The American International School of Medicine (AISM) is a private medical school with its main campus in Georgetown, Guyana and clinical campuses in Atlanta Georgia, clinical placements in United Kingdom, and training sites in Nigeria. Graduates obtain a Medical Doctorate upon successful completion of the four or five years of didactic education and training candidates earn the doctor of medicine degree to successfully exit the medical program.The AISM is chartered in and is recognized by the government of Guyana. AISM is registered with the National Accreditation Council of Guyana. The university is listed in the AVICENNA directory of medicine and the FAIMER International Medical Education Directory (IMED) and World Health Organization.
Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory condition and a major cause of morbidity and mortality. Atrial fibrillation (AF) is the most common chronic arrhythmia in patients with and without COPD, with numerous factors contributing to its development. These include hypoxemia, hypercapnia, hyperinflammation and changes in cardiac geometry and autonomic function. The presence of COPD is associated with an elevated risk of thromboembolic events, recurrence of atrial fibrillation after cardioversion, and increased all-cause mortality. Conversely, AF itself further increases the risk of mortality in patients with COPD. Medications employed in the COPD treatment may have deleterious effects on AF, while medications used to treat AF have the potential to exacerbate COPD. The majority of bronchodilator agents have been observed to increase heart rate and induce AF episodes. However, antimuscarinic agents appear to be better tolerated than β-receptor agonists in COPD. It is imperative that the AF treatment be tailored to the individual needs of patients with COPD. The efficacy and safety of AF catheter ablation in cases with COPD appears to be well-established. Further research is warranted to develop appropriate AF screening protocols in COPD patients, incorporating artificial intelligence and telemonitoring, as well as to establish COPD-specific tools for estimating thromboembolic risk. This narrative review comprehensively explores the complex relationship between COPD and AF, incorporating the latest evidence and offering novel insights and updated perspectives.
Background Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in the United States, with risk driven by the clustering of modifiable factors such as hypertension, diabetes, obesity, dyslipidemia, and smoking. Prescription pain medication use is common among adults with chronic conditions, yet its relationship with cardiovascular risk burden is not well-characterized. Objective The objective of this study is to evaluate the association between prescription pain medication use and cardiovascular risk burden among adults in the United States. Methods This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020 prepandemic cycle. Adults aged 18 years and older were included. The exposure was prescription pain medication use. The outcome was a composite cardiovascular risk burden score categorized into low, moderate, and high risk. Survey-weighted logistic regression was used to examine the association with high cardiovascular risk, adjusting for demographic and socioeconomic factors. The final analytic sample included 6,662 participants, corresponding to a weighted population of 195,893,244 US adults. Results Prescription pain medication use was associated with higher odds of high cardiovascular risk factor burden (adjusted odds ratio, 1.54; 95% confidence interval (CI), 1.15-2.07; p = 0.005). Increasing age was associated with higher odds (adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.03; p = 0.003). A higher income-to-poverty ratio was associated with lower odds (adjusted odds ratio, 0.92; 95% confidence interval, 0.85-0.99; p = 0.029). Physical activity was associated with lower odds (adjusted odds ratio, 0.53; 95% confidence interval, 0.39-0.74; p < 0.001). Conclusion Prescription pain medication use is associated with a higher cardiovascular risk factor burden among US adults. These findings support the need for integrated cardiovascular risk assessment in individuals receiving pain medications.
BACKGROUND:Effective and safe pain management is crucial for optimal recovery after cardiac surgery. Traditionally, opioids have been the mainstay for postoperative pain control, but their negative health effects have led to a recent shift toward multimodal analgesia to minimize opioid use. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been controversial owing to concerns about bleeding, acute kidney injury (AKI), graft patency, and cardiovascular risks. Despite these concerns, many perioperative teams continue to use NSAIDs alongside opioids as part of multimodal analgesia. This meta-analysis evaluated the efficacy and safety of NSAIDs as a multimodal pain management tool following cardiac surgery. METHODS:An electronic search was conducted on November 15, 2024, using PubMed, Scopus, Web of Science, Embase, and Cochrane databases. Only controlled trials that combined NSAIDs with opioids for pain management following cardiac surgeries were included. The primary outcome was the visual analog scale (VAS), a 0 to 10 scale measuring pain intensity assessed at 6, 12, 18, 24, and 48 hours. Total opioid consumption was measured at 6, 12, 24, and 48 hours. Secondary outcomes included myocardial infarction, atrial fibrillation, kidney function, gastrointestinal bleeding, nausea, and vomiting. The mean difference (MD) was used for continuous outcomes, and the odds ratio (OR) was used for dichotomous outcomes. A random-effects model was applied for the analysis. RESULTS:Out of the 1,194 articles screened, 11 articles, totaling 1,463 patients, were included in the meta-analysis. The NSAID group demonstrated significantly lower VAS scores at the 12-hour (MD, -1.19, 95% confidence interval [CI], -1.83 to -0.56; p < 0.001), 24-hour (MD, -0.61; 95% CI, -0.97 to -0.24; p = 0.001), 18-hour (MD, -1.43; 95% CI, -2.58 to -0.28; p = 0.01), and 48-hour (MD, -0.68; 95% CI, -0.87 to -0.49; p < 0.001) time points. However, no significant differences in VAS scores were observed at the 6-hour mark. Regarding opioid consumption, the NSAID group demonstrated significantly lower opioid consumption at the 24-hour (MD, -8.10; 95% CI, -10.60 to -5.61; p < 0.001) and 48-hour (MD, -7.13; 95% CI, -12.44 to -1.82; p = 0.009); however, no differences were observed at the 6-hour and 12-hour marks. Finally, there were no significant differences between the NSAID and control groups in the incidence of gastrointestinal bleeding, atrial fibrillation, myocardial infarction, or AKI. CONCLUSIONS:NSAID use was associated with modestly reduced VAS scores at 12, 18, 24, and 48 hours, while opioid consumption was significantly lower at 24 and 48 hours postoperatively. Short-term NSAID use can be effective in reducing pain and opioid requirements. Although no significant difference in complications was observed, the analysis was limited by small sample sizes. More extensive randomized controlled trials are needed to assess the effectiveness and safety of NSAIDs as part of a multimodal analgesic strategy.
Abstract Breast cancer is the leading cause of cancer-related mortality among women worldwide. The development of predictive biomarkers and immunologic markers has revolutionized breast cancer diagnosis and treatment, enabling personalized medicine approaches. This study aims to review the current status, challenges, and future directions of predictive and immunologic biomarkers in breast cancer. Predictive biomarkers such as HER2/neu expression, estrogen receptor (ER)/progesterone receptor (PR) status, and genomic signatures play a crucial role in treatment decisions, particularly for hormone receptor-positive and HER2-positive tumors. Immunologic markers, including PD-L1 expression, microsatellite instability (MSI), tumor mutational burden (TMB), and tumor-infiltrating lymphocytes (TILs), are essential for predicting responses to immunotherapy, especially in aggressive subtypes like triple-negative breast cancer (TNBC). However, challenges such as tumor heterogeneity, therapy resistance, and standardization of biomarker testing remain significant barriers. This study also explores emerging technologies like artificial intelligence (AI), genomic profiling, and liquid biopsy, which are expected to enhance precision medicine, improve early diagnosis, and optimize treatment strategies. The integration of these advanced molecular approaches holds great promise for improving patient outcomes and overcoming existing limitations in breast cancer management.
Asbestos still represents a major public health problem on a global scale. In Central Asia chrysotile is still mined and used, claiming that it is safer with respect to amphibole asbestos within certain concentrations. However, the problem of asbestos exposure in Central Asia and its consequences on human health have been poorly investigated. We analysed, for the first time, samples of raw and wrought material coming from one of the two asbestos-cement industries, currently active, located near the city of Bishkek, the capital of Kyrgyzstan, as well as air samples collected on different sites of Bishkek and Kant and lung tissues taken from the general population during clinical autopsies. Air samples have been analyzed using a scanning electron microscopy (SEM) equipped with energy dispersive spectroscopy (EDS). Heavy air asbestos pollution was detected in Kant (30.2 ff/L), while Bishkek had lower levels. Lung tissue analysis in the general population, carried out using both SEM and transmission electron microscopy (TEM) with EDS, revealed the presence of both chrysotile and amphibole asbestos. Such findings underline that, even in countries where the use of asbestos is allowed based on the presumed pureness of chrysotile used and the lower carcinogenic potential of chrysotile compared to amphibole asbestos, the general population could be exposed also to amphibole asbestos.
