reza arefizadeh

Acute COVID-19 infection is associated with increased adverse clinical outcomes in patients with acutecoronary syndromes (ACS). Given that some studies suggested improved pulmonary function with Ticagrelor, this clin-ical trial aimed to compare the effects of Ticagrelor versus Clopidogrel on the short-term outcomes of these patients.

In this multicenter clinical trial, 180 COVID-19 patients with ACS who underwent urgent percutaneous coro-nary intervention (PCI) were randomized to receive Ticagrelor (180mg loading dose followed by 90mg twice daily, n=90)or Clopidogrel (600mg loading dose with 75mg daily, n=90), and then followed for one month after their procedure. Theprimary composite endpoint was a combination of all-cause mortality, myocardial infarction, and early stent throm-bosis within the first month after stent implantation.

After thirty days of follow-up, the primary compositeendpoint was non-significantly lower in the Ticagrelor compared to the Clopidogrel group (18.5% vs 23.5% respectively,p = 0.254). Based on the time-to-event analysis, the mean survival rate was 26.8 ±7.7 and 24.7 ±9.9 days, respectively, forthe Ticagrelor and the Clopidogrel arms (Log-rank p = 0.275). Secondary endpoints were similar in the two trial arms,except for the mean oxygen saturation, which was higher in the Ticagrelor group (95.28 ±2.68 % vs. 94.15 ± 3.55 %, re-spectively; p = 0.021).

Among COVID-19 patients with concomitant ACS, who were treated with urgent PCI,the composite outcome of death, myocardial infarction, and early stent thrombosis was not different between Ticagrelorand Clopidogrel groups. However, administration of Ticagrelor was associated with a slight but statistically significantincrease in oxygen saturation compared to Clopidogrel, but this difference wasn’t clinically important.

Radiation protection plays a key role in medicine, due to the considerable usage of radiation in diagnosis and treatment. The protection against radiation exposure with inappropriate equipment is concerning.  The current study aimed to investigate the efficiency and quality of the radiation protection gowns with multi-layered nanoparticles compositions of Bismuth, Tungsten, Barium, and Copper, and light non-lead commercial gowns in angiography departments for approval of the manufacturers’ declarations and improve the quality of gowns. In this case study, physicians, physician assistants, radiology technologists, and nurses were asked to wear two commercial and proposed gowns in the angiography departments. Dosimetry of personnel was conducted using a Thermoluminescent Dosimeter (TLD) (GR-200), and the radiation dose received by personnel was compared in both cases. The participants were asked to fill out a questionnaire about the quality and comfort of two radiation protection gowns.  However, both gowns provide the necessary radiation protection; the multi-layer proposed gown has better radiation protection than the commercial sample (2 to 14 percent reduction in effective dose). The proposed gown has higher flexibility and efficiency than the commercial sample due to the use of nanoparticles and multi-layers (2.3 percent increase in personnel satisfaction according to the questionnaires).   However, the multi-layer gown containing nanoparticles of Bismuth, Tungsten, Barium, and Copper has no significant difference from the non-lead commercial sample in terms of radiation protection, it has higher flexibility and comfort with more satisfaction for the personnel.

Coronary heart disease is the leading cause of death worldwide. Myocardial infarction (MI) is a fatal manifestation of coronary heart disease, which can present as sudden death. Although the molecular mechanisms of coronary heart disease are still unknown, global gene expression profiling is regarded as a useful approach for deciphering the pathophysiology of this disease and subsequent diseases. This study used a bioinformatics analysis approach to better understand the molecular mechanisms underlying coronary heart disease. This experimental study was conducted in the department of cardiology, Aja University of Medical Sciences (2021-2022), Tehran, Iran. To identify the key deregulated genes and pathways in coronary heart disease, an integrative approach was used by merging three gene expression datasets, including GSE19339, GSE66360, and GSE29111, into a single matrix. The t test was used for the statistical analysis, with a significance level of P<0.05.  The limma package in R was used to identify a total of 133 DEGs, consisting of 124 upregulated and nine downregulated genes. KDM5D, EIF1AY, and CCL20 are among the top upregulated genes. Moreover, the interleukin 17 (IL-17) signaling pathway and four other signaling pathways were identified as the potent underlying pathogenesis of both coronary artery disease (CAD) and MI using a systems biology approach. Accordingly, these findings can provide expression signatures and potential biomarkers in CAD and MI pathophysiology, which can contribute to both diagnosis and therapeutic purposes. Five signaling pathways were introduced in MI and CAD that were primarily involved in inflammation, including the IL-17 signaling pathway, TNF signaling pathway, toll-like receptor signaling pathway, C-type lectin receptor signaling pathway, and rheumatoid arthritis signaling pathway.

Thyroid hormones are well-known for their various effects on the cardiovascular system. However, contradictory results have been obtained regarding the association between thyroid hormones within the Reference Range (RR) and Coronary Artery Disease (CAD). Moreover, scarce evidence is available regarding the association between thyroid hormones and Coronary Slow Flow Phenomenon (CSFP).

This study aimed to investigate the relationship between thyroid hormones in the RR, and CSFP and CAD.

A total of 1033 euthyroid patients who underwent coronary angiography were enrolled and divided into four groups based on their coronary angiography and Thrombolysis in Myocardial Infarction (TIMI) flow grade: Normal Coronary Artery (NCA), CSFP, Non-obstructive CAD (N-CAD), and Obstructive CAD (O-CAD). Multivariate multinomial regression analysis was conducted to assess the association between thyroid hormone levels and CSFP as well as CAD. Thereafter, the prediction accuracy of Free Triiodothyronine (FT3) levels for the presence of CSFP and CAD was evaluated by the Receiver Operating Characteristic (ROC) curve analysis.

FT3 serum level was significantly lower in the CSFP and both CAD groups compared to the NCA group (P < 0.001). FT3 level was inversely correlated to the presence of CSFP and CAD (both N-CAD and O-CAD) only in young females. Moreover, TSH was found to be an independent predictor of O-CAD in young individuals, regardless of their gender. Furthermore, FT3 levels ≤ 2.56 pg/mL predicted the presence of CSFP (78% sensitivity and 62% specificity) and FT3 levels ≤ 2.38 pg/mL predicted the presence of CAD (64% sensitivity and 75% specificity) in young females.

FT3 level was negatively associated with CSFP and CAD in young females. In addition, high levels of TSH were associated with O-CAD only in young patients. Further studies are required to shed more light upon the regarded associations.