Amit Rout

Sinus of Valsalva Aneurysm (SOVA) is a rare congenital or acquired cardiac anomaly. SOVA can remain undiagnosed till it ruptures and can present as acute heart failure, acute coronary syndrome or cardiac tamponade [1]. The aneurysm usually involves the right coronary sinus and ruptures into the Right Atrium (RA) or Right Ventricle (RV) leading to significant left to right shunting and can subsequently cause acute heart failure. Management involves multimodality imaging to verify anatomy followed by surgical resection and repair [2].

Background: Optimal oxygen saturation target in patients resuscitated after cardiac arrest is unknown. Previous randomized controlled trials (RCTs) comparing restrictive oxygen therapy with liberal therapy have shown conflicting results. Study Question: We performed a meta-analysis of available RCTs to consolidate the contrasting findings regarding the oxygen targets after cardiac arrest. Data Sources: We searched electronic databases for RCTs comparing restrictive versus liberal oxygen targets in patients resuscitated after cardiac arrest. Study Design: End points of interest were mortality, unfavorable neurological outcomes, and rearrests. Random-effects meta-analysis was performed to estimate the risk ratio (RR) with a 95% confidence interval (CI). Results: Eight RCTs with 1641 patients (restrictive n = 833, liberal n = 808) were included in the analysis. The oxygen targets were defined by either saturation, partial pressure (PaO₂), or supplementation rates. The mean age and male percentage were 63 years and 80%, respectively. There was no significant difference observed in the 2 groups for overall mortality (RR = 0.91, 95% CI = 0.75–1.10, P = 0.33), unfavorable neurological outcomes (RR = 0.93, 95% CI = 0.74–1.18, P = 0.56), and rearrests (RR = 0.67, 95% CI = 0.22–1.98, P = 0.47). Conclusions: Overall, this meta-analysis shows no significant difference in mortality, unfavorable neurological outcomes, and rearrests when using restrictive or liberal oxygen targets in patients after cardiac arrest. The limitations in the newer trials should be kept in mind while interpreting the overall results.

In India, climate change has a huge impact on the agricultural sector. It directly affects crop yield, nutritional quality and productivity. In this paper, a mo

Background: The optimal dual antiplatelet therapy (DAPT) duration and regimen in patients undergoing percutaneous coronary intervention (PCI) using current generation drug eluting stents (DES) is still unclear.Aims: To compare the safety and efficacy of short‐term DAPT (S‐DAPT) with longer duration DAPT (l‐DAPT) after contemporary PCI.Methods: We searched for studies comparing S‐DAPT (≤3 months) followed by single antiplatelet therapy (SAPT) with aspirin or a P2Y₁₂ inhibitor against L‐DAPT (6−12 months) after PCI with current generation DES. Primary end‐points of interest were major bleeding and stent thrombosis (ST) at 1 year. Random‐effects meta‐analyses were performed to calculate odds ratios with 95% CIs.Results: Eleven RCTs (n = 48,946) were included in the primary analysis. Major bleeding was significantly lower with S‐DAPT (n = 24,424) (odd ratio [OR 0.65; 95% confidence interval, CI 0.52−0.80]) compared with L‐DAPT (n = 24,486). There were no differences in ST between the two groups [OR 1.26; 95% CI 0.97−1.63]. There were no significant differences in risks of all‐cause death, cardiovascular death or myocardial infarction between S‐DAPT and L‐DAPT groups. In a subgroup analysis, there was borderline significantly higher ST with 1 month S‐DAPT [1.39; 1.0–1.92], but not with 3 months S‐DAPT [1.07; 0.70−1.64], when compared to L‐DAPT. Finally, there were no significant treatment interactions observed when trials using SAPT with aspirin were compared with those using P2Y₁₂ inhibitor monotherapy.Conclusion: Among patients undergoing current generation DES implantation, S‐DAPT for 1−3 months reduces major bleeding without an increase in ischemic events compared with L‐DAPT. Three months S‐DAPT might provide a better risk‐benefit profile based on current analysis. Further study is needed to define the SAPT of choice after 1−3 months DAPT.

Randomized controlled trials (RCTs) have reported conflicting outcomes with the use of vitamin D in critically ill patients. With reporting of newer RCTs, we conducted this updated meta-analysis. Electronic databases were searched for RCTs comparing vitamin D with placebo in critically ill patients admitted to the intensive care unit (ICU). A random-effects meta-analysis was used to calculate the risk ratio (RR) and standardized mean difference (SMD) with a 95% confidence interval (CI). Eleven RCTs with a total of 2,187 patients (vitamin D: n = 1,120; placebo: n = 1,067) were included. Vitamin D when compared to placebo was associated with the decreased duration of mechanical ventilation (SMD = -0.50; 95% CI = [-0.97, -0.03]; p = 0.04) and ICU stay (SMD = -0.60; 95% CI = [-1.03, -0.16]; p = 0.007) without any difference in the mortality (RR = 0.85; 95% CI = [0.68, 1.04]; p = 0.12) and length of hospital stay (SMD = -0.21; 95% CI = (-0.51, 0.09); p = 0.18]. Subgroup analysis showed that parenteral vitamin D may reduce the risk of mortality (RR = 0.54; 95% CI = [0.35, 0.83], p = 0.005). Vitamin D supplementation in critically ill patients decreases the duration of mechanical ventilation and ICU stay. Further studies should identify specific groups of patients who will derive the most benefit from vitamin D supplementation.

BRASH syndrome is characterized by bradycardia, renal failure, AV nodal blockade, shock, and hyperkalemia. The proposed mechanism involves a vicious cycle between AV nodal blockers, hyperkalemia, and renal failure and was first described in 2016. We present a case of a 52-year-old woman who presented with progressively worsening shortness of breath and hypertensive urgency who subsequently developed profound bradycardia and shock that was refractory to resuscitative measures, she was diagnosed with BRASH syndrome. In this article, we explore the predisposing factors and challenges faced during the management of patients with BRASH syndrome.