Short-term and long-term risk of stroke in patients with perioperative atrial fibrillation after cardiac surgery: Systematic review and meta-analysis, CJC Open (2021), doi:

Sentiment Analysis is a technique that is being used abundantly nowadays for customer reviews analysis, popularity analysis of electoral candidates, hate speech detection and similar applications. Sentiment analysis on tweets encounters challenges such as highly skewed classes, high dimensional feature vectors and highly sparse data. In this study, we have analyzed the improvement achieved by successively addressing these problems in order to determine their severity for sentiment analysis of tweets. Firstly, we prepared a comprehensive data set consisting of Urdu Tweets for sentiment analysis-based hate speech detection. To improve the performance of the sentiment classifier, we employed dynamic stop words filtering, Variable Global Feature Selection Scheme (VGFSS) and Synthetic Minority Optimization Technique (SMOTE) to handle the sparsity, dimensionality and class imbalance problems respectively. We used two machine learning algorithms i.e., Support Vector Machines (SVM) and Multinomial Naïve Bayes' (MNB) for investigating performance in our experiments. Our results show that addressing class skew along with alleviating the high dimensionality problem brings about the maximum improvement in the overall performance of the sentiment analysis-based hate speech detection.

In a post-bariatric surgery patient with suspected biliary dyskinesia, what does an ejection fraction (EF) of 87% on hepatobiliary iminodiacetic acid (HIDA) scan indicate to a healthcare provider? Conventionally, in post-bariatric patients, the gallbladder becomes hypofunctional; however, in this case, the gallbladder activity increased exponentially. Of note, there are no previously documented cases of developing an overactive gallbladder after undergoing a bariatric surgery procedure. This report aims to explore the possible associations between bariatric surgery and the development of gallbladder hyperkinesis in the early postoperative period, the diagnostic tool used to discover the source of our patient's ailment, as well as the rationality behind a surgical procedure that led to an excellent response, namely, laparoscopic cholecystectomy.

Beer potomania is a unique condition characterized by hyponatremia secondary to excessive beer drinking and low daily solute intake. We report a case of a 41-year-old African American female with multiple comorbidities, notably alcohol use disorder, who was initially treated for hypertensive emergency and was subsequently found to be hyponatremic during the same visit. Beer potomania was suspected as a leading etiology of hyponatremia. This report emphasizes the importance of the proper diagnosis and appropriate management of beer potomania in the setting of concomitant comorbidities. Clinician awareness is crucial in implementing immediate treatment and in the prevention of potentially fatal sequelae such as severe malnutrition and osmotic demyelination syndrome.

Background Perioperative atrial fibrillation (POAF) after cardiac surgery has been associated with an increased risk of stroke. However, many previous studies have not systematically excluded patients with pre-existing AF. As such, the association between new-onset POAF and stroke risk has not been well established. Purpose To perform a systematic review and meta-analysis on the short and long-term risks of stroke in patients experiencing new-onset POAF after cardiac surgery. Methods We searched MEDLINE, EMBASE, and the Cochrane Library databases for studies comparing the risk of stroke in patients with versus without new-onset POAF after cardiac surgery. Studies were included in our review if they enrolled ≥100 patients and defined POAF as new-onset AF in patients with no history of preoperative AF. Data were independently extracted in duplicate. The quality of studies was assessed using the Newcastle Ottawa Scale. Random-effects meta-analysis was used to calculate summary risk ratios. Short-term stroke risk was calculated using events occurring either in-hospital or ≤30 days after surgery, and long-term risk was calculated using events occurring >30 days after surgery. Results After reviewing 11,791 citations, 46 studies met the inclusion criteria. These studies included 364,822 patients, of which 76,388 (20.9%) developed new-onset POAF. The incidence of stroke was higher among patients with POAF versus no POAF (n=44 studies; incidence 2.76% vs. 1.53%; relative risk (RR) 1.91, 95% CI 1.65–2.23; I2 = 78%). A sensitivity analysis of high-quality studies alone yielded similar results (n=9 studies; RR 1.74, 95% CI 1.31–2.30; I2 = 88%). Patients with POAF had a higher incidence of stroke both in the short-term (n=35 studies; 2.71% vs. 1.36%; RR 2.13, 95% CI 1.81–2.51; I2 = 69%) and long-term (n=20 studies; 1.6 vs. 1.0 per 100 patient-years; RR 1.39, 95% CI 1.24–1.57; I2 = 27%). The risk of stroke was increased in POAF patients across all types of cardiac surgery performed, including isolated CABG (n=19 studies; RR 1.93, 95% CI 1.60–2.32; I2 = 62%), isolated transcatheter aortic valve implantation (n=7 studies; RR 1.86, 95% CI 1.32–2.63; I2 = 0%), and studies including multiple procedure types (n=16 studies; RR 1.90, 95% CI 1.44–2.51; I2 = 89%). Conclusion New-onset POAF after cardiac surgery is associated with an increased risk of stroke, both in the short and long term. The absolute risk difference is small, and randomized trials are needed to assess the efficacy and safety of treatment interventions in this patient population. Funding Acknowledgement Type of funding source: None