Kumar, Ashish

Background Although micro‐ and nanoplastics are an emerging risk factor for the development of cardiovascular diseases, the association of marine microplastic levels (MMLs) with the burden of cardiometabolic diseases at a population level remains unexplored. We investigated the relationship between the mean microplastic concentration in ocean water within 200 nautical miles of the US coastline and the prevalence of type 2 diabetes, coronary artery disease, and stroke in nearby counties. Methods Microplastic concentration data within 200 nautical miles of the US coastline were geospatially analyzed to calculate mean MMLs. The coastal counties were stratified into 4 categories based on MMLs in the adjacent ocean water body: low, medium, high, or very high. The Behavioral Risk Factor Surveillance System 2019 to 2020 survey data were used to identify the prevalence of type 2 diabetes, coronary artery disease, and stroke in these counties. Univariate and population‐weighted multivariate quasi‐Poisson regression, adjusted for county‐level confounding variables, was used to evaluate the unadjusted and adjusted associations between disease prevalence and MMLs. Results The mean age of the population was 43±6 years. After adjusting for age, sex, physician access, and socioenvironmental vulnerabilities at the county level, counties with very high MMLs exhibited an 18%, 7%, and 9% higher adjusted prevalence of type 2 diabetes, coronary artery disease, and stroke, respectively, compared with those with low levels. Conclusion Marine microplastic levels were significantly associated with the prevalence of cardiometabolic diseases in coastal counties. Comprehensive studies at an individual level are needed to further investigate the health impacts of microplastic pollution.

ABSTRACTBackgroundMicroplastics are emerging as environmental pollutants with potential neurotoxic effects, yet their association with neurological disabilities remains largely unexplored.MethodsIn this cross‐sectional study comprising 218 coastal counties in the United States, we compared the self‐reported prevalence of cognitive disability, mobility disability, self‐care disability, and independent living disability in counties with very high and low marine microplastic levels (MMLs). Unadjusted and adjusted prevalence ratios (PRs) were computed using population‐weighted quasi‐Poisson regression across three different models to examine the relationship between disability prevalence and MMLs.ResultsCounties exposed to very high marine microplastic levels had a higher mean prevalence of self‐reported cognitive disability (15.2% vs. 13.9%), mobility disability (14.1% vs. 12.3%), self‐care disability (4.2% vs. 3.6%), and independent living disability (8.5% vs. 7.7%) compared to those exposed to low levels (p < 0.001). Regression analyses revealed significantly elevated adjusted prevalence ratios (PRs) for cognitive (PR: 1.09 [95% CI: 1.06–1.12], p < 0.001), mobility (PR: 1.06 [1.03–1.10], p < 0.001), self‐care (PR: 1.16 [1.11–1.20], p < 0.001), and independent living disability (PR: 1.08 [1.05–1.12], p < 0.001) in counties with very high microplastic exposure compared to those with low exposure.ConclusionsThis study highlights a significant association between marine microplastic pollution and the self‐reported prevalence of cognitive, mobility, self‐care, and independent living disabilities at the county level. While merely associative, these findings emphasize the urgent need for further investigation into the individual‐level health impacts of microplastic exposure and underscore the importance of environmental interventions to mitigate potential risks.

Introduction: Ventricular arrhythmias, including ventricular tachycardia (VT) and ventricular fibrillation (VF), are associated with high mortality and morbidity. Sedation through agents like benzodiazepines, propofol, and opiates are mainstays of treatment but are limited by side effects. Dexmedetomidine is a α2-presynaptic receptor agonist with a safe and efficacious sedative profile. Furthermore, it has been recently proposed as a sedative agent in VT due its additional antiarrhythmic properties. Methods: A systemic literature review was conducted of MEDLINE, EMBASE, Cochrane, and Scopus. Randomized controlled trials comparing the incidence of ventricular arrhythmias of dexmedetomidine with placebo or an alternative sedative agent were included. Two researchers independently extracted the data and performed quality assessments. Results: We identified 6 studies that met the selection criteria. Our meta-analysis demonstrated significant reduction of the overall risk of ventricular arrhythmias in patients receiving dexmedetomidine (RR 0.35, 95% CI 0.16, 0.76). Furthermore, there was no significant difference in risk of mortality (RR 0.59 95% CI 0.12, 3.02). Dexmedetomidine also significantly increased the risk of bradycardia (RR 2.78 95% CI 2.00, 3.87). There was no significant difference in risk of tachycardia (RR 0.59 95% CI 0.12, 3.02) or hypotension (RR 1.07 95% CI 0.64, 1.81). Conclusions: Our study demonstrates that the dexmedetomidine reduces the risk of VA by 65% compared to control. Further prospective research is necessary to clarify the antiarrhythmic and sedative properties of dexmedetomidine and its potential effect on patient outcomes.

AbstractNew‐onset atrial fibrillation (NOAF) in COVID‐19 raises significant clinical and public health issues. This systematic review and meta‐analysis aims to compile and analyze the current literature on NOAF in COVID‐19 and give a more comprehensive understanding of the prevalence and outcomes of NOAF in COVID‐19. A comprehensive literature search was carried out using several databases. The random effect model using inverse variance method and DerSimonian and Laird estimator of Tua2 was used to calculate the pooled prevalence and associated 95% confidence interval (CI). Results for outcome analysis were presented as odds ratios (ORs) with 95% CI and pooled using the Mantel‐Haenszel random‐effects model. The pooled prevalence of NOAF in COVID‐19 was 7.8% (95% CI: 6.54%–9.32%),a pooled estimate from 30 articles (81 929 COVID‐19 patients). Furthermore, our analysis reported that COVID‐19 patients with NOAF had a higher risk of developing severe disease compared with COVID‐19 patients without a history of atrial fibrillation (OR = 4.78, 95% CI: 3.75–6.09) and COVID‐19 patients with a history of pre‐existing atrial fibrillation (OR = 2.75, 95% CI: 2.10–3.59). Similarly, our analysis also indicated that COVID‐19 patients with NOAF had a higher risk of all‐cause mortality compared with, COVID‐19 patients without a history of atrial fibrillation (OR = 3.83, 95% CI: 2.99–4.92) and COVID‐19 patients with a history of pre‐existing atrial fibrillation (OR = 2.32, 95% CI: 1.35–3.96). The meta‐analysis did not reveal any significant publication bias. The results indicate a strong correlation between NOAF and a higher risk of severe illness and mortality. These results emphasize the importance of careful surveillance, early detection, and customized NOAF management strategies to improve clinical outcomes for COVID‐19 patients.

Introduction: Intravenous heparin is strongly associated with pocket hematoma (PH) formation in patients undergoing cardiac implantable electronic device (CIED) implantation. However, there is no data on subcutaneous prophylactic heparin in this population Hypothesis: We hypothesized that the subcutaneous heparin may increase the odds of PH in patients undergoing CIED implantation using data from a large, nationally representative sample of the US population. Methods: The Premier Healthcare Database was analyzed from 2016-2019 to identify patients >18 years old undergoing CIED implantation. Patients with PH were then identified by using ICD-10 CM codes. A multivariable logistic regression model was used to adjust for confounders Results: A total of 267,650 patients underwent CIED implantation between January 1, 2016, and December 31, 2019, of which 4,496 (1.68%) \developed PH. Single chamber pacemaker in 7.22%, dual-chamber pacemaker was implanted in 58.3% of patients, and CRT-P in 4.59%, ICD in 18.58%, CRT-D in 11.31%. Of the total cohort, 559 Patients received subcutaneous heparin within 3 days of the CIED implant procedure. Of these 559 patients, 91 (16%) patients were on subcutaneous heparin (pre-procedural: 19; post-procedural: 57) and developed PH. Subcutaneous heparin is associated with increased odds (OR :13.8,p<0.01) of PH formation. Conclusions: This study suggests that subcutaneous heparin is a strong risk factor for the development of PH. This may independently drive up the rates of PH in the inpatient population. Further studies on the timing of subcutaneous heparin need to be conducted.

Background: New-onset atrial fibrillation (NOAF) in COVID-19 raises significant clinical and public health issues. This systematic review and meta-analysis aims to compile and analyze the current literature on NOAF in COVID-19 and give a more comprehensive understanding of the prevalence and outcomes of NOAF in COVID-19. Methods: A comprehensive literature search was carried out using several databases. The random effect model using inverse variance method and DerSimonian and Laird estimator of Tua2 was used to calculate the pooled prevalence and associated 95% confidence interval (CI). Results for outcome analysis were presented as odds ratios (ORs) with 95% CI and pooled using the Mantel-Haenszel random-effects model. Results: The pooled prevalence of NOAF in COVID-19 was 7.8% (95% CI, 6.54% to 9.32%), pooled estimate from 30 articles (81,929 COVID-19 patients). Furthermore, our analysis reported that COVID-19 patients with NOAF had a higher risk of developing severe disease compared with COVID–19 patients without a history of atrial fibrillation (OR= 4.78, 95% CI 3.75 to 6.09) and COVID-19 patients with a history of pre-existing atrial fibrillation (OR= 2.75, 95% CI 2.10 to 3.59) . Similarly, our analysis also indicated that COVID–19 patients with NOAF had a higher risk of all-cause mortality compared with, COVID–19 patients without a history of atrial fibrillation (OOR= 3.83, 95% CI 2.99 to 4.92) and COVID-19 patients with a history of pre-existing atrial fibrillation (OR= 2.32, 95% CI 1.35 to 3.96). The meta-analysis did not reveal any significant publication bias. Conclusion: The results of the current meta-analysis a high prevalence rate of NOAF among COVID-19 patients. Further the study reported higher disease severity with NOAF compared with COVID-19 patients without a history of atrial fibrillation and with a history of atrial fibrillation.

AbstractBackgroundLeft ventricular assist device (LVAD) implantation is frequently employed in patients with end‐stage heart failure. The outcomes of addressing the repair of all substantial aortic valvular disease at the time of LVAD implantation remain unclear. We sought to assess the clinical outcomes in patients undergoing LVAD implantation concomitant with aortic valve procedures (AVPs) compared with isolated LVAD implantation.MethodsA literature search was performed using PubMed, Embase, and Cochrane library from inception till June 2022. Primary outcomes included short‐term mortality and long‐term survival. Random effects models were used to compute mean differences and odds ratios with 95% confidence intervals (CIs).ResultsA total of 14 observational studies (N = 52 693) met our inclusion criteria. Concomitant LVAD implantation and AVPs were associated with higher short‐term mortality (OR = 1.61 [95% CI, 1.06–2.42]; p = 0.02) and mean CPBt (MD = 43.25 [95% CI, 22.95–63.56]; p < 0.0001), and reduced long‐term survival (OR = 0.70 [95% CI, 0.55–0.88]; p = 0.003) compared with isolated LVAD implantation. No difference in the odds of cerebrovascular accident (OR = 1.05 [95% CI, 0.79–1.39]; p = 0.74) and mean length of hospital stay (MD = 2.89 [95% CI, −4.04 to 9.82]; p = 0.41) was observed between the two groups. On adjusted analysis, short‐term mortality was significantly higher in the LVAD group with concurrent AVPs when compared with the isolated LVAD group (aHR = 1.50 [95% CI, 1.20–1.87]; p = 0.0004).ConclusionsConcurrent AVPs were associated with higher short‐term mortality and reduced long‐term survival in patients undergoing LVAD implantation compared with isolated LVAD implantation.

Purpose: Studies on outcomes related to endovascular treatment (EVT) in advanced stages of chronic kidney disease (CKD) and end-stage renal disease (ESRD) among hospitalizations with acute limb ischemia (ALI) are limited. Methods: The Nationwide Inpatient Sample was quarried from October 2015 to December 2017 to identify the hospitalizations with ALI and undergoing EVT. The study population was subdivided into 3 groups based on their CKD stages: group 1 (No CKD, stage I, stage II), group 2 (CKD stage III, stage IV), and group 3 (CKD stage V and ESRD). The primary outcome was all-cause in-hospital mortality. Results: A total of 51 995 hospitalizations with ALI undergoing EVT were identified. The in-hospital mortality was significantly higher in group 2 (OR = 1.17; 95% CI 1.04 – 1.32, p=0.009) and group 3 (OR = 3.18; 95% CI 2.74–3.69, p<0.0001) compared with group 1. Odds of minor amputation, vascular complication, atherectomy, and blood transfusion were higher among groups 2 and 3 compared with group 1. Group 2 had higher odds of access site hemorrhage compared with groups 1 and 3, whereas group 3 had higher odds of major amputation, postprocedural infection, and postoperative hemorrhage compared with groups 1 and 2. Besides, groups 2 and 3 had lower odds of discharge to home compared with group 1. Finally, the length of hospital stay and cost of care was significantly higher with the advancing CKD stages. Conclusion: Advanced CKD stages and ESRD are associated with higher mortality, worse in-hospital outcomes and higher resource utilization among ALI hospitalizations undergoing EVT. Clinical Impact Current guidelines are not clear for the optimum first line treatment of acute limb ischemia, especially in patients with advanced kidney disease as compared to normal/mild kidney disease patients. We found that advanced kidney disease is a significant risk factor for worse in-hospital morbidity and mortality. Furthermore, patients with acute limb ischemia and advanced kidney disease is associated with significantly higher resource utilization as compared to patients with normal/mild kidney disease. This study suggests shared decision making between treating physician and patients when considering endovascular therapy for the treatment of acute limb ischemia in patients with advanced kidney disease.

Purpose. To assess the antiarrhythmic properties of dexmedetomidine in patients in the intensive care unit. Methods. A literature review was conducted with Ovid MEDLINE (R), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, and Scopus. Study Selection. Randomized controlled trials were included, examining the incidence of ventricular arrhythmias, ventricular tachycardia, or ventricular fibrillation with dexmedetomidine compared to placebo or an alternative sedative agent. For each publication that met the selection criteria, the patient demographics, incidence of arrhythmias, mortality, and adverse events were collected. Data extraction was carried out by two authors independently. Results. We identified 6 out of 126 studies that met the selection criteria for our meta-analysis, all of which focused on the perioperative cardiac surgery period. Patients receiving dexmedetomidine demonstrated a significant reduction of the overall incidence of ventricular arrhythmias (RR 0.35, 95% CI 0.16, 0.76). In particular, dexmedetomidine significantly decreased the risk of ventricular tachycardia compared with control (RR 0.25, 95% CI 0.08, 0.80, I2 0%). Regarding adverse events, dexmedetomidine significantly increased the frequency of bradycardia (RR 2.78 95% CI 2.00, 3.87). However, there was no significant difference in mortality (RR 0.59 95% CI 0.12, 3.02). Conclusion. From this meta-analysis, we report a decreased incidence of ventricular tachycardia with dexmedetomidine in critically ill patients. This result favors the use of dexmedetomidine for its antiarrhythmic properties.

Abstract Background: Atrial fibrillation (AF) is relatively less frequent in younger patients (age<50). Recently, studies have suggested that early restoration of sinus rhythm may lead to improved outcomes compared with rate control. Methods: We included all hospitalized patients between 18 and 50 years with a diagnosis of AF from the Nationwide Readmission Database 2016-2017 from the Healthcare Cost and Utilization Project. Demographic and comorbidity data were collected and analyzed. Outcomes assessed included one-year AF readmission rates, all-cause readmission, ischemic stroke, and all-cause mortality. Subgroup analyses were performed for all demographic and comorbidity variables.Results: Overall, 52,598 patients (medium age 44, interquartile range 38-48, female 25.7%) were included in the study, including 2,146 (4.0%) who underwent catheter ablation for AF. Patients who underwent catheter ablation had a significantly lower rate of readmission for AF or any cause at one year (adjusted hazard ratios (HR) of 0.52 [95% confidence interval (CI): 0.43-0.63] and HR of 0.81 [95% CI: 0.72 - 0.89], respectively). There was no difference in 1-year readmission for stroke or all-cause mortality between the two groups. Subgroup analyses showed a consistent reduction in the risk of AF readmission among major demographic and comorbidity subgroups.Conclusion: Catheter ablation in young patients with AF was associated with a reduction in 1-year AF related and all-cause readmissions. These data merit further prospective investigation for validation.