary outcomes were mortality and severity.

Results

A total of 34,390 patients from 12 studies were included in this meta-analysis. The meta-analysis demonstrated that obesity was associated with composite poor outcome (OR 1.73 [1.40, 2.14], P < 0.001; I²: 55.6%), mortality (OR 1.55 [1.16, 2.06], P = 0.003; I²: 74.4%), and severity (OR 1.90 [1.45, 2.48], P < 0.001; I²: 5.2%) in patients with COVID-19. A pooled analysis of highest BMI versus reference BMI indicate that a higher BMI in the patients was associated with composite poor outcome (aOR 3.02 [1.82, 5.00], P < 0.001; I²: 59.8%), mortality (aOR 2.85 [1.17, 6.92], P = 0.002; I²: 79.7%), and severity (aOR 3.08 [1.78, 5.33], P < 0.001; I²: 11.7%). The dose–response meta-analysis showed an increased risk of composite poor outcome by aOR of 1.052 [1.028, 1.077], P < 0.001 for every 5 kg/m² increase in BMI (P_{non-linearity} < 0.001). The curve became steeper with increasing BMI.

Conclusion

Dose–response meta-analysis demonstrated that increased BMI was associated with increased poor outcome in patients with COVID-19.

Kidney Transplantation From a Donor With Sickle Cell Disease

In the United States, >100 000 patients are waiting for a kidney transplant. Given the paucity of organs available for transplant, expansion of eligibility criteria for deceased donation is of substantial interest. Sickle cell disease (SCD) is viewed as a contraindication to kidney donation, perhaps because SCD substantially alters renal structure and function and thus has the potential to adversely affect multiple physiological processes of the kidney. To our knowledge, transplantation from a donor with SCD has never been described in the literature. In this paper, we report the successful transplantation of two kidneys from a 37-year-old woman with SCD who died from an intracranial hemorrhage. Nearly 4 mo after transplant, both recipients are doing well and are off dialysis. The extent to which kidneys from donors with SCD can be safely transplanted with acceptable outcomes is unknown; however, this report should provide support for the careful expansion of kidneys from donors with SCD without evidence of renal dysfunction and with normal tissue architecture on preimplantation biopsies.

The complete genome sequence and genome structure of frangipani mosaic virus

In this study, the complete sequence of the genomic RNA of frangipani mosaic virus (FrMV) has been determined and compared to those of other known tobamoviruses. The complete genome sequence of FrMV consisted of 6,643 nucleotides. The FrMV genomic RNA encoded four open reading frames (ORFs), for proteins of M(r) 128 kDa (1,147 aa), 186 kDa (1,651 aa), 30 kDa (257 aa) and 18 kDa (175 aa) from the 5' to the 3' end. Overall similarities for the four ORFs of FrMV-P ranged from 26.8 to 53.0% at the amino acid level when compared to those of 24 other tobamoviruses. Phylogenetic analysis of the FrMV replicase (186 kDa) and MP revealed that FrMV is closely related to SHMV and CMMoV, while the FrMV replicase (128 kDa) is more closely related to cucurbit-infecting and malvaceous-infecting tobamoviruses, and the FrMV CP is closely related to that of CMMoV and solanaceous-infecting tobamoviruses.

Clonidine, octopaminergic receptor agonist, reduces protein feeding in the blow fly, Phormia regina (Meigen)

Results in this study are consistent with those of Murdock and his colleagues who clearly demonstrated that clonidine, an agonist of octopaminergic receptors in some insects, significantly increases sucrose feeding. Their studies, however, did not examine the effect of clonidine on protein feeding. Injection of a 20 microg/microl/fly dose of clonidine significantly reduces protein feeding in both sexes of Phormia regina, instead of stimulating feeding as is observed with carbohydrate feeding. The manner in which the flies are fed prior to starvation and the method of testing influences the amounts of diet consumed. It is proposed that the biogenic amines influence the state of hunger (i.e., protein versus carbohydrates) while other chemicals and neural mechanisms (i.e., such as sulfakinins and stretch receptors, respectively) affect satiety.

Blood concentrations of amitriptyline and its metabolite in rats after acute oral administration of amitriptyline

Amitriptyline (AMT), a tricyclic antidepressant that is a dibenzocycloheptadine derivative, is frequently used. However, the case reports of AMT-related fatalities are increased, nowadays, due to the low levels of toxic and fatal concentration in blood. So, this study was carried out to determine the concentrations of AMT and its demethylated metabolite, nortriptyline (NTR), after acute single oral administration of AMT in rats. Blood samples were collected five times from the ophthalmic venous plexus at 0, 1, 2, 4, and 8 h after acute single oral administration of AMT in toxic doses of 10 (Group I) or 20 mg/kg (Group II), and the concentrations of AMT and NTR and the mean ratios of AMT to NTR (AMT/NTR) in the blood were periodically determined at designated times. The blood concentrations of AMT and NTR were identified and quantitated by gas chromatography with thermionic specific detection and gas chromatography-mass spectrometry after solid-phase extraction with a Clean Screen DAU column. The peak blood concentrations of AMT and NTR in Group I were 0.34 and 0.28 microg/mL, respectively, and those of AMT and NTR in Group II were 0.59 and 0.43 microg/mL, respectively, and were reached at 1 h after single oral administration.

Double-blind trial to find dose range using a fixed combination of mefloquine, sulfadoxine and pyrimethamine in falciparum malaria: a field study on adults in Burma

In a field study conducted in Burma, 60 semi-immune adults were randomly assigned to 2 treatment groups. The first (mean parasite count, 12717/mm3) received a single dose of a fixed combination of 500 mg mefloquine base, 1000 mg sulfadoxine and 50 mg pyrimethamine (2 tablets of 'Fansimef') plus 1 tablet placebo. The second group (mean parasite count, 11 863/mm3) were given 3 tablets of the same medication. The study was double-blind. Parasite count was checked daily for the first week and weekly for a further 3 weeks. Average times for parasite clearance were 1.47 d in patients receiving 2 tablets, and 1.87 d in those given 3 tablets. Asexual parasites reappeared on day 28 in one patient in each group, although they had been free of parasites during the previous 4 weeks; this could be due to reinfection. The drugs were generally well tolerated, though mild and transient giddiness was seen in 80% of patients in the first group and 96% in the second. Nausea was reported by 33% and 43% of patients respectively. No vomiting occurred in the first group but 8 patients vomited in the second (P less than 0.01). In conclusion it seems possible to treat falciparum malaria in semi-immune adults, weighing less than 60 kg, with a single dose of 500 mg mefloquine base, 1000 mg sulfadoxine and 50 mg pyrimethamine (2 tablets), instead of the higher dose (3 tablets) currently recommended. This reduces treatment cost and improves tolerance of the drugs.

Characteristics of normal labour among different racial groups in Malaysia

The characteristics of normal labour in 977 Malay, Chinese and Indian parturients were established from a retrospective study. Indian babies were found to be significantly smaller than Malay babies which were significantly smaller than Chinese babies (P less than 0-05, P less than 0-05). The mean duration of the first stage of labour taken from the time of admission to the labour ward was 3-4 hours in primiparae and 2-7 hours in multiparae. The mean durations of the second stage of labour were 23-7 minutes and 13-1 minutes respectively. Curves of mean dilatation of cervix and probit analysis at 80% revealed significant differences in the progress of normal labour in primiparae among the three racial groups. The Indian primiparae not only had a slower rate of cervical dilatation but seemed to reach the accelerated phase of dilatation later. No significant differences were noticed in the labours of multiparae.