Search

Game theory is an excellent mathematical tool to describe the interaction between the immune system and cancerous leukocytes c . l e u . The feature of cancerous leukocytes to differentiate and mutate to give rise to leukemia is in the domain of ecological models as well. In this work, the dynamic of leukemia is described and compared by two models: firstly by a simple probabilistic mathematical model using the zero-sum two player game of Hawk and Dove, and secondly by Leslie Predator Prey model of ecology. The main goal of this study is to compare the results of both models and then discuss the treatment of leukemia i.e., Hematopoietic Stem cell transplant with the best model among them. Hawk and Dove model also describes the cell to cell interaction of cancerous leukocytes and healthy leukocytes l e u after diagnoses and the condition of the patient before and after treatments. In this work, Hematopoietic Stem cell transplant is discussed by using concepts of a zero-sum three player game. Also, both models will be characterized by determining the stability properties, identifying basins of attraction, and locating the equilibrium points to see, at what extent the patient’s survival is possible with leukemia in its body. Results for both models will be presented graphically.

Several problems remain, despite the evident advantages of sentiment analysis of public opinion represented on Twitter and Facebook. On complicated training data, hybrid approaches may reduce sentiment mistakes. This research assesses the dependability of numerous hybrid approaches on a variety of datasets. Across domains and datasets, we compare hybrid models to singles. Text tweets and reviews are included in our deep sentiment analysis learning systems. The support vector machine (SVM), Long Short-Term Memory (LSTM), and ghost model convolution neural network (CNN) are combined to get the hybrid model. The dependability and computation time of each approach were evaluated. On all datasets, hybrid models outperform single models when deep learning and SVM are combined. The traditional models were less trustworthy, and deep learning algorithms have recently shown their enormous promise in sentiment analysis. Linear transformations are used in feature maps to eliminate duplicate or related features. The ghost unit makes ghost features by taking away attributes that are both similar and duplicated from each intrinsic feature. LSTM produces higher results but takes longer to process, while CNN needs less hyperparameter adjusting and monitoring. The effectiveness of the integrated model varies depending on the work, and all performed better than the others. For hybrid deep sentiment analysis learning models, LSTM networks, CNNs, and SVMs are needed. Hybrid models are used to compare SVM, LSTM, and CNN, and we tested each method’s accuracy and errors. Deep learning-SVM hybrid models improve sentiment analysis accuracy. Experimental results have shown the accuracy of the proposed model shown 91.3 percent and 91.5 percent for datasets type 1 and 8, respectively.

Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has been shown to significantly reduce cardiovascular mortality, heart failure hospitalizations, and all-cause mortality in patients with heart failure with reduced ejection fraction. This study aims to investigate the long-term impact of the sacubitril/valsartan combination on lipid parameters in patients with heart failure with reduced ejection fraction.For this single-center retrospective cross-sectional study, data of patients using sacubitril/valsartan because of heart failure with reduced ejection fraction were collected. In addition to routine controls, the patients' lipid levels were measured at 3-month intervals. The parameters that were obtained over 3 years included total cholesterol, high-density lipoprotein cholesterol, triglyceride, and N-terminal pro-B-type natriuretic peptide levels.A total of 192 patients with a functional capacity New York Heart Association II-V, and who were using sacubitril/valsartan because of heart failure with reduced ejection fraction, were included in this study. Independent of statin use, there was a decrease in total cholesterol levels (196.1 ± 44.8 mg/dL vs 161.5 ± 41.7 mg/dL, p0.001) and triglyceride levels (159.1 ± 10.4 mg/dL vs 121.4 ± 6.9 mg/dL, p0.001), and there was an improvement in high-density lipoprotein cholesterol levels (44.9 ± 1.9 mg/dL vs 48.2 ± 2.4 mg/dL, p0.001) when comparing baseline levels with third-year levels.Sacubitril/valsartan in patients with heart failure with reduced ejection fraction, independent of statin use, may cause a decrease in total cholesterol and triglyceride levels and an improvement in high-density lipoprotein cholesterol levels.

The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) is a scoring system that is easy to use in outpatient or inpatient settings and was developed to predict the survival of heart failure (HF) patients after hospitalization.This study aims to determine the prognostic significance of MAGGIC risk score combined with electrocardiography (ECG) parameters in decompensated patients with heart failure with reduced left ventricular ejection fraction (HFrEF) who were hospitalized for worsening HF.A total of 562 HF patients with New York Heart Association (NYHA) II-IV functional class who were discharged after hospitalization for decompensated HF between 2013 and 2018 in a single center were included. MAGGIC risk scores of all participating patients were calculated according to baseline characteristics gathered using data from the initial hospitalization for HF. In addition, electrocardiographic findings of all patients were examined.During the follow-up period (4.5 ± 1.2 years) 177 patients died. MAGGIC scores were observed to be higher in non-survivors compared to surviving patients (28.69 ± 7.01 vs. 22.82 ± 6.05, p0.001). After a multivariate analysis, MAGGIC score (OR:1.090, p0.001), development of cardio-renal syndrome (OR:2.035, p0.001), presence of left bundle branch block (LBBB) (OR:1.931, p0.001), atrial fibrillation (AF) (OR:1.817, p0.001), and fragmented QRS (fQRS) (OR:1.671, p = 0.002) on ECG were found to be independent predictors of mortality. While the MAGGIC score was shown to predict mortality (AUC = 0.739), its predictive power was improved when combined with AF (AUC = 0.752), LBBB (AUC = 0.745), and fQRS (AUC = 0.757) respectively, as well as in the combined final model (MAGGIC score, AF, LBBB, fQRS) (AUC = 0.787).Our findings showed that addition of electrocardiographic findings to the MAGGIC heart failure risk score has prognostic significance in decompensated patients with HFrEF.

This study aimed to evaluate the retinal vasculature of the macula and optic disc in patients with chronic obstructive pulmonary disease (COPD) by optical coherence tomography angiography (OCTA).The right eyes of 70 COPD patients and 71 healthy individuals were evaluated. These patients had moderate airflow limitation and mean POThe COPD group had a significant decrease in the vascular density in the superficial (fovea [p = 0.019]; parafovea [p = 0.013]; and perifovea [p = 0.001]) and deep capillary plexus (fovea [p = 0.028]; parafovea [p = 0.005]; and perifovea [p = 0.002]). Also, the enlargement of the FAZ (p = 0.002) and a decrease in the peripapillary vascular density (p = 0.006) were observed in the COPD group. There was a positive correlation between POHypercapnia, respiratory acidosis, and chronic hypoxia associated with COPD may affect the macula and optic nerve, resulting in a serious decrease in vascular density, and OCTA can be a very important tool in the follow-up and treatment of these patients.

Sodium-glucose cotransporter-2 inhibitor (SGLT2i) in patients with type 2 diabetes reduces the risk of serious heart failure events, specifically the risk of hospitalization for heart failure, and cardiovascular death. The benefit is most apparent in patients with a heart failure with reduced ejection fraction (HFrEF). Dapagliflozin and empagliflozin reduced the risk of cardiovascular death and hospitalizations for heart failure in patients with established HFrEF, including those without diabetes. Considering the magnitude of the problem and the expected benefit on the target population, an Egyptian consensus document was conducted to demonstrate the importance of and the critical knowledge needed for effective and safe implementation of SGLT2i in the daily practice for the management of patients with HFrEF.

Aims To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. Methods and results Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20–74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented left ventricular ejection fraction ≤40%, 84.0% were discharged on an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and 88.7% were discharged on beta-blockers. Conclusion Care for STEMI shows wide geographic variation in the receipt of timely primary PCI, and is in contrast with the more uniform delivery of guideline-recommended pharmacotherapies at time of hospital discharge.

Aims This study aimed to evaluate the clinical characteristics, echocardiographic measurements, medical treatment, pregnancy outcomes, and the 6 month follow‐up outcomes among patients with peripartum cardiomyopathy (PPCM) in Iraq. Methods and results Data were collected prospectively at cardio‐maternal clinic in Baghdad Heart Center, using case report form for the EORP‐PPCM registry from January 2015 to November 2020. Six month follow‐up was performed either by attendance of patients or by phone contact. A total of 64 PPCM patients were enrolled with a mean age of 32.1 ± 6.8 years. Diagnosis in 35 (54.7%) women was made in the post‐partum period. There was a history of previous PPCM in 9 (14%), coexisting hypertension with the current pregnancy in 30 (51.7%), cholelithiasis in 5 (7.8%), and cancer in 3 (4.7%). Baseline mean left ventricular ejection fraction (LVEF) was 34.7 ± 8.1%, significantly higher than that reported globally (31 ± 10%) (P‐value 0.011), and 26 (40.6%) of our patients had LVEF of ≤34%. Baseline mean global longitudinal strain (GLS) for 26 (40.6%) patients was −9.4 ± 4.1%. Baseline mean left ventricular end‐diastolic and end‐systolic dimensions were 61.2 ± 8.5 and 50.6 ± 10.2 mm, respectively. At 6 month follow‐up, 11 (36.7%) women recovered their LVEF, lower than global data (46%) but higher than that in the Middle East (25%) with P‐value 0.241 and 0.919, respectively. The mean LVEF was 44.5 ± 11.9%, and the mean GLS for 15 (23.4%) of patients was −13.4 ± 5.3%, including 5 (33.3%) with the range of −18.6% to −17%. Bromocriptine was the least used drug in 4 (8.2%) vs. globally reported (15%) (P‐value 0.188). Thrombo‐embolic events and maternal death were reported in 2 (4.1%) and 3 (4.7%) cases, respectively, within 6 months. Conclusions Around half of our PPCM patients were diagnosed at post‐partum period with impaired initial LVEF and GLS, and one‐third had early LVEF recovery at 6 month follow‐up, higher than that in the Middle East but lower than the globally reported figure in the EORP‐PPCM registry. Limited use of bromocriptine might explain the later finding. The co‐morbid diseases in our setting were hypertension and cholelithiasis. Interestingly, the comparable ratios of neonatal and maternal mortalities in our study to that of the EORP‐PPCM registry were found less than the Middle East figures. Bromocriptine needs to be considered in Middle East countries, including Iraq, which may be the key to improving LVEF recovery and perhaps reducing maternal mortality.

Objective Acute myocardial damage is detected in a significant portion of patients with coronavirus 2019 disease (COVID-19) infection, with a reported prevalence of 7–28%. The aim of this study was to investigate the relationship between electrocardiographic findings and the indicators of the severity of COVID-19 detected on electrocardiography (ECG). Methods A total of 219 patients that were hospitalized due to COVID-19 between April 15 and May 5, 2020 were enrolled in this study. Patients were divided into two groups according to the severity of COVID-19 infection: severe (n = 95) and non-severe (n = 124). ECG findings at the time of admission were recorded for each patient. Clinical characteristics and laboratory findings were retrieved from electronic medical records. Results Mean age was 65.2 ± 13.8 years in the severe group and was 57.9 ± 16.0 years in the non-severe group. ST depression (28% vs. 14%), T-wave inversion (29% vs. 16%), ST-T changes (36% vs. 21%), and the presence of fragmented QRS (fQRS) (17% vs. 7%) were more frequent in the severe group compared to the non-severe group. Multivariate analysis revealed that hypertension (odds ratio [OR]: 2.42, 95% confidence interval [CI]:1.03–5.67; p = 0.041), the severity of COVID-19 infection (OR: 1.87, 95% CI: 1.09–2.65; p = 0.026), presence of cardiac injury (OR: 3.32, 95% CI: 1.45–7.60; p = 0.004), and d-dimer (OR: 3.60, 95% CI: 1.29–10.06; p = 0.014) were independent predictors of ST-T changes on ECG. Conclusion ST depression, T-wave inversion, ST-T changes, and the presence of fQRS on admission ECG are closely associated with the severity of COVID-19 infection.

Cancer treatment with immune checkpoint blockade (ICB) often induces immune-related adverse events (irAEs). We hypothesized that proteins coexpressed in tumors and normal cells could be antigenic targets in irAEs and herein described DITAS (discovery of tumor-associated self-antigens) for their identification. DITAS computed transcriptional similarity between lung tumors and healthy lung tissue based on single-sample gene set enrichment analysis. This identified 10 lung tissue–specific genes highly expressed in the lung tumors. Computational analysis was combined with functional T cell assays and single-cell RNA sequencing of the antigen-specific T cells to validate the lung tumor self-antigens. In patients with non–small cell lung cancer (NSCLC) treated with ICB, napsin A was a self-antigen that elicited strong CD8+T cell responses, with ICB responders harboring higher frequencies of these CD8+T cells compared with nonresponders. Human leukocyte antigen (HLA) class I ligands derived from napsin A were present in human lung tumors and in nontumor lung tissues, and napsin A tetramers confirmed the presence of napsin A–specific CD8+T cells in blood and tumors of patients with NSCLC. Napsin A–specific T cell clonotypes were enriched in lung tumors and ICB-induced inflammatory lung lesions and could kill immortalized HLA-matched NSCLC cells ex vivo. Single-cell RNA sequencing revealed that these T cell clonotypes expressed proinflammatory cytokines and cytotoxic markers. Thus, DITAS successfully identified self-antigens, including napsin A, that likely mediate effective antitumor T cell responses in NSCLC and may simultaneously underpin lung irAEs.

Aims Prevention guidelines have identified the management of obese patients as an important priority to reduce the burden of incident and recurrent cardiovascular disease. Still, studies have demonstrated that over 80% of patients with coronary heart disease (CHD) fail to achieve their weight target. Here, we describe advice received and actions reported by overweight CHD patients since being discharged from hospital and how weight changes relate to their risk profile. Methods and results Based on data from 10 507 CHD patients participating in the EUROASPIRE IV and V studies, we analysed weight changes from hospital admission to the time of a study visit ≥6 and Conclusions The management of obesity remains a challenge in the secondary prevention of CHD despite a beneficial effect of weight loss on risk factor prevalences and quality of life. Cardiac rehabilitation programmes should include weight loss interventions as a specific component and the incremental value of telehealth intervention as well as recently described pharmacological interventions need full consideration.

Thyroid ultrasonography (US) is the first-step noninvasive and easily accessible diagnostic method widely used in the detection and characterization of nodular thyroid disease. We aimed to develop a TI-RADS, which is easy to apply and only relies on the counting of suspicious criteria. In order to measure the reliability of the system, we investigated its correlation with fine needle aspiration biopsy (FNAB) and post-surgery histological results. In this prospective study, 242 patients who had undergone FNAB with simultaneous cytopathologist in the radiology department between April and August 2016 were analyzed. Before FNAB, the thyroid gland was re-evaluated with US, and TI-RADS classification was made. Demographic characteristics, family thyroid cancer history and radiotherapy history to the neck region were noted. Of the 242 patients, 17.3% were male (42 males/200 females). US-guided FNAB was applied to all patients. Mean age was 50 ± 13 years (min: 19, max: 82). Both FNAB and final post-surgery histology results showed that sex and age were not statistically significantly associated with malignancy (p = 0.193) TI-RADS criteria and FNAB results revealed a statistically significant association between irregular contours, the state of anteroposterior diameter being longer than transverse diameter, microcalcifications, marked hypoechogenicity, and malignancy (p

OBJECTIVE The objective of this study is to evaluate the corneal endothelium in patients with chronic obstructive pulmonary disease (COPD) using a specular microscope. METHODS The right eyes of 64 patients with a COPD diagnosis and 65 healthy individuals were evaluated. Cell density (CD) (cell/mm2 ), corneal thickness (CT) (μ), hexagonal cell ratio (%), and coefficient of variation (cell area standard deviation/mean cell area, μm2 ) were analyzed by specular microscopy (SM). RESULTS The CT was significantly reduced in the COPD group compared with the control group (P = 0.021). Moreover, a significant difference was found between the COPD group and the control group in terms of corneal endothelial CD (P = 0.011), hexagonal cell ratio (P = 0.008), and coefficient of variation (P = 0.012). CONCLUSION The corneal endothelial structure was significantly deteriorated in patients with COPD compared with the control group. SM is a valuable method that could be used in treatment and follow-up of corneal endothelium in patients with COPD.

Coronavirus disease 2019 (COVID-19) was first detected as a form of atypical pneumonia. COVID-19 is a highly contagious virus, and some patients may experience acute respiratory distress syndrome (ARDS) and acute respiratory failure leading to death. We aim to evaluate the clinical, imaging, and laboratory parameters according to survival time to predict mortality in fatal COVID-19 patients.Fatal 350 and survived 150 COVID-19 patients were included in the study. Fatal patients were divided into three groups according to the median value of the survival days. Demographic characteristics and in-hospital complications were obtained from medical databases.Of the non-survived patients, 30% (104) died within three days, 32% (110) died within 4-10 days, and 39% (136) died within over ten days. Pneumonia on computational tomography (CT), symptom duration before hospital admission (SDBHA), intensive care unit (ICU), hypertension (HT), C-reactive protein (CRP), D-dimer, multi-organ dysfunction syndrome (MODS), cardiac and acute kidney injury, left ventricular ejection fraction (LVEF), right ventricular fractional area change (RV-FAC), and Tocilizumab/Steroid therapy were independent predictors of mortality within three days compared to between 4-10 days and over ten days mortality. A combined diagnosis model was evaluated for the age, CT score, SDBHA, hs-TnI, and D-dimer. The combined model had a higher area under the ROC curve (0.913).This study showed that age, pneumonia on CT, SDBHA, ICU, HT, CRP, d-dimer, cardiac injury, MODS, acute kidney injury, LVEF, and RV-FAC were independently associated with short-term mortality in non-surviving COVID-19 patients in the Turkish population. Moreover, Tocilizumab/Steroid therapy was a protective and independent predictor of mortality within three days.

The recent emergence of multiple SARS-CoV-2 variants has caused considerable concern due to reduced vaccine efficacy and escape from neutralizing antibody therapeutics. It is therefore paramount to develop therapeutic strategies that inhibit all known and future SARS-CoV-2 variants. Here we report that all SARS-CoV-2 variants analyzed, including variants of concern (VOC) Alpha, Beta, Gamma, and Delta, exhibit enhanced binding affinity to clinical grade and phase 2 tested recombinant human soluble ACE2 (APN01). Importantly, soluble ACE2 neutralized infection of VeroE6 cells and human lung epithelial cells by multiple VOC strains with markedly enhanced potency when compared to reference SARS-CoV-2 isolates. Effective inhibition of infections with SARS-CoV-2 variants was validated and confirmed in two independent laboratories. These data show that SARS-CoV-2 variants that have emerged around the world, including current VOC and several variants of interest, can be inhibited by soluble ACE2, providing proof of principle of a pan-SARS-CoV-2 therapeutic.

This study aimed to evaluate the nutritional status and body composition in children with cystic fibrosis (CF), in accordance with the new nutritional targets defined by European Society for Clinical Nutrition and Metabolism (ESPEN), the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Cystic Fibrosis Society (ECFS) 2016.In this cross-sectional study, data were collected prospectively in a single centre. A record was made for a total of 95 patients with CF of clinical data. Anthropometric data were evaluated using the World Health Organization growth standards. The bone mineral density (BMD) z-score was adjusted for height by measuring dual-energy X-ray absorptiometry (DXA). The speed of sound z-score values were measured with quantitative ultrasound (QUS).The nutritional status was normal in 37.9% of patients aged2 years and 33.3% of patients aged 2-18 years. When the DXA BMD z-score values were corrected for height, it was determined that the BMD deficit was less. The calcaneus QUS SOS z-score mean value was lower than the mean height for age z-score adjusted BMD (BMDHAZ).The malnutrition rates of CF patients were higher than the rates previously reported in literature. As there are insufficient nutritional data in Turkey, there is a need for multi-centre studies to determine the frequency of malnutrition according to the new classifications. It is clear that QUS measurements cannot replace DXA in the diagnosis of osteopenic bone disease. However, when low values are determined with QUS as the first recommended measurement in the screening of bone status, it can be considered appropriate to confirm the status with DXA.

Purpose: In the present study we evaluate the corneal endothelium using specular microscopy in patients with obstructive sleep apnea syndrome (OSAS). Methods: The study included a total of 100 patients including 35 patients with mild OSAS, 34 patients with moderate OSAS and 31 patients with severe OSAS, and the right eyes of 30 patients as a control group. Patients were examined to exclude the possibility of ocular diseases. Cellular density in the cornea epithelium (cell/mm2), corneal thickness (µ), percentage of hexagonal cells (%) and the coefficient of variation were evaluated using a specular microscope. Results: Corneal thickness was significantly decreased in all OSAS groups when compared to the control group ( p = 0.002), while no significant difference was identified among the OSAS groups. The corneal endothelial cell density, percentage of hexagonal cells and coefficient of variation were significantly different between the OSAS groups and the control group ( p Conclusion: More significant impairments were noted in the corneal endothelium of the patients in the OSAS group than in the control group, and specular microscopy is in valuable in the follow-up and treatment of such patients.

Ahmed Abdel-Galeel,1 Ahmed El-Zokaim,2 Hosam Hasan-Ali,1 Ahmed Ibrahim,3 Ayman Ibrahim,2 Ramadan Ghaleb2 1Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt; 2Cardiology Department, Aswan University, Aswan, Egypt; 3Community Medicine Department, Assiut University, Assiut, EgyptCorrespondence: Ahmed Abdel-GaleelCardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut 71526, EgyptTel +2 01005015156Email ahmed.galeel@aun.edu.egIntroduction: Percutaneous coronary intervention (PCI) has improved recanalization of infarct-related arteries (IRA); however, TIMI-III flow does not always mean an efficient myocardial reperfusion. Myocardial blush grade (MBG) is used as a predictor for coronary microvascular obstruction. We assessed the association between ankle-brachial index (ABI), a widely used method for diagnosis of peripheral arterial disease (PAD), and coronary microvascular obstruction (MVO) as detected by MBG after primary PCI.Patients and Methods: The study included 335 patients with ST-elevation myocardial infarction who had primary PCI. History taking, clinical examination, laboratory assessment, ECG and Echocardiography were done for every participant. MBG was assessed for patients after PCI procedure. ABI for all participating patients was calculated.Results: Two hundred and sixty-one patients fulfilled the inclusion criteria with mean age 58.8 ± 10.7 years, 84% were males. Sixty-one percent had anterior wall myocardial infarction. After primary PCI, despite achieving TIMI flow III in all study patients, only 37% had normal MBG. There was a statistically significant relationship between MBG and site of infarction, left ventricular ejection fraction and ABI. Low ABI was found to predict poor MBG.Conclusion: Coronary artery disease (CAD) is well linked to PAD. MBG can be used to assess coronary MVO after primary PCI. Poor MBG is associated with low ABI. This could establish a relationship between PAD and coronary MVO after primary PCI.Keywords: microvascular coronary obstruction, peripheral arterial disease, myocardial blush grade, ankle-brachial index

Penetrating head injuries caused by blunt or piercing objects are rare. In this paper, we present the case of a 9-year-old boy referred to our hospital with rebar-induced injury. The patient's neurological examination findings were normal. Computed tomography undertaken revealed that the rebar had entered through the oral cavity transorally-transpalatally, passing the frontal bone, and then exited the body by piercing the skin. The patient was taken to emergency surgery, and first, tracheostomy was performed. The rebar had been cut and shortened by the emergency rescue unit, which resulted in shortening the part of the foreign body that would pass through the brain parenchyma. During surgery, the rebar was carefully removed by following the route of the entry. All the defects caused by the foreign body were surgically repaired using a multidisciplinary approach, including neurosurgery and plastic and reconstructive surgery, by otolaryngology teams.

Objective: Cardiac resynchronization therapy (CRT) has been shown to reduce mortality in selected patients with heart failure with reduced ejection fraction (HFrEF). CRT Survey-II was a snapshot survey to assess current clinical practice with regard to CRT. Herein, we aimed to compare Turkish data with other countries of European Society of Cardiology (ESC). Methods: The survey was conducted between October 2015 and December 2016 in 42 ESC member countries. All consecutive patients who underwent a de novo CRT implantation or a CRT upgrade were eligible. Results: A total of 288 centers included 11,088 patients. From Turkey, 16 centers recruited 424 patients representing 12.9% of all implantations. Compared to the entire cohort, Turkish patients were younger with a lower proportion of men and a higher proportion with ischemic etiology. Electrocardiography (ECG) showed sinus rhythm in 81.5%, a QRS duration of

Purpose Immune checkpoint inhibitor (ICI)-induced hepatitis belongs to the frequently occurring immune-related adverse events (irAEs), particularly with the combination therapy involving ipilimumab and nivolumab. However, predisposing factors predicting the occurrence of ICI-induced hepatitis are barely known. We investigated the association of preexisting autoantibodies in the development of ICI-induced hepatitis in a prospective cohort of cancer patients. Methods Data from a prospective biomarker cohort comprising melanoma and non-small cell lung cancer (NSCLC) patients were used to analyze the incidence of ICI-induced hepatitis, putatively associated factors, and outcome. Results 40 patients with melanoma and 91 patients with NSCLC received ICI between July 2016 and May 2019. 11 patients developed ICI-induced hepatitis (8.4%). Prior to treatment, 45.5% of patients in the hepatitis cohort and 43.8% of the control cohort showed elevated titers of autoantibodies commonly associated with autoimmune liver diseases (p = 0.82). We found two nominally significant associations between the occurrence of ICI-induced hepatitis and HLA alleles associated with autoimmune liver diseases among NSCLC patients. Of note, significantly more patients with ICI-induced hepatitis developed additional irAEs in other organs (p = 0.0001). Neither overall nor progression-free survival was affected in the hepatitis group. Conclusion We found nominally significant associations of ICI-induced hepatitis with two HLA alleles. ICI-induced hepatitis showed no correlation with liver-specific autoantibodies, but frequently co-occurred with irAEs affecting other organs. Unlike other irAEs, ICI-induced hepatitis is not associated with a better prognosis.

Objective To evaluate whether there is an effect of the physician who transfers the embryos on pregnancy rates in in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) treatment. Methods A total of 757 participants were analyzed between 2012 and 2017. Participants were classified according to 3 physicians who transferred the embryos: ([group 1=164 patients]; [group 2=233 patients]; [group 3=360 patients]). Baseline parameters and IVF-ICSI outcomes were compared between the groups. Results No differences were determined between the groups regarding the baseline parameters (age, age subgroups [20-29, 30-39, and ≥ 40 years old)], body mass index (BMI), smoking status, infertility period, cause of infertility, baseline follicle stimulating hormone, luteinizing hormone, estradiol (E2), thyroid stimulating hormone, prolactin levels, antral follicle count, duration of stimulation, stimulation protocol, gonadotropin dose required, maximum E2 levels, progesterone levels, endometrial thickness on human chorionic gonadotropin (hCG) administration and transfer days (p>0.05). The numbers of oocytes retrieved,metaphase II (MII), 2 pronucleus (2PN), transferred embryo, fertilization rate, day ofembryo transfer, the catheter effect and embryo transfer technique, and clinical pregnancy rates (CPRs) were also comparable between the groups (p>0.05). Conclusion Our data suggests that the physician who transfers the embryos has no impact on CPRs in patients who have undergone IVF-ICSI, but further studies with more participants are required to elucidate this situation. Resumo Objetivo Avaliar se há ou não efeito do médico que realiza a transferência de embriões nas taxas de gravidez no tratamento com fertilização in vitro-injeção intracitoplasmática de espermatozoide (FIV-ICSI, na sigla em inglês). Métodos Um total de 757 participantes foram analisados entre 2012 e 2017. Os participantes foram classificados de acordo com 3 médicos que transferiram os embriões: ([grupo 1=164 pacientes]; [grupo 2=233 pacientes]; [grupo 3=360 pacientes]). Parâmetros basais e resultados de FIV-ICSI foram comparados entre os grupos. Resultados Nenhuma diferença foi determinada entre os grupos nos parâmetros basais (idade, subgrupos de idade [20-29, 30-39 e ≥ 40 anos)], índice de massa corporal (IMC), tabagismo, período de infertilidade, causa da infertilidade, hormônio folículo estimulante basal , hormônio luteinizante, estradiol (E2), hormônio estimulador da tireoide, níveis de prolactina, contagem de folículos antrais, duração da estimulação, protocolo de estimulação, dose de gonadotrofina necessária, níveis máximos de E2, níveis de progesterona e espessura endometrial na administração de hCG e nos dias de transferência (p>0,05). O número de oócitos recuperados, MII e 2PN, embrião transferido, taxa de fertilização, dia da transferência do embrião, o efeito do cateter e a técnica de transferência de embrião e taxas clínicas de gravidez (RCPs) também foram comparáveis entre os grupos (p>0,05). Conclusão Nossos dados sugerem que o médico que transfere os embriões não tem impacto sobre as RCPs em pacientes que se submeteram a FIV-ICSI, mas mais estudos com mais participantes são necessários para elucidar esta situação.

The aim of this experimental animal study was to investigate the histopathological and biochemical efficacy of trimetazidine (TMZ) in decreasing ovary damage in an ovary ischaemia/reperfusion (I/R) model in the rat. A total of 35 Wistar albino female rats were randomly separated into five groups

The main goals in the treatment of acute coronary syndrome are to prevent myocardial ischemia, damage, and possible complications. Accordingly, we evaluated the predictive value of glypican-6 (GPC6) for cardiac remodeling after myocardial infarction (MI). Baseline plasma GPC6 levels were measured in patients who underwent primary percutaneous coronary intervention (PCI) for acute MI. Left ventricular ejection fraction (LVEF) was measured at baseline and at 6 months with transthoracic echocardiography. Reduced LVEF persisted in 89 out of 276 patients after 6 months. The majority of the patients were male (n = 198, 72%) and the mean age was 57.8 ± 10.8 years. Glypican-6, N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitive troponin levels were significantly lower in the improved LVEF group compared with the low LVEF group (10.54 ± 4.46 vs 6.98 ± 3.34 ng/mL, P < .001; 500 pg/mL [range, 300-600 pg/mL] vs 350 pg/mL [range, 200-550 pg/mL], P = .008; 396 pg/mL [range, 159-579 pg/mL] vs 300 pg/mL [range, 100-500 pg/mL], P = .016, respectively). Logistic regression analysis revealed the SYNTAX Score 2, GPC6, and NT-proBNP as significant independent predictors of low LVEF (hazard ratio [HR]: 1.064, P = .041; HR: 1.215, P < .001; HR: 1.179, P < .001). Glypican-6 may prove to be useful for the detection of low LVEF development in patients undergoing PCI following MI.

PURPOSE: The aim of this study was to investigate the efficacy of shear wave elastography (SWE) in the diagnosis of perforating vein insufficiency, and to determine the applicability of these measurements. METHODS: A total of 140 symptomatic patients with a total of 280 lower extremities were investigated. All patients presented with venous insufficiency (VI) symptoms, and received Doppler ultrasound assessment to determine VI and SWE measurements. The SWE values were measured in the adjacent perivenous tissue of the largest Cockett’s perforating vein (PV) of both lower extremities, at the level where they pass the fascia. The Cockett’s PV diameter and the presence of reflux in Cockett’s PV and the great saphenous vein were compared with SWE values in perivenous tissue of PVs. RESULTS: The SWE values of the perforating vein insufficiency group were significantly higher than those of the normal PV without insufficiency group (P

Objectives We aimed to examine the clinical characteristics and outcomes of patients admitted for acute pancreatitis (AP) in the population with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Methods The National Inpatient Sample from 2010 to 2014 was used to identify adult patients admitted with AP. Patients were grouped based on the HIV status. Primary outcomes were mortality, length of stay (LOS), disposition and total hospitalization charges. Secondary outcomes included acute kidney injury, septic shock, respiratory failure and pancreatic procedures. Results After matching and weighting, a total of 14,152 HIV-positive patients (6904 with AIDS and 7248 with asymptomatic HIV [aHIV]) with AP were identified. Acute pancreatitis with AIDS were associated with a higher rate of acute kidney injury, longer LOS, higher hospitalization charges, and less routine disposition compared with HIV-negative AP. Patients with aHIV had less septic shock, shorter LOS, and less hospitalization charges compared with HIV-negative patients and less respiratory failure, shorter LOS, and less hospitalization charges compared with AIDS patients. Conclusions Patients admitted for AP with AIDS have worse outcomes. On the contrary, aHIV status was not only associated with better outcomes when compared with AIDS, but to HIV-negative status as well.

WOS:000560834200001 PubMed ID: 32803484 A new infectious outbreak sustained by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now spreading all around the world. The aim of this study was to evaluate the prognostic value of left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) in patients with coronavirus disease 2019 (COVID-19). In this prospective, single-center study, data were gathered from patients treated for COVID-19 between April 15 and April 30, 2020. Two-dimensional echocardiography (2-DE) and speckle tracking echocardiography (STE) images were obtained for all patients. Patients were divided into three groups: those with severe COVID-19 infection, those with non-severe COVID-19 infection, and those without COVID-19 infection (the control group). Data regarding clinical characteristics and laboratory findings were obtained from electronic medical records. The primary endpoint was in-hospital mortality. A total of 100 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n = 44) was 59.1 +/- 12.9, 40% of whom were male. The mean age of the non-severe group (n = 56) was 53.7 +/- 15.1, 58% of whom were male. Of these patients, 22 died in the hospital. In patients in the severe group, LV-GLS and RV-LS were decreased compared to patients in the non-severe and control groups (LV-GLS: - 14.5 +/- 1.8 vs. - 16.7 +/- 1.3 vs. - 19.4 +/- 1.6, respectively [p < 0.001]; RV-LS: - 17.2 +/- 2.3 vs. - 20.5 +/- 3.2 vs. - 27.3 +/- 3.1, respectively [p < 0.001]). The presence of cardiac injury, D-dimer, arterial oxygen saturation (SaO2), LV-GLS (OR 1.63, 95% confidence interval [CI] 1.08-2.47; p = 0.010) and RV-LS (OR 1.55, 95% CI 1.07-2.25; p = 0.019) were identified as independent predictors of mortality via multivariate analysis. LV-GLS and RV-LS are independent predictors of in-hospital mortality in patients with COVID-19.

Smoking during pregnancy has negative effects on both maternal and fetal health. One of these negative maternal effects is the potential for depression. A high rate of cigarette smoking in pregnancy is an important public health issue since it affects not only the pregnant woman but also the newborn and its healthy development. The aim of this study is to investigate the relationship between smoking, influencing factors, and depression prevalence in pregnant Syrian refugees and pregnant citizens of the Republic of Turkey (TR). Pregnant citizens in the TR and pregnant Syrian refugees who were registered at health centers between 15.04.2017 and 15.10.2017 in the border city of Ceylanpınar in the Province of Şanlıurfa in Syria were visited in their living areas in the district center and at a tent village, respectively. A total of 414 pregnant women agreed to participate in the study and were included in the survey. To collect data for the cross-sectional study, a sociodemographic and pregnancy characteristics questionnaire was used, in addition to the Fageström Test for Nicotine Dependence (FTND) and the Beck Depression Inventory (BDI). The rate of smoking in all pregnant women was determined to be 49.3% (n = 204) before pregnancy and 37.9% (n = 157) during pregnancy. A statistically significant difference was found between age groups and educational status in relation to smoking status (p = 0.005, p = 0.001). There was also a statistically significant difference between the smoking status of pregnant women and that of their partners and family members (p = 0.001, p = 0.002). The percentage of pregnant women who were passive smokers was 80.2% (n = 332), and a statistically significant difference was found between passive smoking and smoking status (Fisher; 0.000). The presence of risk for depression was detected in 49.8% (n = 206) of all pregnant women surveyed; the rate of depression risk was 50.5% (n = 104) in pregnant TR citizens and 49.5% (n = 102) in pregnant refugees, with no significant difference between the two groups. There was a statistically significant difference between smoking status in pregnancy and the presence of depression risk (p = 0.001). 32.5% of pregnant women were highly nicotine dependent. A moderate positive correlation was determined between the FTND and BDI scores of pregnant women (r = 0.346; p = 0.001). It was found that one-third of all pregnant women smoked and that one of every two showed a risk for depression. A statistically significant correlation was found between smoking status and risk for depression. No statistically significant difference was determined between the two groups, despite high levels of smoking, nicotine dependence, and depression in both. These data suggest the need to develop new preventive strategies in regard to smoking among pregnant women.

Background and objectives Needle insertion pain during spinal anesthesia is an unpleasant experience for patients. This study aimed to investigate the effects of Transcutaneous Electrical Nerve Stimulation (TENS) on the pain intensity during the insertion of spinal needles in patients undergoing spinal anesthesia. Materials and methods In a double-blind clinical trial, 60 candidates for elective Trans Ureteral Lithotripsy surgery under spinal anesthesia were randomly divided into intervention and control groups. The electrodes of the TENS device were placed in the space between L3-L4 and L5-S1 vertebrae. The intensity of pain during insertion of the spinal needle by Visual Analog Scale and the frequency of attempts were recorded. Results The mean age of the study samples was 34.26 ± 5.07 and 32.8 ± 5.28 in the control and intervention group, respectively. The pain intensity during insertion of spinal needles was less significant in the intervention group compared to the control group (p = 0.001). The number of attempts to insert the spinal needle between the two groups was not statistically significant (p = 0.51). The duration of spinal anesthesia implementation procedure by physician in the intervention group was significantly shorter than that of the control group (p = 0.001). Conclusion The use of TENS effectively reduced the pain of spinal needle insertion. Considering these beneficial effects, it is suggested that this procedure be used to relive pain in patients with spinal anesthesia.

Objective: Fabry disease (FD) is a progressive, X-linked inherited disorder of glycosphingolipid metabolism which arises due to deficient or absent activity of lysosomal α-galactosidase A (α-Gal A). This may be associated with increased left ventricular (LV) wall thickness and may mimic the morphological features of hypertrophic cardiomyopathy. The purpose of this study was to define the ratio of occurrence of FD to the manifestation of unexplained left ventricular hypertrophy (LVH). Methods: We studied a prospectively assembled a consecutive cohort of 190 patients with unexplained LVH on echocardiography. The criterion for LVH diagnosis was a maximum LV wall thickness of 13 mm or greater. All patients were tested for mutations in the GLA gene. Results: The majority of patients were male (n=119, 63%) and the mean patient age was 47.2+-15 years. In 190 patients diagnosed with LVH, we identified 2 patients (1.05%) with documented GLA mutations [c.427G>A (p.A143T)(p.Ala143Thr)] and [c.937G>T (p.D313Y)(p.Asp313Tyr)]. After the family screening, 3 additional patients with FD were identified in 2 families, including 5 individuals who are now receiving enzyme replacement therapy. Conclusion: We identified 2 index patients with FD and unexplained LVH. Cardiologists should, therefore, be aware of FD in cases of unexplained LVH. Family screening is crucial for the earlier identification of unaffected new patients who may benefit from enzyme replacement therapy.

Objective: To investigate the prevalence of female sexual dysfunction (FSD) and depression in primary infertile women with 25-Hydroxyvitamin D3 (25-OH VD) deficiency undergoing in-vitro fertilization (IVF)eintracytoplasmic sperm injection (ICSI) treatment. Materials and methods: A total of 80 women with 25-OH VD3 deficiency (= 17) was high (p < 0.05). Correlation analysis showed that the sexual domain scores were positively correlated with the 25-OH VD level, and the BDI score showed a significant negative correlation with the total FSFI score and 25-OH VD levels. Conclusion: The 25-OH VD status was associated with FSD and depression and that the degree of sexual dysfunction could depend on the severity of 25-OH VD levels. Further studies are needed to elucidate this issue. (C) 2020 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V. WOS:000508660100016 2-s2.0-85076223077 PubMed: 32039808

Millions of people worldwide suffer from depression. Assessing, treating, and preventing recurrence requires early detection of depressive symptoms as depression-related datasets expand and machine learning improves, intelligent approaches to detect depression in written material may emerge. This study provides an effective method for identifying texts describing self-perceived depressive symptoms by using long short-term memory (LSTM) based recurrent neural networks (RNN). On a huge dataset of a suicide and depression detection dataset taken from Kaggle with 233337 datasets, this information channel featured text-based teen questions. Then, using a one-hot technique, medical and psychiatric practitioners extract strong features from probably depressed symptoms. The characteristics outperform the usual techniques, which rely on word frequencies rather than symptoms to explain the underlying events in text messages. Depression symptoms can be distinguished from nondepression signals by using a deep learning system (nondepression posts). Eventually, depression is predicted by the RNN. In the suggested technique, the frequency of depressive symptoms outweighs their specificity. With correct annotations and symptom-based feature extraction, the method may be applied to different depression datasets. Because of this, chatbots and depression prediction can work together.

COVID-19 has depleted healthcare systems around the world. Extreme conditions must be defined as soon as possible so that services and treatment can be deployed and intensified. Many biomarkers are being investigated in order to track the patient's condition. Unfortunately, this may interfere with the symptoms of other diseases, making it more difficult for a specialist to diagnose or predict the severity level of the case. This research develops a Smart Healthcare System for Severity Prediction and Critical Tasks Management (SHSSP-CTM) for COVID-19 patients. On the one hand, a machine learning (ML) model is projected to predict the severity of COVID-19 disease. On the other hand, a multi-agent system is proposed to prioritize patients according to the seriousness of the COVID-19 condition and then provide complete network management from the edge to the cloud. Clinical data, including Internet of Medical Things (IoMT) sensors and Electronic Health Record (EHR) data of 78 patients from one hospital in the Wasit Governorate, Iraq, were used in this study. Different data sources are fused to generate new feature pattern. Also, data mining techniques such as normalization and feature selection are applied. Two models, specifically logistic regression (LR) and random forest (RF), are used as baseline severity predictive models. A multi-agent algorithm (MAA), consisting of a personal agent (PA) and fog node agent (FNA), is used to control the prioritization process of COVID-19 patients. The highest prediction result is achieved based on data fusion and selected features, where all examined classifiers observe a significant increase in accuracy. Furthermore, compared with state-of-the-art methods, the RF model showed a high and balanced prediction performance with 86% accuracy, 85.7% F-score, 87.2% precision, and 86% recall. In addition, as compared to the cloud, the MAA showed very significant performance where the resource usage was 66% in the proposed model and 34% in the traditional cloud, the delay was 19% in the proposed model and 81% in the cloud, and the consumed energy was 31% in proposed model and 69% in the cloud. The findings of this study will allow for the early detection of three severity cases, lowering mortality rates. Web of Science 2022 art. no. 5012962

BACKGROUND Bacterial infections can trigger acute coronary syndromes. This study aimed to examine bacterial footprints in the aspirate of infarct-related artery. PATIENTS AND METHODS We studied 140 patients with ST-elevation myocardial infarction who underwent a primary coronary intervention using thrombus aspiration catheters. The aspirate was sent for bacteriological and pathological examinations and immunoassay for pneumolysin toxin. RESULTS Bacterial culture showed different bacteria in 14 samples. Leukocyte infiltrate was detected in all pathologically examined samples. Pneumolysin toxin was detected in only two samples. Patients with bacteria had similar baseline data as those without, except for the median age [46 (44-50) vs. 55 (47-62) years, P = 0.001, respectively], and white blood cells (WBCs) (16670 vs. 7550 cells/µl, P < 0.0001, respectively). In hospital-major clinical events (death, stroke, reinfarction, lethal arrhythmia, and heart failure) were not significantly different between the 2 groups with and without bacteria [4 (28.6%) vs. 20 (18.6%) events, respectively, odds ratio (OR) 1.8 (95% CL: 06-6.3), P = 0.5]. Patients with bacteria, heavy infiltration, and pneumolysin had insignificant higher events compared with those without [10/35 (28.6%) vs. 16/105 (15.2%) events, OR 2.2 (95% CL: 0.92-5.43), P = 0.13]. However, the difference was not significant. By multivariate analysis, bacteria, leukocyte infiltration, and pneumolysin were not predictors for in-hospital clinical events. Higher WBCs and younger age were significant predictors of bacterial footprints (P < 0.0001 and P = 0.04, respectively). CONCLUSION Bacterial footprints existed in the aspirate of infarct-related artery of ST-elevation myocardial infarction patients. Predictors were higher WBCs and younger age. Bacterial markers were not predictors for in-hospital clinical events. The presence of bacterial footprints supports the infectious hypothesis of atherosclerosis.

Twitter’s popularity has exploded in the previous few years, making it one of the most widely used social media sites. As a result of this development, the strategies described in this study are now more beneficial. Additionally, there has been an increase in the number of people who express their views in demeaning ways to others. As a result, hate speech has piqued interest in the subject of sentiment analysis, which has developed various algorithms for detecting emotions in social networks using intuitive means. This paper proposes the deep learning model to classify the sentiments in two separate analyses. In the first analysis, the tweets are classified based on the hate speech against the migrants and the women. In the second analysis, the detection is performed using a deep learning model to organise whether the hate speech is performed by a single or a group of users. During the text analysis, word embedding is implemented using the combination of deep learning models such as BiLSTM, CNN, and MLP. These models are integrated with word embedding methods such as inverse glove (global vector), document frequency (TF-IDF), and transformer-based embedding.

Currently, semiconductor nanoparticles known as quantum dots (QDs) have attracted interest in various application fields such as those requiring sensing properties, binding assays, and cellular imaging and are the very important in the acceleration of drug discovery due to their unique photophysical properties. Here, we applied graphene quantum dots (GQDs) for the binding assay of membrane progesterone receptor alpha (mPRα), one of the probable membrane receptors that have potential in drug discovery applications. By coupling the amino groups of mPRα with GQDs, we prepared fluorogenic GQD-conjugated mPRα (GQD-mPRα). When mixed with a progesterone-BSA-fluorescein isothiocyanate conjugate (P4-BSA-FITC) to check the ligand receptor binding activity of GQD-mPRα, fluorescence at 520 nm appeared. The fluorescence at 520 nm was reduced by the addition of free progesterone into the reaction mixture. GQD-coupled BSA (GQD-BSA) did not show a reduction in fluorescence at 520 nm. The results demonstrated the formation of a complex of GQD-mPRα and P4-BSA-FITC with ligand receptor binding. We established a ligand binding assay for membrane steroid receptors that is applicable for high-throughput assays.

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Today, COVID-19-patient health monitoring and management are major public health challenges for technologies. This research monitored COVID-19 patients by using the Internet of Things. IoT-based collected real-time GPS helps alert the patient automatically to reduce risk factors. Wearable IoT devices are attached to the human body, interconnected with edge nodes, to investigate data for making health-condition decisions. This system uses the wearable IoT sensor, cloud, and web layers to explore the patient’s health condition remotely. Every layer has specific functionality in the COVID-19 symptoms’ monitoring process. The first layer collects the patient health information, which is transferred to the second layer that stores that data in the cloud. The network examines health data and alerts the patients, thus helping users take immediate actions. Finally, the web layer notifies family members to take appropriate steps. This optimized deep-learning model allows for the management and monitoring for further analysis.

Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset Conclusions The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.

Norovirus, an enteric virus primarily responsible for gastroenteritis outbreaks worldwide, is currently causing outbreaks around the United Kingdom during the COVID‐19 pandemic. With an already exhausted health care system, the significant burden norovirus can have on the National Health Service, including economic and social burdens, is immense and cannot be tolerated. Primary challenges and priorities to be focused on due to the increase in norovirus outbreaks include a further depletion of health care services, increase cases in schools, nurseries, and care facilities, underreporting of the cases, and no effective vaccine being available. Therefore, it is essential to increase awareness about norovirus and its transmission in public, take necessary precautions, and increase reporting of cases. This article discusses the impact norovirus has during the COVID‐19 pandemic, and the challenges, and recommendations to achieve control before it reaches epidemic levels., Highlights Norovirus outbreaks are increasing in the United Kingdom, with an epidemic potential in the midst of the COVID‐19 pandemic.60% of these outbreaks are occurring in educational settings, nurseries, and childcare facilities.The challenges and priorities for norovirus response include healthcare exhaustion, increased outbreak prevalence in schools, colleges, and child nursing facilities, underreporting of cases and no vaccination for definitive immunity available.Recommendations to tackle the situation include increasing awareness about norovirus and its transmission in public, taking necessary precautions, and increasing reporting of cases.

Aims To evaluate outcomes of percutaneous left atrial appendage closure (LAAC) in patients with congestive heart failure (CHF) and non‐valvular atrial fibrillation (AF) in a consecutive, industry‐independent registry associated with periprocedural success and complications during long‐term follow‐up. Methods and results For this analysis, we included patients who underwent transcatheter LAAC from January 2014 to December 2019 at the University Heart Center in Lübeck, Germany, and compared patients with presence of CHF defined as patients with a reduced left ventricular ejection fraction (LVEF ≤ 40%), patients with a mid‐range LVEF (LVEF 41–49%), patients with diastolic dysfunction and preserved LVEF (LVEF ≥ 50%), and patients with right‐sided heart failure and impaired right ventricular function (tricuspid annular plane systolic excursion

In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography is defined as spontaneous reperfusion (SR).The present study aimed to determine the impact of lesion complexity and the CHAA total number of 1,641 consecutive patients with STEMI undergoing primary PCI were assessed for this study. Patients were divided into 2 groups, those with SR, SR(+) (The CHAOur study demonstrated that lesion complexity and the CHA

Objective This study investigated the impact of COVID‐19 home confinement on autism spectrum disorder (ASD) symptoms and irritability in children and adolescents with ASD. Method The study participants included 46 drug‐naive children aged 4‐17 years diagnosed with ASD. Parents of the participants completed the Autism Behaviour Checklist (AuBC) and Affective Reactivity Index (ARI) scales for both normal conditions and COVID‐19 home confinement. Results All subscale scores for AuBC (sensory, relating, body and object use, language, and social and self‐help) and ARI scores significantly increased during the COVID‐19 home confinement period (P

Objective:In this study, we assessed the acute changes in biventricular longitudinal strain after atrial septal defect transcatheter closure and its relation to the device size.Methods:Hundred atrial septal defect patients and 40 age-matched controls were included. Echocardiography and strain study were performed at baseline and 24 hours and 1 month after the intervention. The study group was divided into two subgroups; group 1: smaller devices were used (mean device size = 1.61 ± 0.05 cm, n = 74) and group 2: larger devices were used (mean device size = 2.95 ± 0.07 cm, n = 26).Results:At baseline, there was a significant difference between the study group and controls as regards right ventricular global longitudinal strain with significant hyperkinetic apex (p = 0.033, p = 0.020, respectively). There was a significant immediate reduction in right ventricular global longitudinal strain (from −24.43 ± 0.49% to −21.62 ± 0.47%, p < 0.001), which showed insignificant improvement after 1-month follow-up. While only left ventricular global longitudinal strain increased after 1 month. Within 24 hours of device closure, all the basal- and mid-lateral segments strains and apical right ventricular strains showed a significant reduction. There was a significant negative correlation between the indexed large device size and an immediate change in the right ventricular global longitudinal strain (r = −0.425, p = 0.034).Conclusion:Significant right ventricular global longitudinal strain reduction starts as early as 24 hours after transcatheter closure, irrespective of the device size used. The rapid impact of closure was mainly on the biventricular basal and lateral segments and right ventricular apical ones, especially with the large sized atrial septal defect.

Subintimal plaque modification to restore some antegrade flow can promote subsequent lesion recanalization (investment procedure) in cases of failed re-entry into the distal true lumen during chronic total occlusion percutaneous coronary intervention. In this case, we aimed to present a case in which TIMI 0 flow was observed in the LAD after unsuccessful PCI attempt, but was left to recover with the investment procedure and TIMI 3 flow was detected in the control angiogram. In unsuccessful PCI-CTO cases, even in the presence of TIMI 0, flow can improve in the future through an investment procedure.

The covid-19 global pandemic has influenced the day-to-day lives of people across the world. One consequence of this has been significant distortion to the subjective speed at which people feel like time is passing. To date, temporal distortions during covid-19 have mainly been studied in Europe. The current study therefore sought to explore experiences of the passage of time in Iraq. An online questionnaire was used to explore the passage of time during the day, week and the 11 months since the first period of covid-19 restrictions were imposed in Iraq. The questionnaire also measured affective and demographic factors, and task-load. The results showed that distortions to the passage of time were widespread in Iraq. Participants consistently reported a slowing of the passage of time for the day and the week during the pandemic in comparison to normal (i.e. before the pandemic). Participants also reported that it felt like longer than 11-months since the first lockdown began. The passage of time during the day and week were not predicted by any demographic, affective or task-load measures taken in the study. The perceived length of time since the first lockdown was however predicted by stress and change of life due to covid, with greater stress and greater change of life being associated with greater subjective lengthening of the pandemic. The findings indicate that whilst distortions to the passage of time during covid-19 appear to be a global phenomenon, the factors which predict temporal experience during the pandemic differ between countries and cultures.

The aim of this study was to investigate the relationship between comorbid obesity/overweight and cold executive functions, verbal short-term memory, and learning in children with attention deficit and hyperactivity disorder (ADHD). Our study was conducted on 100 drug-naive participants, including 70 patients with ADHD and 30 healthy controls. In our study, patients diagnosed with ADHD were divided into two groups according to body mass index as above the 85th percentile and at or below the 85th percentile. Cold executive functions were evaluated by the Stroop Test (ST) and Cancellation Test (CT). Serial Digit Learning Test (SDLT) was administered to measure verbal short-term memory and learning capacity. To evaluate the severity of ADHD objectively, the parents completed the Conners' Parents Rating Scale-Revised Short Version (CPRS-RS). There was no statistically significant difference in ST, SDLT, CT scores, and CPRS-RS subscale scores between the two groups with ADHD. This study show that overweight/obesity comorbid with ADHD may not be associated with cold executive functions, verbal short-term memory, learning, or ADHD symptom severity.

Aims Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. Methods and results The European Society of Cardiology EURObservational Research Programme PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: (i) women without hypertension (PPCM-noHTN); (ii) women with hypertension but without pre-eclampsia (PPCM-HTN); (iii) women with pre-eclampsia (PPCM-PE). Maternal (6-month) and neonatal outcomes were compared. Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (New York Heart Association class IV in 44.4% vs. 29.9%, P < 0.001), more frequent signs of heart failure (pulmonary rales in 70.7% vs. 55.4%, P = 0.002), a higher baseline left ventricular ejection fraction (LVEF) (32.7% vs. 30.7%, P = 0.005) and a smaller left ventricular end-diastolic diameter (57.4 +/- 6.7 mm vs. 59.8 +/- 8.1 mm, P = 0.001). There were no differences in the frequencies of death from any cause, rehospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF >= 50%) (adjusted odds ratio 2.08, 95% confidence interval 1.21-3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted odds ratio 2.84, 95% confidence interval 1.66-4.87). Conclusion Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM.