Long-term outcomes of titanium-nitride-oxide coated stents and drug-eluting stents in acute coronary syndrome:A systematic review and meta-analysis

BACKGROUND In severe cases of coronary artery disease,percutaneous coronary intervention provide promising results.The stent used could be a drug-eluting stent(DES)or a titanium-nitride-oxide coated stent(TiNOS).AIM To compare the 5-year effectiveness and safety of the two stent types.METHODS The following systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines,and PubMed/MEDLINE,Scopus,and Cochrane Central were searched from inception till August 2023.Primary outcomes were major adverse cardiac events(MACE),cardiac death,myocardial infarction(MI),cardiac death or MI,and ischemia-driven total lesion revascularization(ID-TLR).RESULTS Four randomized controlled trials(RCT),which analyzed a sum total of 3045 patients with acute coronary syndrome(ACS)after a median follow-up time of 5 years were included.Though statistically insignificant,an increase in the ID-TLR was observed in patients receiving TiNOSs vs DESs.In addition,MI,cardiac death and MI,and definite stent thrombosis(DST)were significantly decreased in the TiNOS arm.Baseline analysis revealed no significant results with meta-regression presenting non-ST elevated MI(NSTEMI)as a statistically significant covariate in the outcome of MACE.CONCLUSION TiNOS was found to be superior to DES in terms of MI,cardiac death or MI,and DST outcomes,however,the effect of the two stent types on ID-TLR and MACE was not significant.A greater number of studies are required to establish an accurate comparison of patient outcomes in TiNOS and DES.

Are doctors protected enough during COVID-19 in South Asia?

Background:The highly contagious nature of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)places physicians in South Asia at high risk of contracting the infection.Accordingly,we conducted this study to provide an updated account of physician deaths in South Asia during the COVID-19 pandemic and to analyze and compare the different characteristics associated with physician mortality amongst the countries of the region.Methods:We performed a cross-sectional study by using published news reports on the websites of news agencies from 9 selected countries in South Asia.Our study included only those physicians and doctors who died after contracting COVID-19 from their respective workplaces.All available data about the country of origin,type of,sex,age,medical or surgical specialty,and date of death were included.Results:The total number of physician deaths reported due to COVID-19 in our study was 170,with half(87/170,51%)of the deaths reported from Iran.Male physician deaths were reported to be 145(145/170=85%).Internal Medicine(58.43%)was the most severely affected sub-specialty.The highest physician mortality rate in the general population recorded in Afghanistan(27/1000 deaths).General physicians from India[OR=11.00(95%CI=1.06-114.08),p=0.045]and public sector medical practitioners from Pakistan[aOR=4.52(95%CI=1.18-17.33),p=0.028]were showing significant mortality when compared with other regions in multivariate logistic regression.Conclusion:An increased number of physician deaths,owing to COVID-19,has been shown in South Asia.This could be due to decreased personal protective equipment and the poor health care management systems of the countries in the region to combat the pandemic.Future studies should provide detailed information of characteristics associated with physician mortalities along with the main complications arising due to the virus.

Tocilizumab in severe COVID-19-A randomized,double-blind,placebo-controlled trial

Background:The therapeutic effectiveness of interleukin-6 receptor inhibitor in critically ill hospitalized patients with coronavirus disease 2019(COVID-19)is uncertain.Methods:To evaluate the efficacy and safety of the outcome as recovery or death of tocilizumab for severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)infection,we conducted a randomized,double-blinded,placebo-controlled phase 2 trial in critically ill COVID-19 adult patients.The patients were randomly assigned in a 4:1 ratio to receive standard medical treatment plus the recommended dose of either tocilizumab or the placebo drug.Randomization was stratified.The primary outcome was the recovery or death after administration of tocilizumab or a placebo drug.The secondary outcomes were clinical recovery or worsening of the patients’symptoms and inflammatory markers and discharge from the hospital.Results:Of 190 patients included in this study,152 received tocilizumab,and 38 received a placebo.The duration of hospital stay of the interventional group was 12.9±9.2,while the placebo group had a more extended hospital stay(15.6±8.8).The mortality ratio for the primary outcome,ie,mortality or recovery in the tocilizumab group was 17.8%;p=0.58 by log-rank test).The mortality ratio in the placebo group was 76.3%;p=0.32 by log-rank test).The inflammatory markers in the tocilizumab group significantly declined by day 16 compared to the placebo group.Conclusions:The use of tocilizumab was associated with decreased mortality,earlier improvement of inflamma-tory markers,and reduced hospital stay in patients with severe COVID-19.