Atrial fibrillation occurs frequently after open-heart surgery. It is associated with increased morbidity and mortality, longer hospital stays, and increased healthcare costs. Prophylactic administration of colchicine may mitigate post-operative atrial fibrillation (POAF). We searched PubMed, ClinicalTrials.gov and CENTRAL databases to identify randomized controlled trials (RCTs) that; (1) compared prophylactic use of colchicine to placebo, or usual care, in patients with sinus rhythm who underwent elective open-heart surgery and (2) reported POAF-incidence. We excluded trials focused on incidence of atrial fibrillation after percutaneous interventions or colchicine treatment of diagnosed pericarditis or post-pericardiotomy-syndrome. A random-effects model was used to pool data for POAF-incidence as the primary outcome and for drug-related adverse effects, major adverse events (death and stroke), and hospital length-of-stay as secondary outcomes. We included five RCTs (1412 patients). Colchicine treatment reduced POAF-events by 30% versus placebo or usual care (18% vs. 27%, risk ratio (RR) 0.69, 95% confidence interval (CI) 0.57 to 0.84, p=0.0002). Adverse drug-related effects, especially gastrointestinal intolerance, increased with colchicine; (21% vs. 8.2%, RR 2.52, 95% CI 1.62 to 3.93, p<0.0001). However, major adverse events were unchanged (3.2% vs. 3.2%, RR 0.96, 95% CI 0.48 to 1.95, p=0.92). Length-of-stay decreased by 1.2days with colchicine (95% CI -1.89 to -0.44, p=0.002). Colchicine demonstrated superior efficacy versus usual care for prevention of atrial fibrillation after cardiac surgery. Moreover, colchicine treatment was associated with shorter hospital stays. These benefits outweigh increased risk of adverse drug-related effects; although further work is needed to minimize gastrointestinal effects.

European Society of Cardiology (ESC) clinical practice guidelines are currently considered as an essential tool supporting many cardiologists in clinical decision-making not only in Europe but all-over the world. In this study we analyzed these recommendations regarding their class of recommendations (COR) and level of evidence (LOE) to detect how solid is the scientific background behind these recommendations. We have abstracted all the current guidelines defined as “the guidelines available on the ESC website by 01 October 2022”. All recommendations were classified according to their COR (Class I, IIa, IIb, or III) and LOE (A, B, or C). As every topic has different number of recommendations, we have used the median values in comparisons between different topics to give all the topics the same weight. Current ESC guidelines consist of 37 clinical topics including a total of 4289 recommendations. Their distribution was 2140 with a median of 49.9% in Class I, Class II and Class III were 1825 with a median of 42.6% and 324 with a median of 7.5% respectively. LOE A was only present in 667(15.5%) recommendations, 1285(30%) in LOE B, while LOE C was behind the majority of the recommendations, 2337 with a median of 54.5%. Although ESC guidelines are considered a gold standard for management of cardiovascular diseases, but surprisingly more than half of its recommendations are based on such scientific evidence. Deficiency in clinical trials is not the same across all guideline’s topics, some are needier for clinical research.

Advanced Cardiovascular Life Support (ACLS) guidelines recommend intravenous (IV) and intraosseous (IO) epinephrine as a basic cornerstone in the resuscitation process. Data about the efficacy and safety of intracoronary (IC) epinephrine during cardiac arrest in the catheterization laboratory are lacking. To examine the efficacy and safety of IC vs. IV epinephrine for resuscitation during cardiac arrest in the catheterization laboratory. This is a prospective observational study that included all patients who experienced cardiac arrest in the cath lab at two tertiary centres in Egypt from January 2015 to July 2022. Patients were divided into two groups according to the route of epinephrine given; IC vs. IV. The primary outcome was survival to hospital discharge. Secondary outcomes included rate of return of spontaneous circulation (ROSC), time-to-ROSC, and favourable neurological outcome at discharge defined as modified Rankin Scale (MRS) <3. A total of 162 patients met our inclusion criteria, mean age (60.69 ± 9.61), 34.6% women. Of them, 52 patients received IC epinephrine, and 110 patients received IV epinephrine as part of the resuscitation. Survival to hospital discharge was significantly higher in the IC epinephrine group (84.62% vs. 53.64%, P < 0.001) compared with the IV epinephrine group. The rate of ROSC was higher in the IC epinephrine group (94.23% vs. 70%, P < 0.001) and achieved in a shorter time (2.6 ± 1.97 min vs. 6.8 ± 2.11 min, P < 0.0001) compared with the IV group. Similarly, favourable neurological outcomes were more common in the IC epinephrine group (76.92% vs. 47.27%, P < 0.001) compared with the IV epinephrine group. In this observational study, IC epinephrine during cardiac arrest in the cath lab appeared to be safe and may be associated with improved outcomes compared with the IV route. Larger randomized studies are encouraged to confirm these results.

Background: In primary percutaneous coronary intervention (pPCI), balloon predilation is frequently carried out before stenting but there is a lack of data regarding optimal balloon size and the effect of balloon size on procedural and clinical outcomes. Aims: This study compares small balloon predilation (≤50% of proximal vessel diameter) with large balloon predilation (>50% of proximal vessel diameter) in pPCI. Methods: This multicentre prospective observational study included consecutive ST elevation MI (STEMI) patients undergoing pPCI at three tertiary centres in Egypt. Demographic, clinical and angiographic data were collected for all the patients. The primary outcome was the presence of no reflow at the conclusion of the procedure and secondary outcomes included procedural complications – no reflow, dissection, abrupt vessel closure, fluoroscopy time and procedural time – and clinical outcomes – in-hospital left ventricular ejection fraction (LVEF), cardiogenic shock, stent thrombosis, ventricular fibrillation, stroke, death, ST-segment resolution >50% 1 hour after PCI and LVEF at discharge. Results: A total of 384 pPCI procedures were included. The small balloon group (n=222) and the large balloon group (n=162) were comparable in terms of baseline characteristics. The large balloon group had a significantly higher incidence of no reflow (n=23 [14.2%] versus n=6 [2.7%], p<0.001), procedural complications: n=31 [19.4%] versus n=10 [4.5%], p50% after PCI was more frequent in the small balloon group (n=182 [81.98%] versus n=109 [67.28%], p<0.001). Conclusion: This study suggests that using a smaller balloon size for predilation in pPCI is associated with improved coronary flow, reduced procedural complications and better ST-segment resolution.

Background: The widespread use of social media among university students raises critical questions about its cognitive implications. While existing literature has explored psychological outcomes, few studies have investigated the direct relationship between social media screen time and standardized measures of intelligence. Objectives: This study aimed to evaluate the correlation between daily social media screen time and intelligence quotient (IQ) scores among Egyptian undergraduate students, while considering related academic and behavioral factors. Methods: A cross-sectional study was conducted from December 2023 to May 2024 involving 303 undergraduate students aged 18-24 years across multiple universities in Egypt. Participants completed an online survey capturing sociodemographic data, GPA, self-reported screen time, and a validated 20-item IQ assessment. Pearson’s correlation coefficient was used to assess the relationship between screen time and IQ. Results: Participants reported a mean daily screen time of 6.1 ± 3.1 hours and an average IQ of 117.8 ± 19.5. A statistically significant inverse correlation was observed between social media screen time and IQ scores (r = -0.12, p = 0.037). Additionally, a substantial proportion of students reported frequent distraction, memory lapses, and distress related to phone use, with over 46% identifying themselves as phone dependent. Conclusion: This study identifies a modest but statistically significant negative association between social media screen time and IQ among undergraduates. These findings underscore the potential cognitive costs of excessive digital engagement and support the integration of digital wellness education into university curricula.

Background: Contrast-induced nephropathy (CIN) remains a significant and potentially preventable complication following percutaneous coronary intervention (PCI), linked to increased morbidity, prolonged hospitalization, and higher mortality. Existing risk scores such as CHA₂DS₂-VASc and the Mehran Risk Score (MRS) fail to capture the full spectrum of risk factors.Objective: To develop and validate the MENT Score (Multifactorial Evaluation for Nephropathy after Transcatheter Intervention), a streamlined predictive model that integrates key clinical and procedural variables from CHA₂DS₂-VASc, MRS, and PCI urgency.Methods: In this prospective study, 1000 consecutive PCI patients were enrolled—500 for derivation and 500 for validation. CIN was defined as a ≥25% or ≥0.5 mg/dL rise in serum creatinine within 48 hours post-procedure. Variables from established risk models and PCI-related factors were assessed through multivariable logistic regression.Results: Six independent predictors were incorporated into the MENT Score: female sex (p=0.009), diabetes mellitus (p=0.002), peripheral arterial disease (p=0.021), contrast volume ≥200 mL (p=0.060), systolic blood pressure ≤80 mmHg or inotrope use (p=0.0005), and baseline serum creatinine >1.5 mg/dL (p=0.043). A score >3 yielded strong discriminatory power:Derivation cohort: AUC = 0.770, sensitivity = 52.5%, specificity = 91.6%, accuracy = 82.4% Validation cohort: AUC = 0.861, outperforming MRS (0.76) and CHA₂DS₂-VASc (0.71) Conclusion: The MENT Score offers a concise, clinically relevant tool for early CIN risk stratification in PCI patients. Its superior predictive accuracy and ease of use make it a promising alternative to existing models, with potential to guide targeted preventive strategies.