Simra Shadab

Atrial fibrillation (AF)/flutter and renal dysfunction commonly coexist and are associated with substantial cardiovascular and thromboembolic risk. Despite this clinical overlap, national mortality patterns among individuals whose death certificates record both conditions have not been well characterized over an extended period. We examined changes over time in deaths documenting both AF/flutter and renal failure and assessed whether these patterns differed across demographic and geographic groups among U.S. adults aged ≥ 45 years from 1999 to 2023. We queried the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple-Cause-of-Death database for death certificates of U.S. adults aged ≥ 45 years in which AF/flutter (International Classification of Diseases, Tenth Revision I48) and renal failure (N17–N19) were both recorded. Either diagnosis could appear as the underlying or a contributing cause of death. Mortality rates were age-standardized to the 2000 U.S. population and expressed per 100,000 persons. Joinpoint regression was used to evaluate changes in annual age-adjusted mortality rates and to estimate annual percentage changes (APCs). The study included 392,927 death certificates meeting these criteria. The age-adjusted mortality rate increased from 6.3 per 100,000 in 1999 to 20.6 per 100,000 in 2023. Significant upward trends occurred during 1999 to 2012 (APC, 6.21%) and 2015 to 2023 (APC, 9.62%). Rates were higher among men than women throughout the study period. In 2023, the age-adjusted mortality rate was 22.55 per 100,000 among non-Hispanic White individuals, 19.91 among non-Hispanic Black or African American individuals, 14.31 among non-Hispanic American Indian or Alaska Native individuals, 11.75 among Hispanic or Latino individuals, and 10.28 among non-Hispanic Asian or Pacific Islander individuals. The age-adjusted mortality rate for deaths documenting both AF/flutter and renal failure increased markedly among U.S. adults aged ≥ 45 years between 1999 and 2023. The magnitude of this mortality pattern differed by sex, race/ethnicity, and geographic location. Because the analysis is based on diagnoses documented on death certificates, the findings reflect population-level co-documentation of the 2 conditions and do not establish that either condition, alone or in combination, directly caused death. Individual-level studies are needed to determine the clinical and healthcare factors associated with these trends.

Background: Surgical site infections (SSIs) are significant postoperative complications in gynecologic and obstetric surgeries. Preoperative vaginal antisepsis is vital for prevention. This review compares the efficacy and safety of chlorhexidine gluconate (CHG) vs. povidone-iodine (PI) for vaginal antisepsis in preventing postoperative infections. Materials and Methods: A systematic search of major databases was conducted through 8 Ja-nuary 2025. Randomized controlled trials (RCTs) comparing CHG and PI for vaginal antisepsis during urogynecologic procedures were included. Meta-analyses were performed using random-effects models to estimate risk ratios (RRs) with 95% confidence intervals (CIs). The GRADE approach assessed the certainty of evidence. The primary outcome was SSIs; secondary outcomes included febrile morbidity, hospital stay, antiseptic-related side effects, and wound complications. Results: Twelve RCTs, including 4936 participants, were analyzed. The results showed that CHG significantly reduced compared to PI (RR: 1.71; 95% CI: 1.30–2.26; I ² = 17%; high-certainty evidence). Subgroup analyses showed higher SSI risk with PI in upper/lower-middle-income countries (RR: 1.79; 95% CI: 1.17–2.74) and high-income countries (RR: 1.66; 95% CI: 1.08–2.56). PI was also associated with increased risks of superficial SSIs (RR: 1.57), deep SSIs (RR: 2.35), and readmissions (RR: 1.59). Conclusion: CHG was superior to PI in preventing SSIs in gynecologic and obstetric surgeries. With high-quality evidence supporting its use, CHG is recommended for vaginal preparation. Future research should explore cost-effectiveness and long-term outcomes.

Ischemic stroke is one of the leading causes of morbidity and mortality worldwide, with carotid atherosclerosis being its key etiological factor. MicroRNA-21 (miR-21) regulates intracellular signal pathways responsible for vascular changes and ischemic brain injury, and is recognized as a potential diagnostic and prognostic biomarker. It modifies the activity of macrophages (MΦ) and vascular smooth muscle cells, causing inflammation and affecting the stability of atherosclerotic plaques. A deficiency of miR-21 in macrophages stimulates the inflammatory response and plaque growth. It promotes both the synthesis of extracellular matrix, stabilizing the plaque, and the degradation of the fibrin cap, which leads to plaque instability. The effect of miR-21 on endothelial cells differs: it stimulates both NO· synthesis and inflammation. During ischemic stroke, miR-21 demonstrates neuroprotective effects by modulating post-ischemic inflammation and protecting the integrity of the blood–brain barrier. Therapy targeting miR-21 shows potential in experimental models, but it requires cell-specific delivery and precise timing. Further research efforts should focus on the effects of miR-21 on different cell types, as well as the development of new technologies for diagnostic and therapeutic applications.