To cite this article: Garc ıa-Poza P, de Abajo FJ, Gil MJ, Chac on A, Bryant V, Garc ıa-Rodr ıguez LA. Risk of ischemic stroke associated with non-steroidal anti-inflammatory drugs and paracetamol: a population-based case-control study. J Thromb Haemost 2015; 13: 708-18.Summary. Objective: To assess the risk of non-fatal ischemic stroke associated with non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol. The effects of dose, duration of treatment, background cardiovascular (CV) risk and use of concomitant aspirin were studied. Methods: We performed a population-based case-control study. Patients were considered exposed if they were on treatment within a 30-day window before the index date. We estimated adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) using logistic regression. Results: Two thousand eight hundred and eighty-eight cases and 20 000 controls were included. No increased risk was observed with traditional NSAIDs as a group (OR = 1.03; 95% CI, 0.90-1.19), but results varied across individual agents and conditions of use. An increased risk was found with diclofenac (OR = 1.53; 95% CI, 1.19-1.97), in particular when used at high doses (OR = 1.62; 1.06-2.46), over long-term periods (> 365 days; OR = 2.39; 1.52-3.76) and in patients with a high background CV risk (OR = 1.78; 1.23-2.58), as well as with aceclofenac when used at high doses (OR = 1.67; 1.05-2.67), in long-term treatments (OR = 2.00; 1.14-3.53) and in patients with CV risk factors (OR = 2.33; 1.40-3.87). No association was found with ibuprofen (OR = 0.94; 0.76-1.17) or naproxen (OR = 0.68; 0.36-1.29). The concomitant use of aspirin did not show a significant effect modification. Paracetamol did not increase the risk overall (OR = 0.97; 0.85-1.10) or in patients at high CV risk (OR = 0.94; 0.78-1.14). Conclusions: Diclofenac and aceclofenac increase the risk of ischemic stroke while ibuprofen and naproxen do not. Dose, duration and baseline CV risk, but not aspirin use, appear to modulate the risk. Paracetamol does not increase the risk, even in patients with a high background CV risk.

The novel coronavirus (SARS-CoV-2) has produced millions of infections and deaths worldwide. It is believed that adaptive immunity to the virus occurs although with variation in its pattern and duration. While uncommon, confirmed reinfection with the novel coronavirus has been reported. Telemedicine has emerged as a viable tool for the delivery of healthcare in lieu of in-person patient contact. The variable and occasionally rapid course of clinical disease raises safety concerns of using telemedicine in the clinical management of acute infection with the novel coronavirus. We present a case of novel coronavirus infection in an immunocompetent individual with obstructive sleep apnea (OSA) who failed to manifest an adaptive immune response to acute infection and was subsequently reinfected. The case highlights the use of telemedicine in managing novel coronavirus respiratory disease and the potential role of OSA as a disease facilitator.

Participatory Sensing (PS) is a new fast-growing sensing approach that involves the participation of mobile phone users, and the corresponding communication infrastructure, to create a large-scale monitoring system. Using PS-based system makes it possible to measure and detect variables and events with an improvement in spatial and time resolution over traditional monitoring system. Pollution-Spots proposes an air pollution monitoring solution by means of using an infrastructure of fixed low-cost sensing devices, and reporting the measurements using a PS approach. The sensing devices acquire the variables and the pedestrian forwards this information, completing the cycle with no extra cost of data transport and/or human resources. However, including humans to the sensing loop, rises new challenges, such as protecting user private data, motivating user's participation, and reducing mobile phone's power consumption, all while maintaining the quality of the collected data. Pollution-Spots proposes a combined algorithm that protects the participant's private information and also implements a gamification technique to encourage the participation without any monetary reward. The proposed system has proven to be energy efficient when compared to similar approaches, with the additional benefit of considering the quality of the collected information, which is normally affected by privacy protection algorithms.

Background Limited data exist about the impact of gender-specific outcomes in patients with heart failure (HF) who develop concomitant sepsis. Methods This is a retrospective cohort study of patients with HF who developed sepsis. Clinical outcomes, including in-hospital mortality, development of cardiogenic shock (CS), pulmonary edema requiring urgent intravenous diuretics (IVD), acute kidney injury (AKI), length of stay (LOS), and 30-day HF-related readmission, were evaluated in men vs. women. Results This cohort of 618 patients includes 272 (44%) women with a mean age of 75±14 years. Coronary artery disease (p<0.0001), diabetes mellitus (p=0.0213), stage ≥ 3 chronic kidney disease (p<0.0001), and HF with reduced ejection fraction (HFrEF) (p=0.0015) were more prevalent in men. The implementation of the Surviving Sepsis Campaign (i.e., intravenous (IV) crystalloids in the first six hours) was more aggressive in women (p=0.0192). There was no difference in in-hospital mortality (p=0.2385) between men and women. After adjusting for HF types, women with HF with preserved ejection fraction (HFpEF) developed more episodes of pulmonary edema requiring urgent IVD (p=0.0389), while men with HFpEF had more CS requiring inotropes (p=0.0400) and a longer LOS (p=0.0434). Conversely, women with HFrEF were most likely to develop CS requiring inotropes (p=0.0132). Conclusion Women with HF who developed sepsis receive a more aggressive implementation of the Surviving Sepsis Campaign than men, leading to more pulmonary edema events in women with HFpEF and more cardiogenic shock in women with HFrEF. A cautiously tailored approach is desperately needed for patients with HF who develop sepsis.

Background: Renal impairment is common among patients with heart failure and portends worse outcomes. We sought to describe the impact of euvolemia maintenance via pulmonary artery pressure-guided management of heart failure on the trajectory of kidney function. Hypothesis: We hypothesized that PAP-guided management is associated with slowing eGFR decline in heart failure patients. Methods: We retrospectively reviewed kidney function 1 year prior to implant, and 1 year after implantation of a wireless pulmonary-artery hemodynamic monitoring sensor (CardioMEMS, St Jude Medical, St Paul, MN). Glomerular filtration rate (eGFR) was estimated using standard equations (MDRD, Cockroft-Gault, and CKD-EPI). Standardized annual change in eGFR was compared prior to and after CardioMEMS implantation using related-samples Wilcoxon Signed Rank Test. Results: A total of 70 patients were included with a median age of 74 [67-79] years. Forty-two patients (60%) were male and 53 (76%) were white. Their median left ventricular ejection fraction was 41% . Median eGFR before CardioMEMS implantation decreased from 61 to 48 [30-64] ml/ min/1.73 m 2 (P<0.001) but did not change after CardioMEMs implantation (44 [30-67] ml/min/1.73 m 2 , P=0.17). Annualized rate of eGFR change was -6.1 [-18.6 to 2.2] ml/min/1.73 m 2 before vs -1.1 [-9.6 to 4.0] ml/min/1.73 m 2 after CardioMEMS (P=0.046). This difference was more pronounced among patients <74 years (P=0.009), with left ventricular ejection fraction 50% (P=0.039), RA pressure <10 mmHg (P=0.022), eGFR 60 (P=0.015), diabetes (P=0.019), not receiving ACE/ARB (P=0.025) and not receiving aldosterone antagonists (P=0.045). Conclusions: Decline in kidney function slows down after the maintenance of euvolemia with pulmonary artery pressure-guided therapy of heart failure.Background: In recent years, there has been an emphasis on multidisciplinary team (MDT) care of the heart failure (HF) patient. A dedicated HF MDT was created on the 1 st of January 2017 at Cleveland Clinic Abu Dhabi; consisting of HF cardiologists, clinical pharmacists and HF nurses. This study aims to assess the impact of a dedicated HF MDT on the mortality, length of stay and readmission rate in patients who are admitted with acute HF decompensation. Methods: A retrospective review of the patients' charts was conducted. We identified patients who were admitted for acute exacerbation of HF between the years 2015 and 2017. Group 1 consisted of 90 patients who were admitted prior to the creation of the HF MDT, while Group 2 consisted of 94 patients who were admitted after the establishment of the team. The groups were propensity-matched in order to account for any confounding variables between the two patient populations. Results: Table 1 shows the baseline characteristics on admission of patients in both Group 1 and Group 2. The majority of patients in both groups had HFrEF. There were no significant differences between the two groups in terms of the baseline characteristics outlined. Table 2 highlights the differences in outcom...