BACKGROUND:In patients with coronary artery disease, diabetes increases the risk of restenosis and adverse cardiovascular events after percutaneous coronary intervention (PCI). The Abluminus DES+ is a thin-strut cobalt-chromium sirolimus-eluting stent (SES) with abluminal and balloon-surface coating intended to enhance drug delivery to the vessel wall. We aimed to compare the efficacy and safety of the Abluminus DES+ SES versus the XIENCE durable-polymer everolimus-eluting stent (EES) in patients with diabetes undergoing PCI. METHODS:ABILITY Diabetes Global was a multicentre, prospective, open-label, randomised controlled trial conducted at 74 sites in 16 countries. Adults (aged ≥18 years) with type 1 or type 2 diabetes undergoing PCI for at least one de novo coronary lesion due to chronic coronary syndrome or non-ST-elevation acute coronary syndrome were eligible. Patients were randomly assigned (1:1) to the Abluminus DES+ SES or the XIENCE EES. Randomisation was stratified by site using a secure web-based system with concealed allocation and randomly varying block sizes (4, 6, and 8). Operators were unmasked to allocation; staff performing clinical follow-up and the independent clinical events committee were masked. For the Abluminus DES+ SES, a balloon inflation time of at least 45 s was recommended to facilitate drug transfer; dual antiplatelet therapy was prescribed to all patients according to clinical guidelines and local practice. The primary hypothesis of the study was the non-inferiority of the Abluminus DES+ SES compared with the XIENCE EES for the two coprimary endpoints at 12 months (in the per-protocol population): ischaemia-driven target-lesion revascularisation (2·8% non-inferiority margin) and target-lesion failure (3·0% margin), defined as a composite of cardiovascular death, target-vessel myocardial infarction, or ischaemia-driven target-lesion revascularisation. Time-to-event analyses were conducted with Kaplan-Meier estimates and Cox proportional hazards models. This trial is registered with ClinicalTrials.gov (NCT04236609) and is complete. FINDINGS:Between June 12, 2020, and Sept 9, 2022, 3032 patients were randomly assigned to the Abluminus DES+ SES (n=1514) or XIENCE EES (n=1518). 2931 (96·7%) of 3032 patients completed follow-up to death or 24-month follow-up. Median age was 68·0 years (IQR 60-74). 879 (29·0%) of 3032 patients were female and 2153 (71·0%) were male. At 12 months, in the per-protocol analysis, the Abluminus DES+ SES did not meet the criteria for non-inferiority for ischaemia-driven target-lesion revascularisation compared with XIENCE EES (67 of 1421 patients [Kaplan-Meier estimate 4·8%, 95% CI 3·9-6·2] vs 30 of 1446 [2·1%, 95% CI 1·6-3·2]; absolute risk difference 2·7%, 95% CI 1·3-4·1; pnon-inferiority=0·44) and target lesion failure (137 [9·7%, 8·4-11·5] vs 89 [6·2%, 5·3-7·8]; 3·5%, 1·5-5·5; pnon-inferiority=0·68). For both endpoints, the lower bound of the 95% CI for the absolute risk difference excluded zero. Target-vessel myocardial infarction occurred more frequently in the Abluminus DES+ SES group (73 of 1421 patients [Kaplan-Meier estimate 5·2%, 95% CI 4·1-6·5] vs 44 of 1446 patients [3·1%, 2·4-4·3]) but there were no significant differences in cardiovascular death (41 of 1421 patients [2·9%, 2·1-3·9] vs 30 of 1446 patients [2·1%, 1·5-3·0]) and all-cause death (52 of 1421 patients [3·7%, 2·8-4·8] vs 48 of 1446 patients [3·3%, 2·5-4·4]). Results were consistent at 24 months in the intention-to-treat analysis, however no significant differences were observed between the two groups in landmark analyses between 12 and 24 months. INTERPRETATION:In patients with diabetes undergoing PCI, the Abluminus DES+ SES was not non-inferior to the XIENCE EES, resulting in higher rates of ischaemia-driven target-lesion revascularisation and target lesion failure at 12-month follow-up. Event rates between 12 and 24 months were similar between groups. These findings highlight the persistent challenge of optimising outcomes in patients with diabetes and underscore the need for continued innovation in stent design and adjunctive pharmacotherapy to reduce residual ischaemic risk in this population. FUNDING:Concept Medical.
Abstract The May Measurement Month (MMM) campaign was conducted in Bangladesh in 2023 to raise awareness of raised blood pressure (BP). Adults aged ≥ 18 years were recruited through convenience sampling at 600 screening sites in 64 districts in Bangladesh. Three seated BP readings were taken in each participant, and a questionnaire collected information on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or being on BP-lowering medication. Controlled BP was defined as being on BP-lowering medication with a BP <140/90 mmHg. Multiple imputation was used to estimate missing BP readings. In total, 25,185 were screened, with a mean age of 46.9 years and 53.1% of whom were female. Of all participants, 12,974 (51.5%) had hypertension, of whom 10,708 (82.5%) were aware, and 10,219 (78.8%) were on antihypertensive medication. Of those on antihypertensive medication, 5495 (53.8%) had controlled BP, and of all participants with hypertension, 42.4% had controlled BP. The MMM campaign in Bangladesh identified a substantial number of participants with untreated or inadequately treated hypertension. Opportunistic BP screening can detect a considerable proportion of individuals with unrecognised and inadequately treated hypertension, thereby supporting early intervention and contributing to the prevention of cardiovascular diseases.
Objectives:This systematic review aimed to identify culturally adapted lifestyle intervention packages and evaluate their effectiveness in reducing blood pressure across diverse populations. The focus was on interventions incorporating dietary, physical activity, and behavioral components within culturally relevant contexts. Study design:Systematic review of literature. Methods:A comprehensive systematic review search was conducted across PubMed, CINAHL, Scopus, Embase, and the Cochrane Library from March 5 to 11, 2024, covering studies published from 1995 to 2024, per the registered PROSPERO protocol. Search strategies targeted three key concepts: blood pressure, cultural adaptation, and lifestyle interventions, with cultural adaptation defined as any change made to the intervention's content, delivery, or materials to take into account the language, dietary patterns, social or societal norms, or community structures of the target group. Reference lists of included articles and relevant reviews were manually screened and explored. All studies were assessed using predefined inclusion and exclusion criteria to ensure methodological rigor and relevance. Results:Thirty-two studies involving 21,990 participants aged 18-95 years were included. Sample sizes ranged from 19 to 10,741, with most studies enrolling both sexes. Most interventions reported significant reductions in systolic and/or diastolic blood pressure. Multi-component interventions combining dietary modification, physical activity, and behavioral education were consistently effective. Culturally tailored programs, particularly group-based interventions with longer duration and follow-up, showed sustained improvements; certainty of evidence, assessed using GRADE, was moderate for dietary interventions but very low for behavioral/educational and exercise-based interventions, reflecting variation between studies and the predominance of data from high-income countries. Conclusions:Culturally adapted lifestyle interventions are effective, feasible, and sustainable strategies for lowering blood pressure. Multi-component approaches that integrate dietary, physical, and behavioral elements, particularly when culturally contextualized and community-based, offer practical, non-pharmacological options for hypertension management across diverse populations.
Background Timely detection, prevention, and response to infectious diseases are essential for enhancing quality of life, societal well-being, and reducing healthcare costs. Advanced diagnostics like reverse transcription polymerase chain reaction (RT-PCR) improve accuracy, mitigate suffering, limit transmission, and decrease mortality. This study evaluated utility of RT-PCR for detecting infectious agents, including Nontuberculous mycobacteria (NTM), to guide clinical decision-making. Methods This retrospective study analyzed infectious disease data from Apollo Imperial Hospitals Ltd., Chattogram, Bangladesh from June 2019 to July 2024. Of 810 anonymized records extracted from the molecular biology laboratory, 786 samples with complete diagnostic information undergoing RT-PCR testing were included after excluding incomplete entries. As a hospital-based analysis, no eligible cases were overlooked beyond incomplete records. Results Among 786 patients (mean age 38.8 ± 19.3 years), 53.7% were female, and 87.1% were adults or elderly. Samples comprised blood (31.6%), tissue (27.2%), body fluids (19.3%), swabs (8.1%), sputum (6.1%), pus (4.8%), and urine (2.8%). Mycobacteria were detected in 6.4% of samples, including Mycobacterium tuberculosis (MTB; 2.9%) and nontuberculous mycobacteria (NTM; 3.5%). Overall RT-PCR positivity was 12.7%. Associations between positivity and socio-demographic/clinical factors (e.g., gender, sample type, pathogen) were analyzed, revealing higher NTM than MTB rates, a concern for policymakers, in particular National Tuberculosis Program (NTP). Conclusions Rapid identification and treatment of infectious diseases are essential. NTM warrants particular attention due to symptom overlapping with tuberculosis. The NTP should prioritize accurate diagnostics and management to avert misdiagnosis and inappropriate therapy. Annual NTP and WHO reports should highlight NTM prevalence and challenges to inform policy.
Introduction: Stress among medical students is a global concern that affects their well-being, learning, and future professional performance. Although Bangladeshi studies have quantified stress prevalence and stressors, evidence on students' lived experiences, coping responses, and recommendations for well-being is limited. This study aimed to assess stress and stressors among medical undergraduates; explore stress experiences, contextual stressors, coping, and recommendations; and integrate quantitative and qualitative findings for institutional stress-reduction strategies. Methods A convergent mixed-methods study was conducted on medical students from one private (PrMC) and one public (PbMC) college in Dhaka, Bangladesh. The quantitative survey included 201 participants using proportionate stratified random sampling. Perceived stress and stressors were assessed using the Perceived Stress Scale-10 (PSS-10) and Medical Student Stressor Questionnaire (MSSQ-40). The qualitative component comprised six focus groups with 53 students from various academic phases. Quantitative data were analyzed using descriptive statistics, non-parametric tests, and multivariable regression, and qualitative data using reflexive thematic analysis. The findings were integrated using joint display and meta-inference. Results The mean PSS-10 score was 22.23 ± 6.19, with 70.6% and 24.4% of participants reporting moderate and high stress, respectively. Academic-related (mean = 2.252) and teaching- and learning-related stressors (mean = 2.024) were the highest-rated MSSQ-40 domains. Female sex and private medical college enrolment were independently associated with lower stress, whereas academic-related stressors were associated with higher stress (all p < 0.01). Qualitative analysis showed stress stemmed from interconnected academic, institutional, and social contexts, including workload, assessment pressure, unsupportive institutional practices, limited recreational and social infrastructure, and inadequate mental health services. Students described informal peer support as a lifeline. Although students employed both problem- and emotion-focused coping strategies, many perceived these responses as insufficient because organizational constraints limited their effectiveness. Students often see stress as inevitable in academia and endure it. Participants suggested refining curriculum, supportive faculty interactions, a better learning environment, and trustworthy mental health resources. Conclusion Medical students in Bangladesh experience moderate-to-high stress driven by academic, institutional and social contexts. Improving medical student well-being requires system-level reforms that address academic structures, institutional support, and learning environments rather than relying solely on individual resilience-focused approaches.
