Blockchain technology (BCT) has emerged in the last decade and added a lot of interest in the healthcare sector. The purpose of this systematic literature review (SLR) is to explore the potential paradigm shift in healthcare utilizing BCT. The study is compiled by reviewing research articles published in nine well-reputed venues such as IEEE Xplore, ACM Digital Library, Springs Link, Scopus, Taylor & Francis, Science Direct, PsycINFO, Ovid Medline, and MDPI between January 2016 to August 2021. A total of 1,192 research studies were identified out of which 51 articles were selected based on inclusion criteria for this SLR that presents the modern information on the recent implications and gaps in the use of BCT for enhancing the healthcare procedures. According to the outcomes, BCT is being applied to design the novel and advanced interventions to enrich the current protocol of managing, distributing, and processing clinical records and personal medical information. BCT is enduring the conceptual development in the healthcare domain, where it has summed up the substantial elements through better and enhanced efficiency, technological innovation, access control, data privacy, and security. A framework is developed to address the probable field where future researchers can add considerable value, such as data protection, system architecture, and regulatory compliance. Finally, this SLR concludes that the upcoming research can support the pervasive implementation of BCT to address the critical dilemmas related to health diagnostics, enhancing the patient healthcare process in remote monitoring or emergencies, data integrity, and avoiding fraud.

The prevalence of childhood obesity has increased over the years in the United States and contributed to a rise in metabolic syndrome and non-alcoholic fatty liver disease (NAFLD). Animal studies suggested the role of histamine blockade on mesenteric lymphatics tone, contributing to weight gain and hepatic steatosis. This study aimed to investigate an association between antihistamines (AH) use in children and obesity. A single-center retrospective cohort study on children with a diagnosis of NAFLD, followed in the gastroenterology clinic, was performed between January 2018 and April 2019. The demographics, medications, and body mass index (BMI) were assessed. Participants were divided into an AH group with documented use and comparison group, antihistamine naïve. Of the 32 participants in the study, 13 used AH, and 19 did not. Antihistamine users had a mean increase in BMI percentile per year of 1.17 compared to a decrease of 0.06 in comparison group (p = 0.0008). AH usage correlated with a mean increase in BMI z-score of 0.23 per year, as opposed to a decrease by 0.012 in comparison group (p = 0.0016). No difference was found in triglycerides (TG), glucose, and liver enzymes. AH use increases BMI percentiles and z-scores over time and is associated with obesity in children.

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A myocardial bridge is a congenital band of heart muscle that lies on top of a coronary artery, instead of underneath it. Part of a coronary artery dips into and underneath the heart muscle bridge, and then comes back out again. During systole, the bridge can tighten down on the artery, pinching it and decreasing the blood flow. CASE PRESENTATION: A 39-year-old presented with acute pulmonary edema after undergoing elective laparoscopic appendectomy. After surgery, he desaturated to 85%, along with hypotension and bradycardia. ECG showed normal sinus rhythm at 66 BPM with 1mm ST elevations in I, aVL, and V2-6. Troponin I was 2.85. Echocardiogram revealed low normal EF and lateral wall motion abnormalities. Coronary angiography (CA) showed EF 55% with distal LAD artery myocardial bridge (Figure 1). He was discharged on aspirin and beta-blocker. The second case was a 67-years-old female who was admitted for chest pain and found to have inferior wall NSTEMI. CA showed 99% stenosis of distal LCA with grade II flow. A stent was placed and she was discharged on aspirin, clopidogrel and statin. Nine days later, she presented with recurrent chest pain, dyspnea and fatigue. Vitals were stable and ECG was similar to that from prior discharge. A repeat CA showed patent LCA stent, with systolic compression of LAD artery. She did not require further intervention and was transferred to the telemetry unit where she remained chest pain free and hemodynamically stable for 48 hours. DISCUSSION: Although myocardial bridging is a systolic phenomenon, arterial compression with over 70% arterial lumen reduction can result in myocardial ischemia, arrhythmia, depressed LV function, myocardial stunning and SCD. Atherosclerosis preferentially develops immediately proximal to the bridged segment, possibly due to shear stress, while the compressed segment itself is often spared. It is therefore important to treat these patients with beta-blockers and antiplatelet therapy. Surgical myotomy, intracoronary stenting, and CABG have been used for refractory symptoms, but long-term outcomes remain uncertain. CONCLUSIONS: Physicians should be aware of myocardial bridge as an independent risk factor for coronary artery atherosclerosis.