Low-dose unfractionated heparin (LDUH) prophylaxis decreases the incidence of venous thromboembolism (VTE) in hospitalized patients, but increases the risk of bleeding events. Patients who develop a prolonged activated partial thromboplastin time (aPTT) while on LDUH may be at higher risk for bleeding complications. To determine the incidence and risk factors for aPTT prolongation in hospitalized patients receiving LDUH thromboprophylaxis, we performed a retrospective pharmacoepidemiologic cohort study of adult patients admitted to an academic medical center from September 2013 through September 2015. Among 3857 patients with at least one aPTT checked within 24 h of LDUH administration, aPTT prolongation > 1.5 times the upper limit of normal occurred in 131 (3.4%). Age 68-78 years (OR 1.6, 95% CI 1.01-2.4), age > 78 years (OR 1.9, 95% CI 1.3-2.9), female gender (OR 1.9, 95% CI 1.4-2.5), black race (OR 1.6, 95% CI 1.1-2.3), low BMI (OR 1.8, 95% CI 1.3-2.5), being admitted to a surgical service (OR 0.5, 95% CI 0.3-0.8), and receipt of high-dose (> 10,000 units in a day) unfractionated heparin prophylaxis (OR 1.4, 95% CI 1.003-2.0), were independently associated with aPTT prolongation after LDUH exposure. LDUH VTE prophylaxis is associated with aPTT prolongation in 3.4% of general hospitalized patients. We demonstrated several factors independently associated with aPTT prolongation. Monitoring aPTT levels may be indicated for select patients on LDUH thromboprophylaxis who are at high risk or consequence of bleeding and for aPTT prolongation.

Digitalization offers support and innovative approaches in the diagnosis and therapy of headaches. With the German digital health care act (Digitale-Versorgung-Gesetz) it is now possible to integrate this into regular care for the first time. However, it is currently difficult to assess the various offers; quality standards and conclusive studies to determine the efficacy and safety are missing.

Overview of current digital approaches in headache treatment and presentation of two specific examples (App M‑sense and DMKG headache registry).

Literature research, product information, and presentations by the project managers.

Most digital offers for headache treatment are currently headache calendars, mostly as asmartphone app. However, there are also promising extensions (e.g. trigger analysis) and new approaches such as digital instructions for relaxation and endurance sports, chatbots for patients, as well as support for doctors through structured collection of patient data and processing for diagnostic purposes.

Different digital approaches could support practitioners and patients effectively in headache treatment and therapy guidance in the near future. However, high-quality studies are necessary to evaluate their benefits and efficacy.

Different digital approaches could support practitioners and patients effectively in headache treatment and therapy guidance in the near future. However, QNZ NF-κB inhibitor -quality studies are necessary to evaluate their benefits and efficacy.Dental prosthesis laboratories (DPLs) are among the workplaces where predominantly manual production takes place. In such working environments, during the manual manufacturing process, which involves fine smoothing and polishing of dental prostheses, fine particulate matter is released into the ambient air. In this study, the particulate matter (PM) concentrations and elemental content of the fine particles in the working ambient air were identified in six DPLs in Kocaeli, Turkey. PM2.5 mass concentrations, measured in all the DPLs, ranged between 80.8 and 1645 μg/m3 (mean 414 ± 406). As a result of the analyses performed with an ICP-MS device (Perkin Elmer Elan®DRC-e), trace elements of Be, Cd, Hg, and, notably, Co, Cr, Mo, and Ni were found. The researchers calculated the excess lifetime cancer risks and total hazard indexes. The average total cancer risk for all the DPLs was 8 × 10-3, which is higher than the acceptable limit of 1.0 × 10-6, and the total hazard index was 187, which is greater than the acceptable limit of 1.0. Considering these high-level risks, the study concluded that there is a need for new production methods, and strict application of occupational health and safety measures, to reduce the fine particle exposure of the workers in the laboratories. In addition, there are prescribed limit values for particulate matter only for respirable particles in working environments. #link# The establishment of limit values, especially for PM2.5 concentrations, is important for the protection of the health of the employees.

Dosing frequency is an important factor influencing medication compliance in patients with heart failure (HF), which in turn is imperative in achieving the desired therapeutic outcome. Here we assessed the efficacy and safety of ivabradine prolonged-release (PR) once-daily (test) vs. ivabradine immediate-release (IR) twice-daily (reference) formulations in patients with stable chronic HF with systolic dysfunction.

Patients with sinus rhythm and heart rate (HR) ≥ 50bpm, left ventricular ejection fraction ≤ 40% (HF with reduced ejection fraction), on guideline-based standard care, receiving a stable dose of ivabradine IR 5/7.5mg twice daily for ≥ 1month were enrolled in this randomized, double-blind, phase 3 non-inferiority study. Patients were randomly assigned 11 to ivabradine PR (10mg/15mg) based on the ivabradine IR dosage or continued ivabradine IR (5mg/7.5mg). The primary endpoint was change in resting ECG HR from baseline to the end of 3months, assessed by 12-lead ECG. Safety assessments and 24-h Hol, of which one was fatal (ivabradine IR group). The bradycardia events reported were comparable between groups.

Ivabradine PR was found to be non-inferior to ivabradine IR in the management of patients with stable CHF, with a comparable safety profile. Once-daily ivabradine PR effectively maintained the HR in patients shifted from the ivabradine IR twice-daily regimen, and thus may aid in improving treatment compliance.

CTRI/2018/04/013464(Trial Registered Prospectively on 24/04/2018).

CTRI/2018/04/013464 (Trial Registered Prospectively on 24/04/2018).