Abstract Background Patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI) are at an elevated risk of bleeding and adverse cardiovascular events due to dual-antiplatelet therapy (DAPT). Limited data exist on the safety of DAPT in this subset of patients. Methods This single-centre prospective cohort study was conducted at SMS Medical College, Jaipur, India, over 12 months (March 2024–March 2025). A total of 368 patients with baseline (pre-PCI) thrombocytopenia who underwent elective or emergency PCI while on DAPT were enrolled. DAPT comprised aspirin plus a P2Y12 inhibitor: clopidogrel in 317 patients (86.1%), ticagrelor in 48 (13.0%), and prasugrel in 3 (0.8%), with the choice based on clinician discretion; the distribution did not differ significantly across thrombocytopenia grades (p = 0.204). DAPT was generally maintained for 6–12 months per institutional protocol, without a standardized de-escalation strategy. Thrombocytopenia was classified based on pre-procedural platelet counts as mild (100,000–150,000/mm³; n = 237, 64.4%), moderate (50,000–100,000/mm³; n = 104, 28.2%), or severe (30,000–50,000/mm³; n = 27, 7.3%). The primary outcomes were major adverse cardiovascular events (MACE), defined as a composite of total death, myocardial infarction (MI), coronary revascularization, stroke, and hospitalization due to heart failure; and bleeding events assessed using Bleeding Academic Research Consortium (BARC) criteria. Secondary outcomes included in-hospital mortality, stent thrombosis, target vessel revascularization, and post-PCI MI. Follow-up was conducted at 1, 2, and 6 months post-PCI. Multivariate logistic regression was used to adjust for confounders across three sequential models (demographics; clinical variables; procedural outcomes). Results Severe thrombocytopenia independently predicted higher risks for MACE (HR: 2.30, CI: 1.89–2.81) and bleeding (HR: 2.88, CI: 2.37–3.49) across all models. Mild thrombocytopenia showed no significant risk after adjustment for confounders. Patients with moderate thrombocytopenia demonstrated consistent risks for both outcomes. Smoking and history of PCI/MI significantly correlated with thrombocytopenia severity (p < 0.01). Conclusion Moderate and severe thrombocytopenia are independently associated with increased risks of bleeding and cardiovascular events in patients on DAPT post-PCI. These observational findings support the incorporation of thrombocytopenia severity into existing risk stratification frameworks; however, as this study did not evaluate alternative management strategies, prospective randomized trials are needed to determine whether modified antiplatelet regimens can improve outcomes in this high-risk population.
This review examines the bidirectional relationship between the gut microbiota and cardiovascular diseases (CVDs), aiming to understand how microbial dysbiosis contributes to CVDs, including atherosclerosis, hypertension, and heart failure. Recent research emphasizes the gut microbiota's role in modulating immunity via SCFAs and tryptophan metabolites, maintaining intestinal barrier integrity, and producing metabolites such as SCFAs (acetate, propionate, butyrate) and pro-atherogenic TMAO. Dietary patterns, particularly the Mediterranean versus Western diet, significantly influence gut microbiota composition and CVD risk. Polyphenols and exercise have shown positive effects on gut microbiota and cardiovascular outcomes. A significant interplay exists between gut microbiota and cardiovascular health. Dysbiosis and metabolites like TMAO and LPS are implicated in CVD, while SCFAs and a balanced microbiota offer protection. Future research should focus on precision medicine, next-gen probiotics, optimized FMT, and multiomics approaches to identify personalized CVD therapies.
B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T-cell therapy has revolutionized treatment for heavily pretreated multiple myeloma, achieving unprecedented response rates in patients with otherwise dismal outcomes. However, the vast majority of patients eventually relapse due to complex resistance mechanisms. These include antigen-dependent escape-such as loss of the BCMA target through genetic deletion, epitope-level mutation, or antigen downregulation via shedding and trogocytosis-as well as antigen-independent tumor adaptations like clonal evolution and lineage plasticity that allow myeloma cells to evade immune clearance despite retaining BCMA. In addition, intrinsic CAR T-cell dysfunction (poor expansion, early exhaustion, and limited persistence) and an immunosuppressive bone marrow microenvironment (enriched in regulatory T cells, myeloid-derived suppressor cells, inhibitory cytokines, and physical sanctuary sites) critically limit long-term efficacy. We propose an integrated framework linking resistance biology to clinical relapse patterns. Finally, we review emerging strategies to overcome resistance, including dual-targeted CAR T-cell designs, enhanced CAR T engineering for improved fitness and persistence, combination approaches to boost antigen density, and novel salvage therapies targeting alternative antigens. These advancements lay the groundwork for more durable remissions and personalized immunotherapeutic interventions in multiple myeloma.
Social media use is nearly universal among adolescents and has become a prominent focus of concern regarding its potential impact on mental health. The aim of this narrative review is to synthesize and critically evaluate the evidence on the relationship between social media use and adolescent mental health, with particular attention to risk pathways, protective factors, underlying mechanisms, moderating variables, and intervention strategies. Existing research suggests that social media may function as both a risk factor and a source of support, depending on patterns of use, individual vulnerability, and contextual influences. A narrative review of the literature was conducted using PubMed, Google Scholar, and PsycINFO to identify peer-reviewed articles published between 2007 and 2025. Search terms included social media, adolescents, mental health, depression, anxiety, sleep, cyberbullying, body image, problematic use, and digital interventions. Systematic reviews, meta-analyses, longitudinal studies, experimental trials, and high-quality observational studies were prioritized, and findings were synthesized thematically. Social media influences adolescent mental health through multiple risk and protective pathways, with modest individual-level effects but meaningful population-level relevance due to widespread use during a sensitive developmental period. Outcomes are shaped by psychological mechanisms, moderating factors, and patterns of engagement, while emerging multilevel interventions show promise in reducing harm and enhancing benefits. Overall, social media is not inherently harmful to adolescent mental health; rather, its impact depends on how, why, and in what context it is used, underscoring the need for nuanced, developmentally informed, and multilevel approaches.
Abstract Background We aim to investigate the association between Takotsubo cardiomyopathy (TCM) and study the gender differences in clinical outcomes. Methods We reviewed 120 cases of Takotsubo syndrome in patients admitted between 2017 and 2022. Demographic data, comorbidities, and hospitalization-related objective parameters were collected through a retrospective chart review. Our primary focus was to examine gender differences in clinical characteristics and outcomes. The clinical outcomes of interest included cardiogenic shock, defined as an LVOT VTI of less than 15 cm or the requirement for two or more vasopressor infusions, as well as the need for invasive mechanical ventilation, length of hospitalization, and all-cause mortality at 30 days. Results A total of 120 patients with Takotsubo cardiomyopathy (TCM) were included in the study, of whom 112 (93%) were female. Among these, 9 patients (7.5%) developed TCM in the setting of septic shock, with diabetes being the most common risk factor in this subgroup, affecting 66% of patients. Demographic summary and clinical characteristics are summarized in Table 1. All-cause mortality was significantly higher among females (95% CI: -0.067 to 0.712, p = 0.0021). The need for mechanical ventilation was also greater in females (95% CI: 0.064 to 0.76, p = 0.015). However, there was no significant difference between groups in the incidence of cardiogenic shock (95% CI: 0.11 to 0.76, p = 0.15). Clinical outcomes are summarized in Table 2. Discussion Takotsubo cardiomyopathy (TCM) was more prevalent among females, with a quarter of cases occurring in critically ill patients in the ICU. This underscores the importance of critical care echocardiography in elucidating the underlying pathophysiology and guiding resuscitation efforts. Females had a higher risk of all-cause mortality and a greater need for mechanical ventilation; however, our findings may be limited by statistical power. We emphasize the need for larger prospective studies to better delineate gender differences in the clinical outcomes of Takotsubo cardiomyopathy. This abstract is funded by: NA
