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Nearly 7% of the world’s population lives with a hemoglobin variant. Hemoglobins S, C, and E are the most common and significant hemoglobin variants worldwide. Sickle cell disease, caused by hemoglobin S, is highly prevalent in sub-Saharan Africa and in tribal populations of Central India. Hemoglobin C is common in West Africa, and hemoglobin E is common in Southeast Asia. Screening for significant hemoglobin disorders is not currently feasible in many low-income countries with the high disease burden. Lack of early diagnosis leads to preventable high morbidity and mortality in children born with hemoglobin variants in low-resource settings. Here, we describe HemeChip, the first miniaturized, paper-based, microchip electrophoresis platform for identifying the most common hemoglobin variants easily and affordably at the point-of-care in low-resource settings. HemeChip test works with a drop of blood. HemeChip system guides the user step-by-step through the test procedure with animated on-screen instructions. Hemoglobin identification and quantification is automatically performed, and hemoglobin types and percentages are displayed in an easily understandable, objective way. We show the feasibility and high accuracy of HemeChip via testing 768 subjects by clinical sites in the United States, Central India, sub-Saharan Africa, and Southeast Asia. Validation studies include hemoglobin E testing in Bangkok, Thailand, and hemoglobin S testing in Chhattisgarh, India, and in Kano, Nigeria, where the sickle cell disease burden is the highest in the world. Tests were performed by local users, including healthcare workers and clinical laboratory personnel. Study design, methods, and results are presented according to the Standards for Reporting Diagnostic Accuracy (STARD). HemeChip correctly identified all subjects with hemoglobin S, C, and E variants with 100% sensitivity, and displayed an overall diagnostic accuracy of 98.4% in comparison to reference standard methods. HemeChip is a versatile, mass-producible microchip electrophoresis platform that addresses a major unmet need of decentralized hemoglobin analysis in resource-limited settings.

Graphical abstract, Highlights • Three-dimensional TEE adds value in diagnosing IE in bioprosthetic valves. • Bioprosthetic valve IE resolves with appropriate antibiotic therapy. • Misdiagnosis of IE can lead to inappropriate treatment and lethal complications.

Echocardiography is the most common imaging modality for assessment of the right ventricle in patients with pulmonary arterial hypertension (PAH). Echocardiographic parameters were identified as independent risk factors for mortality in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) and other PAH cohorts. We sought to identify readily obtained echocardiographic features associated with PAH survival.Retrospective analysis of 175 patients with Group 1 was performed. Baseline clinical and laboratory assessment including REVEAL risk criteria were obtained and standard 2-Dimensional and Doppler echocardiography performed at baseline was reviewed. Univariate and multivariate analyses of echocardiographic parameters were performed. Estimated right atrial pressure15 mmHg (HR 2.39, P = .02), tricuspid regurgitation ≥ moderate (HR 2.16, P = .04), and presence of pericardial effusion (HR 1.8, P = .05) were identified as independent, high-risk echocardiographic features in PAH. A validation cohort of 677 patients was identified and Kaplan-Meier survival analysis was performed in both cohorts. High-risk echocardiographic features stratified survival curves of both cohorts (P.01 for all). The presence of 3 high-risk echocardiographic features greatly increased risk of 1-year (RR 4.86) and 3-year (RR 3.35) mortality (P.05 for both).Estimated right atrial pressure15, tricuspid regurgitation ≥ moderate, and presence of pericardial effusion are high-risk echocardiographic features in PAH. When seen in combination, these features greatly increase risk of mortality in PAH and may lead to more timely enhanced therapy for patients identified as having an increased risk for death.

Purpose Since the 2018 UNOS Allocation system for heart transplantation change there has been concern for increased wait times for patients with durable left ventricular assist devices (LVAD) as bridge to transplantation (BTT). Furthermore, there are increasing trends to utilize axillary intra-aortic balloon pumps (Ax-IABP) to optimize cardiac unloading while maintaining ambulatory status in listed hospitalized patients. BTT outcomes data for Ax-IABP patients is limited. Understanding risks vs benefits of prolonged support with Ax-IABP vs LVAD in the current UNOS allocation environment is imperative. Methods We performed a single center retrospective review from October 18, 2017 to October 18, 2019 for all patients who underwent heart transplant. Waitlist times based on device (Ax-IABP or LVAD) to transplant were assessed in addition to time from transplant to discharge. Intraoperative cardiopulmonary bypass time, transfusion requirements and post-operative vasoactive support was also compared. Results 59 heart transplants occurred during our review period. 8 bridged with Ax-IABP (13%) and 22 with LVAD (37%). Average age in both groups was 53 with 75% and 68% males in the IABP and LVAD groups respectively. More LVAD as BTT were transplanted prior to the UNOS change (13 vs. 9). All Ax-IABP patients were transplanted after the UNOS change. Waitlist time for LVAD was higher than Ax-IABP patients (109d vs. 575d, p=0.0003). Waitlist time before and after UNOS change was not statistically different among LVAD patients, but did increase (497d vs 688d, p=0.176). Cardiopulmonary bypass time was longer in LVAD patients, but not significant, despite similar UNOS Status at transplant. More PRBC transfusions in the LVAD group (7.5u, IQR 0u - 24u) compared to the Ax-IABP group (2.6u, IQR 0u - 6u, p=0.0012). Time from transplant to discharge was 25 days for LVAD group and 13 for Ax-IABP group (p=0.075). Conclusion Waitlist time and transfusion requirements are statistically increased in LVAD as compared to Ax-IABP as BTT. In the current listing schema for heart transplant, risk vs. benefit of increased waiting time, perioperative hemodynamic compromise and increased transfusions in the LVAD population pose significant concerns. Further prospective studies with larger cohorts may be needed to better evaluate this trend.

Right heart failure (RHF) is routinely overlooked during the resuscitation of cardiogenic shock and is common after left ventricular assist device (LVAD) placement. RHF leads to downstream effects of escalating vasoactive support, thereby increasing the release of cytokines. RHF can result in

In recent years, several novel anticoagulants have been approved for the prevention of thromboembolic strokes as an alternative to warfarin in patients with atrial arrhythmias. Studies have evaluated these medications in patients undergoing radiofrequency ablation, yet no data exists to evaluate the bleeding risk in patients undergoing cryoballoon ablation procedures. Patients that underwent either cryoballoon ablation alone or with additional radiofrequency ablation over the past 3 years were included in the study. Patients were stratified into one of three subsets based on type of anticoagulation (warfarin, dabigatran, or rivaroxaban). Bleeding complications during the first 48 h and first 2 weeks following the ablation were recorded. Major complications were defined as hemorrhage requiring blood products or need for vascular intervention. Minor complications included prolonged bleeding from catheter insertion site, development of ecchymosis, or hematoma formation. Intraprocedural activated clotting times (ACT) were assessed and compared. A total of 217 patients met inclusion criteria of which 87 (40.1 %) patients were on warfarin, 90 (41.5 %) patients on dabigatran, and 40 (18.4 %) patients on rivaroxaban. The overall bleeding complication rate was 12.0 %. All complications occurred within the first 48 h post-ablation. Nine (10.3 %) complications occurred in the warfarin subset, ten (11.1 %) in the rivaroxaban subset, and seven (17.5 %) in the dabigatran subset (p = 0.49). The warfarin and dabigatran subsets had higher average ACT levels (424.9 versus 406.5) compared to the rivaroxaban subset (393.4; p

Sickle Cell Disease (SCD) affects 100,000 Americans and more than 14 million people globally, mostly in economically disadvantaged populations, and requires early diagnosis after birth and constant monitoring throughout the life-span of the patient. Areas covered: Early diagnosis of SCD still remains a challenge in preventing childhood mortality in the developing world due to requirements of skilled personnel and high-cost of currently available modalities. On the other hand, SCD monitoring presents insurmountable challenges due to heterogeneities among patient populations, as well as in the same individual longitudinally. Here, we describe emerging point-of-care micro/nano platform technologies for SCD screening and monitoring, and critically discuss current state of the art, potential challenges associated with these technologies, and future directions. Expert commentary: Recently developed microtechnologies offer simple, rapid, and affordable screening of SCD and have the potential to facilitate universal screening in resource-limited settings and developing countries. On the other hand, monitoring of SCD is more complicated compared to diagnosis and requires comprehensive validation of efficacy. Early use of novel microdevices for patient monitoring might come in especially handy in new clinical trial designs of emerging therapies.