Risk Of Adverse Events Research Articles

Effect of Insulin Dependence on Perioperative Risk in Patients With Diabetes Undergoing Total Shoulder Arthroplasty.

Approximately 15% of patients who undergo total shoulder arthroplasty (TSA) have diabetes mellitus, and this group is particularly at risk for perioperative complications. The objective of this study was to quantify the effects of insulin dependence on the risk of 30-day perioperative adverse events after TSA in patients with diabetes mellitus using a large national database. We retrospectively identified patients with diabetes mellitus who underwent TSA in the National Surgical Quality Improvement Program (NSQIP) database from 2011 to 2020. Patients were grouped as having insulin-dependent or non-insulin-dependent diabetes mellitus. The primary outcome was 30-day complication, and secondary outcome variables included 30-day readmission, reoperation, and death. Multivariable logistic regression analyses adjusted for baseline differences were performed. The cohort included 5888 patients with diabetes mellitus who underwent TSA, with 1705 patients in the insulin-dependent group and 4183 patients in the non-insulin-dependent group. The 30-day postoperative complication rate was higher in patients with insulin-dependent diabetes mellitus (8.7%) than in patients with non-insulin-dependent diabetes mellitus (5.6%). The 30-day hospital readmission rate was higher in patients with insulin-dependent diabetes mellitus (4.8%) than in patients with non-insulin-dependent diabetes mellitus (3.3%). These significant differences in complication and readmission rates persisted in the multivariable logistic regression analyses after adjusting for baseline differences between the two groups. Reoperation and death were not associated with insulin dependence. Patients with insulin-dependent diabetes mellitus have higher odds of episode-of-care complication and readmission compared with patients with non-insulin-dependent diabetes mellitus, even after adjusting for between-group baseline differences. [Orthopedics. 20XX;4X(X):XXX-XXX.].

The impact of continuous positive airway pressure therapy on cardiovascular events in patients with obstructive sleep apnoea: an updated systematic review and meta-analysis.

Obstructive sleep apnoea (OSA) is positively associated with cardiovascular diseases, and continuous positive airway pressure (CPAP) is a common treatment for such patients. This study aimed to explore the impact of CPAP on cardiovascular outcomes and prognosis in patients with OSA. A search was conducted in the PubMed, Embase and CENTRAL databases for relevant studies published up to March 2024. Two independent reviewers screened the studies based on inclusion and exclusion criteria, and data were synthesised using RevMan 5.3 software. Heterogeneity was assessed using the Cochran Q test and the I2 statistic. A total of 10 randomised controlled trials and 3 observational studies, comprising 13,832 patients, were included. Compared with standard treatment, the use of CPAP did not significantly reduce the risk of major adverse cardiovascular events (MACE) (risk ratio [RR]: 0.73, 95% confidence interval [CI]: 0.52-1.03; p = 0.07; I2 = 66%), all-cause mortality (RR: 0.92, 95% CI: 0.72-1.16; p = 0.48; I2 = 0%), cardiovascular mortality (RR: 0.63, 95% CI: 0.33-1.19; p = 0.15; I2 = 70%) or non-cardiovascular mortality (RR: 0.81, 95% CI: 0.57-1.15; p = 0.23; I2 = 0%). Similarly, there were no significant differences in the incidence of myocardial infarction, stroke, hospitalisation due to unstable angina or heart failure or atrial fibrillation among those using CPAP. However, when CPAP adherence was ≥ 4h, CPAP significantly reduced the risk of MACE and cardiovascular mortality. Although CPAP's cardiovascular benefits in patients with OSA are not confirmed, it may be that bias risks, CPAP adherence and characteristics of the study population may attenuate the perceived benefits of CPAP. Further research is needed to optimise CPAP therapy.

Effectiveness of palliative photodynamic therapy for unresectable biliary cancer. Systematic review and meta-analysis

A systematic review and meta-analysis was aimed to assess the effectiveness of palliative photodynamic therapy for unresectable malignant tumors of the biliary system in order to justify the feasibility of including photodynamic therapy (PDT) in the complex treatment of this category of patients. Publications in the databases PubMed Central, the bibliographic database of scientifi citations of the RSCI, and the Cochrane library were considered. Heterogeneity was assessed graphically using forest plots and statistically using tau2 and I2 statistics. A meta-analysis of 5-year survival revealed a statistically signifiantly longer pooled estimate of the survival period in groups where PDT was used – 339±161 days (95% CI 25-710; p < 0.001) compared to groups where PDT was not used – 83±16 days (95% CI 33-100; p < 0.001). Heterogeneity among studies was found to be statistically insignifiant (I2 = 29%, p = 0.23). A meta-analysis of the risk difference for adverse events revealed a statistically signifiantly lower risk (-0.2306; 95% CI -0.3917-0.0696; p = 0.005) of adverse events after PDT compared with the comparison group. Heterogeneity among studies was found to be statistically insignifiant (I2 = 0%, p = 0.35). There were no signifiant publication biases in either meta-analysis. The presented meta-analysis demonstrated that PDT may be the method of choice in the palliative complex treatment of patients with unresectable cholangicarcinomas, increasing the ˝ve-year survival of patients along with the absence of increased risks of postoperative complications in comparison with other methods of palliative surgical treatment.

Prognostic Implications of Resistive Reserve Ratio in Patients With Nonobstructive Coronary Artery Disease With Myocardial Bridging.

Myocardial bridging (MB) is accompanied by the dynamic extravascular compression of epicardial coronary arteries, leading to intracoronary hemodynamic disturbance with abnormal coronary flow profiles. We aimed to evaluate the prognostic implications of resistive reserve ratio (RRR), a composite measure of flow and pressure parameters that represents the vasodilatory capacity of the coronary arteries, in patients with angina with nonobstructive coronary artery disease (ANOCA) and MB, in comparison with coronary flow reserve (CFR). In this retrospective cohort study, we included patients with ANOCA who underwent coronary reactivity testing, where MB was identified by transient constriction in coronary artery segments between systole and diastole. Abnormal CFR and RRR were defined as <2.5 and <2.62, respectively. Major adverse cardiac events, including cardiovascular death, stroke, myocardial infarction, heart failure, and late revascularization, served as outcomes. Among 1251 patients with ANOCA, 191 (15.3%) had MB. The prevalence of abnormal CFR or RRR was not significantly different between patients with and without MB (P=0.144 and P=0.398, respectively). Over a median follow-up time of 6.9 years, abnormal RRR predicted major adverse cardiac events in patients with MB (hazard ratio [HR], 4.38 [95% CI, 1.71-11.21]; P=0.002) and without MB (HR, 1.91 [95% CI, 1.38-2.64]; P<0.001). Abnormal CFR predicted major adverse cardiac events in patients without MB (HR, 2.15 [95% CI, 1.54-3.00]; P<0.001), whereas it was not predictive of major adverse cardiac events in patients with MB (HR, 2.29 [95% CI, 0.93-5.65]; P=0.073). In patients with ANOCA and MB, impaired RRR was superior to impaired CFR in distinguishing patients at a higher risk of future adverse events, suggesting that RRR may serve as a risk stratification tool in patients with MB and ANOCA.

Assessment of the impact of resting heart rate on the risk of major adverse cardiovascular events after ischemic stroke: a retrospective observational study

BackgroundAlthough elevated heart rate is a risk factor for cardiovascular morbidity and mortality in healthy people, the association between resting heart rate and major cardiovascular risk in patients after acute ischemic stroke remains debated. This study evaluated the association between heart rate and major adverse cardiovascular events after ischemic stroke.MethodsWe conducted a retrospective cohort study analyzing data from the Chang Gung Research Database for 21,655 patients with recent ischemic stroke enrolled between January 1, 2010, and September 30, 2018. Initial in-hospital heart rates were averaged and categorized into 10–beats per minute (bpm) increments. The primary outcome was the composite of hospitalization for recurrent ischemic stroke, myocardial infarction, or all-cause mortality. Secondary outcomes were hospitalization for recurrent ischemic stroke, myocardial infarction, and heart failure. Hazard ratios and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, using the heart rate < 60 bpm subgroup as the reference.ResultsAfter a median follow-up of 3.2 years, the adjusted hazard ratios for the primary outcome were 1.13 (95% CI: 1.01 to 1.26) for heart rate 60–69 bpm, 1.35 (95% CI: 1.22 to 1.50) for heart rate 70–79 bpm, 1.64 (95% CI: 1.47 to 1.83) for heart rate 80–89 bpm, and 2.08 (95% CI: 1.85 to 2.34) for heart rate ≥ 90 bpm compared with the reference group. Heart rate ≥ 70 bpm was associated with increased risk of all secondary outcomes compared with the reference group except heart failure. ConclusionsHeart rate is a simple measurement with important prognostic implications. In patients with ischemic stroke, initial in-hospital heart rate was associated with major adverse cardiovascular events.

Cardiac implantable electronic devices in pregnancy: A position statement.

The aim of this document is to provide guidance for the management of women and birthing people with a permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD). Cardiac devices are becoming more common in obstetric practice and a reference document for contemporary evidence-based practice is required. Where evidence is limited, expert consensus has established recommendations. The purpose is to improve safety and reduce the risk of adverse events relating to implanted cardiac devices during pregnancy, birth and the postnatal period.

Ambient Air Pollution Exposure and Adverse Outcomes Among Medicare Beneficiaries With Heart Failure.

Exposure to fine particulate matter (<2.5 um, particulate matter with an aerodynamic diameter <2.5 microns [PM2.5]) has been implicated in atherogenesis. Limited data in animal studies suggest that PM2.5 exposure leads to myocardial fibrosis and increased incidence of heart failure (HF). Whether PM2.5 is associated with adverse outcomes in patients with preexisting HF has not been widely studied. In this retrospective cohort study, Medicare patients hospitalized with first HF between 2013 and 2020 were identified from the Medicare Provider Analysis and Review Part A 100% files. Patients were linked with integrated estimates of ambient PM2.5 obtained at 1×1 km using the zip code of participants' residence. The study outcomes were all-cause death, HF, and all-cause readmissions burden. A total of 2 599 525 patients were included in this study, with 6 321 731 person-years of follow-up. Mean PM2.5 was 7.3±1.7 μg/m3. Each interquartile range of PM2.5 was associated with 0.9% increased hazard of all-cause death, 4.5% increased hazard of first HF readmission, 3.1% increased risk of HF hospitalization burden, and 5.2% increase in all-cause readmission burden, after adjusting for 11 sociodemographic and medical factors. Subgroup analyses showed that the effects were more pronounced at levels <7 μg/m3 and in patients aged <75 years, Asians, and those residing in rural areas. Ambient air pollution is associated with higher risk of adverse events in Medicare beneficiaries with established HF. These associations persist below the National Air Quality Standards (12 μg/m3), supporting that no threshold effect exists for health effects of air pollution exposure.

Gut-Microbiota-Related Metabolite Phenylacetylglutamine and Risk of Incident Coronary Heart Disease among Women.

Phenylacetylglutamine (PAGln) is a novel metabolite derived from gut microbial metabolism of dietary proteins, specifically phenylalanine, which may be linked to risks of adverse cardiovascular events. We investigated whether higher plasma levels of PAGln were associated with a greater risk of incident coronary heart disease (CHD) and tested whether adherence to a plant-based diet, which characterizes habitual dietary patterns of animal and plant food intake, modified the associations. We examined associations between plasma PAGln and risk of incident CHD over 11-16 years in a nested case-control study of 1520 women (760 incident cases and 760 controls) from the Nurses' Health Study. Separately, we analyzed relations between PAGln and dietary intakes measured through dietary records in the Women's Lifestyle Validation Study (n=725). Higher PAGln levels were related to a greater risk of CHD (p <0.05 for dose-response relationship). Higher PAGln was associated with greater red/processed meat intake and lower vegetable intake (p <0.05 for all). We found a significant interaction between PAGln and adherence to plant-based diet index (PDI) on CHD (Pinteraction=0.008); higher PAGln levels were associated with an increased risk of CHD (relative risk per 1 SD: 1.22 [95% CI: 1.05, 1.41]) among women with low PDI but not among those with high PDI. Higher PAGln was associated with higher risk of CHD, particularly in women with dietary patterns of eating more animal foods and fewer plant-based foods. Adherence to plant-based diets might attenuate unfavorable associations between a novel microbial metabolite and CHD risk.

Surgical outcome of extra sinus zygomatic implants in comparison to conventional implants for the rehabilitation of atrophic maxilla: a systematic review and meta-analysis

Posterior maxillary atrophy in particular presents a challenge for implant-supported dental rehabilitation. The discovery of the zygomatic implant by Branemark and its modifications has brought a much-needed window of hope to most patients with atrophic maxilla. The conventional approach to is believed to be the intra sinus technique but the use of the extra sinus zygomatic implants has advantages like reducing surgical time, the risk of sinus adverse events and improving surgical visualization. A systematic literature search in five databases: Proquest, Google Scholar, PubMed, OVID, Cochrane and a hand search of relevant scientific journals was performed. The meta-analysis done on the included five studies, revealed that the primary outcome, i.e, implant survival rate and prosthesis failure showed no statistically significant difference between the test and the control group. The overall difference between the control (intra sinus zygomatic implants) and test group (extra sinus zygomatic implant) was statistically significant for chronic sinusitis (p=0.0002) and periimplantitis (p=0.01). The use of the extra sinus technique for the placement of zygomatic implants simplified the surgical procedure, improved the prosthetic outcome and reduced the risk of sinusitis and periimplantitis as compared to conventional or intra sinus technique of zygomatic implant placement.

Interleukin-7 risk allele, lymphocyte counts, and autoantibodies for prediction of risk of immune-related adverse events in patients receiving Atezolizumab plus Bevacizumab therapy for unresectable hepatocellular carcinoma.

Atezolizumab plus bevacizumab (AB) therapy was the effective immune checkpoint inhibitor (ICI) for unresectable HCC (u-HCC). However, immune-related adverse events (irAEs) are common in patients receiving ICI therapies. Our research aimed to explore the risk factors for irAE development, with attention to interleukin 7 (IL-7) risk alleles, lymphocyte counts, and autoantibodies. Seventy-six patients receiving AB therapy for u-HCC were recruited. Single nucleotide polymorphism genotyping was done for the analysis of rs16906115 polymorphism near IL-7-expressing genes using 20μL of stored buffy coat at baseline. The association between IL-7 risk alleles, lymphocyte counts, autoantibodies and irAE development was investigated. irAEs were found in 14 (18%) patients. The incidence of irAEs did not differ significantly between the groups showing IL-7 AG/AA and the GG group (p = 0.72). The incidence in the group with a lymphocyte count of 1130/µL or more at baseline was higher than in that with a value below 1130/µL (p = 0.0093). The group showing IL-7 AG/AA or lymphocyte count &gt;1130/μL had a higher irAE prevalence rate than the others (p = 0.019). IL-7 AG/AA or lymphocyte count &gt;1130/μL and positivity for autoantibodies at baseline were the prognostic factors for irAE development. irAE incidence could be stratified using a combination of IL-7 AG/AA or lymphocyte counts ≥ 1130/µL, and positive autoantibodies (p = 0.016). Patients with IL-7 risk alleles, high lymphocyte counts, and autoantibodies at baseline may require careful monitoring for irAE development.

Risk prediction and prognostic analysis of post-implantation syndrome after thoracic endovascular aortic repair

This study aimed to establish a predictive model for the risk of post-thoracic endovascular aortic repair (TEVAR) post-implantation syndrome (PIS) in type B aortic dissection (TBAD) patients, assisting clinical physicians in early risk stratification and decision management for high-risk PIS patients. This study retrospectively analyzed the clinical data of 547 consecutive TBAD patients who underwent TEVAR treatment at our hospital. Feature variables were selected through LASSO regression and logistic regression analysis to construct a nomogram predictive model, and the model's performance was evaluated. The optimal cutoff value for the PIS risk nomogram score was calculated through receiver operating characteristic (ROC) curve analysis, further dividing patients into high-risk group (HRG) and low-risk group (LRG), and comparing the short to midterm postoperative outcomes between the two groups. In the end, a total of 158 cases (28.9%) experienced PIS. Through LASSO regression analysis and multivariable logistic regression analysis, variables including age, emergency surgery, operative time, contrast medium volume, and number of main prosthesis stents were selected to construct the nomogram predictive model. The model achieved an area under the curve (AUC) of 0.86 in the training set and 0.82 in the test set. Results from calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC) demonstrated that the predictive model exhibited good performance and clinical utility. Furthermore, after comparing the postoperative outcomes of HRG and LRG patients, we found that the incidence of postoperative PIS significantly increased in HRG patients. The duration of ICU stay and mechanical assistance time was prolonged, and the incidence of postoperative type II entry flow and acute kidney injury (AKI) was higher. The risk of aortic-related adverse events (ARAEs) and major adverse events (MAEs) at the first and twelfth months of follow-up also significantly increased. However, there was no significant difference in the mortality rate during hospitalization. This study established a nomogram model for predicting the risk of PIS in patients with TBAD undergoing TEVAR. It serves as a practical tool to assist clinicians in early risk stratification and decision-making management for patients.

Acute and chronic complication profiles among patients with chronic kidney disease in Alberta, Canada: a retrospective observational study

BackgroundChronic kidney disease (CKD) poses a substantial burden to individuals, caregivers, and healthcare systems. CKD is associated with higher risk for adverse events, including renal failure, cardiovascular disease, and death. This study aims to describe comorbidities and complications in patients with CKD.MethodsWe conducted a retrospective observational study linking administrative health databases in Alberta, Canada. Adults with CKD were identified (April 1, 2010 and March 31, 2019) and indexed on the first diagnostic code or laboratory test date meeting the CKD algorithm criteria. Cardiovascular, renal, diabetic, and other comorbidities were described in the two years before index; complications were described for events after index date. Complications were stratified by CKD stage, atherosclerotic cardiovascular disease (ASCVD), and type 2 diabetes mellitus (T2DM) status at index.ResultsThe cohort included 588,170 patients. Common chronic comorbidities were hypertension (36.9%) and T2DM (24.1%), while 11.4% and 2.6% had ASCVD and chronic heart failure, respectively. Common acute complications were infection (58.2%) and cardiovascular hospitalization (24.4%), with rates (95% confidence interval [CI]) of 29.4 (29.3–29.5) and 8.37 (8.32–8.42) per 100 person-years, respectively. Common chronic complications were dyslipidemia (17.3%), anemia (14.7%), and hypertension (11.1%), with rates (95% CI) of 11.9 (11.7–12.1), 4.76 (4.69–4.83), and 13.0 (12.8–13.3) per 100 person-years, respectively. Patients with more advanced CKD, ASCVD, and T2DM at index exhibited higher complication rates.ConclusionsOver two-thirds of patients with CKD experienced complications, with higher rates observed in those with cardio-renal-metabolic comorbidities. Strategies to mitigate risk factors and complications can reduce patient burden.

High-risk medication use among older adults with cognitive impairment living alone in the United States.

More than one-fourth of older adults with cognitive impairment (CI) live alone; these individuals often lack support for medication management and face a high risk of adverse drug events. We characterized the frequency and types of high-risk medications used by older adults with CI living alone and, for context, compared patterns with those in older adults with CI living with others. This was a cross-sectional study of National Health and Aging Trends Study (NHATS) data and Medicare claims (2015-2017). We ascertained cognitive status from NHATS and medication use with Part D claims. We compared high-risk medication use (those with adverse cognitive effects or low tolerance for misuse) among older adults with CI living alone versus living with others using logistic regression models adjusted for demographic/clinical factors. The unweighted sample included 1569 older adults with CI, of whom 491 (weighted national estimate, 31%) were living alone. In the living-alone group, the mean age was 79.9 years and 66% were female, 64% reported managing medications on their own without difficulty, 14% reported managing medications on their own with difficulty, and 18% received total support with medication management. Older adults with CI living alone used a median of 5 medications (IQR, 3-8), 16% took ≥10 medications, and 46% took ≥1 high-risk medication (anticholinergic/sedating: 24%; opioid: 13%; anticoagulant: 10%; sulfonylurea: 10%; insulin: 9%). Compared with those living with others, the use of high-risk medications was similar (p > 0.05 for unadjusted/adjusted comparisons). Those living alone were more likely both to take at least one high-risk medication and not receive help with medication management: 34% in those living alone versus 23% living with others (p < 0.05 for unadjusted/adjusted comparisons). Older adults with CI living alone use many medications; nearly half use high-risk medications. Our findings can inform medication optimization interventions supporting this vulnerable population.

Frailty and Clinical Outcomes of Ticagrelor Versus Clopidogrel in Older Adults With Acute Myocardial Infarction.

Ticagrelor is recommended over clopidogrel in acute coronary syndrome based on the results of the PLATO (Study of Platelet Inhibition and Patient Outcomes) trial. We aimed to emulate PLATO in older adults with and without frailty and with acute coronary syndrome treated with percutaneous coronary intervention. We created a new-user cohort of Medicare fee-for-service beneficiaries aged ≥65 years hospitalized for acute coronary syndrome from 2014 to 2018 and initiated ticagrelor or clopidogrel following percutaneous coronary intervention. Frailty was defined using a validated claims-based frailty index ≥0.25. Coprimary outcomes were major adverse cardiovascular events and major bleeding. Follow-up began on the date of first outpatient prescription for ticagrelor or clopidogrel and ended on the earliest date for an outcome event, death, discontinuation of the index drug, or disenrollment from Medicare. The study included 42 843 older adults; 23% were frail. After propensity score matching, the rates of major adverse cardiovascular events per 100 person-years comparing ticagrelor versus clopidogrel groups were 7.8 and 7.3 in the frail cohort (hazard ratio [HR], 1.07 [95% CI, 0.84-1.36]) and 3.7 and 4.2 in the nonfrail cohort (HR, 0.87 [95% CI, 0.75-1.02]). The corresponding rates of major bleeding were 4.3 and 3.8 in the frail cohort (HR, 1.12 95% CI, [0.80-1.56]) and 2.2 and 1.8 in the nonfrail cohort (HR, 1.22 [95% CI, 0.98-1.51]). There was a trend toward a modest reduction in risk of major adverse cardiovascular events and a trend toward a modest increase in risk of major bleeding with ticagrelor compared with clopidogrel in the nonfrail cohort. There was insufficient evidence for the benefit of ticagrelor in frail older adults.

Elevated serum uric acid is a predictor of pulmonary artery involvement and subsequent prognosis in patients with Takayasu's arteritis.

The aim of this study was to investigate the predictive value of uric acid (UA) in prognosis of pulmonary artery involvement (PAI) in patients with Takayasu's arteritis (TAK). A total of 166 TAK patients were enrolled in the study, including 76 with PAI and 90 without. Outcomes of 144 TAK patients were followed up and recorded. The possible associations between serum UA levels and incidence of PAI in TAK and PAI-related prognosis of TAK patients were examined using different statistical models. The serum UA levels were significantly higher in TAK patient with PAI than TAK patients without PAI. Multivariate logistic regression analysis indicated that serum UA level ≥284.5 umol/L was associated with an increasing incidence of PAI in TAK (OR: 2.108, 95% CI: 1.063 to 4.180; p=0.033). Kaplan-Meier survival analysis showed that TAK patients with serum UA level ≥328.1 umol/L had a significantly higher cumulative incidence of PAI-related adverse events compared to TAK patients with serum UA level <328.1 umol/L (p=0.008). Multivariate Cox proportional hazard regression analysis revealed that serum UA level ≥328.1 umol/L (HR: 2.595, 95% CI: 1.198 to 5.622; p=0.016) was a PAI-related prognostic risk factor for TAK. Elevation of serum UA level was associated with an increasing risk of PAI and PAI-related adverse event in patients with TAK, indicating its potential as a predictor for identification of PAI onset and worsening in TAK patients.

Predicting the occurrence of minor adverse events in cardiac rehabilitation using physical variables

The safety of exercise practice by individuals with cardiovascular disease is due to a good clinical evaluation to identify patients with a higher risk of adverse events, thus the study of simple variables capable of predicting the rate of events during exercise is relevant and may provide better screening tools to be applied in the clinical practice. The study aimed to evaluate if clinical and physical parameters can predict the rate of adverse events during exercise-based cardiac rehabilitation. This was a cohort study that followed 73 patients during 24 sessions of exercise. Were registered 217 simple adverse events, at a rate of 2.5 events per hour of exercise. We found that higher adiposity, worse pulmonary function, lower functional capacity, and reduced heart rate variability were significant and acceptable predictors of adverse events during exercise, according to the ROC curve analysis. We state that these simple physical parameters may be useful for cardiac risk stratification in cardiac rehabilitation programs with low resources, contributing to its safety.

Platelet-rich plasma and plasma rich in growth factors in extra-oral wound care.

This narrative review evaluates the existing literature on the clinical efficacy and safety of platelet-rich plasma (PRP) and plasma rich in growth factors (PRGFs) in extra-oral wound care, considering their potential benefits and drawbacks. The review specifically focuses on the impact of these treatments on patients' quality of life, pain management, treatment costs, recurrence rates, and potential complications. Given the extensive literature and diverse range of extra-oral wound types in which these autologous platelet concentrates have been applied, this narrative review focuses on the most frequently described wound types, including diabetic foot ulcers, venous leg ulcers, pressure ulcers, surgical wounds, and burns. The use of PRP has been reported in various medical specialties, with a low risk of adverse events. While there is a growing interest in the use of PRGF with promising results, the available literature on this topic is still limited. Only a few studies evaluated patients' perception of the treatment and the relationship between treatment costs and clinical outcomes. Data on recurrence rates and complications also vary across studies. In conclusion, PRP and PRGF show promise as alternatives or as adjunctive therapies to conventional treatments for various extra-oral wounds and ulcers, leading to reduced wound size and accelerated healing time but should be considered on a case-by-case basis, taking into account the type and severity of the wound.

Natural language processing for detecting adverse drug events: A systematic review protocol

Background Detecting Adverse Drug Events (ADEs) is an emerging research area, attracting great interest in the research community. Better anticipatory management of predisposing factors has considerable potential to improve outcomes. Automatic extraction of ADEs using Natural Language Processing (NLP) has a great potential to significantly facilitate efficient and effective distillation of such knowledge, to better understand and predict risk of adverse events. Methods This systematic review follows the six-stage including the literature from 6 databases (Embase, Medline, Web Of Science Core Collection, ACM Guide to Computing Literature, IEEE Digital Library and Scopus). Following the title, abstract and full-text screenings, characteristics and main findings of the included studies and resources will be tabulated and summarized. The risk of bias and reporting quality was assessed using the PROBAST tool. Results We developed our search strategy and collected all relevant publications. As of July 2024, we have completed all the stages of the systematic review. We identified 178 studies for inclusion through the academic literature search (where data was extracted from all of the papers). Right now, we are writing up the systematic review paper where we are synthesising the different findings. Further refinement of the eligibility criteria and data extraction has been ongoing since August 2022. Conclusion In this systematic review, we will identify and consolidate information and evidence related to the use and effectiveness of existing NLP approaches and tools for automatically detecting ADEs from free text (discharge summaries, General Practitioner notes, social media, etc.). Our findings will improve the understanding of the current landscape of the use of NLP for extracting ADEs. It will lead to better anticipatory management of predisposing factors with the potential to improve outcomes considerably. Our results will also be valuable both to NLP researchers developing methods to extract ADEs and to translational/clinical researchers who use NLP for this purpose and in healthcare in general. For example, from our initial analysis of the studies, we can conclude that the majority of the proposed works are about the detection (extraction) of ADEs from text. An important portion of studies also focus on the binary classification of text (for highlighting if it includes or not ADEs). Different challenges related to the unbalanced dataset, abbreviations and acronyms but also to the lower results with rare ADEs were also mentioned by the studied papers.

Effect of post-storage filters vs. pre-storage filters for leukoreduction of blood components on clinical outcomes: a systematic review and meta-analysis

BackgroundLeukoreduction has been used to limit the risk of adverse events. The most commonly used methodology is filtration (pre- or post-storage). However, whether pre-storage filtration is better than post-storage filtration needs to be clearly defined, particularly for countries that still use post-storage filtration. This study aimed to synthesize the best available evidence on the effectiveness of pre-storage filters compared with post-storage filters for transfusion reactions, for the occurrence of infections, for the length of hospital stay, and for the death of patients undergoing leukoreduced transfusion.MethodsWe searched the MEDLINE (PubMed), CINAHL (EBSCO), PsycINFO (APA), Scopus (Elsevier), The Cochrane Library (J. Wiley), Web of Science Core Collection (Clarivate Analytics), Embase (Elsevier), and LILACS (VHL) databases and gray literature for eligible studies in August 2020 and updated the search in October 2023. The Joanna Briggs Institute critical assessment tools were applied to analyze the quality appraisal of the studies. GRADE was used to determine the certainty of the evidence.ResultsThe meta-analysis showed that pre-storage filtration was a protective factor for the occurrence of febrile non-hemolytic transfusion reaction in red blood cells (RR 0.49, 95% CI 0.41–0.59) and platelet concentrate transfusions (RR 0.16, 95% CI 0.12–0.22). The same did not occur for post-surgical infection after platelet concentrate transfusions (RR 0.82, 95% CI 0.65–1.04). Only one study analyzed the length of hospital stay and showed no significant difference between patients who received leukoreduced transfusions according to the type of filter used. According to the GRADE criteria, the certainty of the evidence for febrile non-hemolytic transfusion reactions was low for red blood cells and very low for platelet concentrate due to the high risk of bias. Infection was a low risk due to imprecision.ConclusionsThe results of this review showed that the certainty of recommending the best type of filter (pre- or post-storage) for the benefit of the outcomes analyzed is still fragile; therefore, more robust evidence is needed.Systematic review registrationPROSPERO CRD42020192202.

A network meta-analysis: evaluating the efficacy and safety of concurrent proton pump inhibitors and clopidogrel therapy in post-PCI patients.

The objective of this research was to evaluate the risk of major adverse cardiovascular events (MACEs) associated with the use of various proton pump inhibitors (PPIs) in combination with clopidogrel in patients who underwent percutaneous coronary intervention (PCI). To accomplish this, we analyzed data from randomized controlled trials and retrospective cohort studies sourced from key electronic databases. These studies specifically examined the effects of different PPIs, such as lansoprazole, esomeprazole, omeprazole, rabeprazole, and pantoprazole, when used in conjunction with clopidogrel on MACEs. The primary focus was on the differential impact of these PPIs, while the secondary focus was on the comparison of gastrointestinal (GI) bleeding events in groups receiving different PPIs with clopidogrel vs. a placebo group. This study's protocol was officially registered with INPLASY (INPLASY2024-2-0009). We conducted a network meta-analysis involving 16 studies with a total of 145,999 patients. Our findings indicated that rabeprazole when combined with clopidogrel, had the lowest increase in MACE risk (effect size, 1.05, 95% CI: 0.66-1.66), while lansoprazole was associated with the highest risk increase (effect size, 1.48, 95% CI: 1.22-1.80). Esomeprazole (effect size, 1.28, 95% CI: 1.09-1.51), omeprazole (effect size, 1.23, 95% CI: 1.07-1.43), and pantoprazole (effect size, 1.38, 95% CI: 1.18-1.60) also significantly increased MACE risk. For the secondary outcome, esomeprazole (effect size, 0.30, 95% CI: 0.09-0.94), omeprazole (effect size, 0.34, 95% CI: 0.14-0.81), and pantoprazole (effect size, 0.33, 95% CI: 0.13-0.84) demonstrated an increased potential for GI bleeding prevention. In conclusion, the combination of lansoprazole and clopidogrel was found to significantly elevate the risk of MACEs without offering GI protection in post-PCI patients. This study is the first network meta-analysis to identify the most effective regimen for the concurrent use of clopidogrel with individual PPIs. https://inplasy.com/inplasy-2024-2-0009/, identifier (INPLASY2024-2-0009).