Cochrane Clinical Trials Database Research Articles

Stroke risk after transcatheter aortic valve replacement in patients with carotid stenosis: A systematic review and meta-analysis

BackgroundStroke is a feared complication of transcatheter aortic valve replacement (TAVR). Patients undergoing TAVR typically have multiple comorbidities, such as carotid artery stenosis (CAS). We conducted the present meta-analysis to determine the risk of stroke and mortality following TAVR in patients with CAS. MethodsWe searched PubMed/Medline, Scopus, ScienceDirect, and Cochrane Clinical Trials databases for clinical studies that compared CAS ≥50% and CAS ≥70% versus non-CAS TAVR population. The endpoints included the 30-day incidence of stroke or transient ischemic attack (TIA) and 30-day all-cause of mortality. ResultsWe identified seven studies that included 12,418 patients in the CAS group and 102,316 in the control group. CAS ≥50% was not associated with an increased risk of 30-day stroke or TIA after TAVR [risk ratio (RR): 1.38; 95% confidence interval (95% CI): 0.95–2.02; p = 0.09]. However, patients with CAS ≥70% had an increased risk of stroke or TIA (RR: 1.43; 95% CI: 1.02–2.01; p = 0.04). No difference in 30-day all-cause mortality was observed between CAS ≥50% or CAS ≥70% and control groups (RR: 1.09; 95% CI: 0.79–1.52; p = 0.59 and RR: 1.11; 95% CI: 0.85–1.45; p = 0.43, respectively). ConclusionsCAS ≥70% was associated with an increased risk of stroke or TIA following TAVR compared with patients without CAS.

Association of gut microbiota with depression post-myocardial infarction: A systematic evaluation and meta-analysis protocol.

Depression post-myocardial infarction (MI) is becoming more prevalent. The gut-brain axis (GBA), influenced by the gut microbiota, is a critical component in understanding depression post-MI. Despite the well-established connection between gut microbiota and depression post-MI, this relationship remains incompletely understood. This protocol will follow the Preferred Reporting Items for Systematic Review and Meta-analysis Protocol (PRISMA-P) 2020 statement. Beginning from inception to October 2023, a systematic search will be conducted across eight electronic databases, including PubMed, MEDLINE, Scopus, Embase, Cochrane Clinical Trials Database, Web of Science, China National Knowledge Infrastructure, and China Biomedical Literature Database. Pre-selected studies will be independently assessed by two researchers following a standard inclusion, data extraction and quality assessment protocol. The primary outcome measures are differences in the profile of gut microbiota and rating scale scores for depression. Fixed-effects models will be used when both clinical heterogeneity and statistical heterogeneity are low, otherwise random-effects models will be used. Furthermore, subgroup analyses will be conducted on the depression severity of the participants using the same psychiatric scales employed, study type and geographic region. Random forest plot runs and research-related statistical analyses will be carried out using Rev Man V.5.3 software. This study will identify the association between the gut microbiota and the onset of depression post-MI, and provide evidence for the use of probiotics as an adjunctive treatment for depression post-MI. Prospero registration number: CRD42023444026.

Aripiprazole and Other Third-Generation Antipsychotics as a Risk Factor for Impulse Control Disorders: A Systematic Review and Meta-Analysis.

Increasing evidence suggests an association between third-generation antipsychotics (TGAs) and impulse control disorders (ICDs). This is thought to be due to their partial agonism of dopamine receptors. However, neither the relative nor absolute risks of ICDs in those prescribed TGAs are well established. To inform clinical practice, this systematic review and meta-analysis summarizes and quantifies the current evidence for an association. An electronic search of Medline, PsychINFO, EMBASE, and the Cochrane Clinical Trials Database was undertaken from database inception to November 2022. Three reviewers screened abstracts and reviewed full texts for inclusion. A random-effects meta-analysis was conducted with eligible studies. A total of 392 abstracts were retrieved, 214 remained after duplicates were removed. Fifteen full texts were reviewed, of which 8 were included. All 8 studies found that TGAs were associated with increased probability of ICDs. Risk of bias was high or critical in 7 of 8 studies. Three studies were included in the pooled analysis for the primary outcome, 2 with data on each of aripiprazole, cariprazine, and brexpiprazole. Exposure to TGAs versus other antipsychotics was associated with an increase in ICDs (pooled odds ratio, 5.54; 2.24-13.68). Cariprazine and brexpiprazole were significantly associated with ICDs when analyzed individually. Aripiprazole trended toward increased risk, but very wide confidence intervals included no effect. Third-generation antipsychotics were associated with increased risk of ICDs in all studies included and pooled analysis. However, the risk of bias is high, confidence intervals are wide, and the quality of evidence is very low for all TGAs examined.

Platelet-Rich Plasma Intrauterine Infusion as Assisted Reproduction Technology (ART) to Combat Repeated Implantation Failure (RIF): A Systematic Review and Meta-Analysis.

Repeated implantation failure (RIF) is considered one of the major challenges facing clinician in assisted reproduction technologies (ART) despite the significant advances that have been made in this field. Platelet rich plasma (PRP), also known as autologous conditioned plasma, is a protein concentrate with anti-inflammatory and pro-regenerative characteristics. The use of PRP in women undergoing ART has been studied in the past, with varying degrees of success. The goal of this trial was to see if injecting PRP into the uterus improves pregnancy outcomes in women receiving ART. PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Clinical Trials were among the databases searched (CENTRAL), from 2015 to 2021. The pooled estimates were calculated using a meta-analysis with a random-effects model. There were 14 studies with a total of 1081 individuals (549 cases and 532 controls). There was no difference in miscarriage rates between women who got PRP and those who received placebo (P≤0.90). Chemical pregnancy (P≤0.00), clinical pregnancy (P ≤0.001), and implantation rate (P≤ 0.001) were all significantly higher in women. Endometrial thickness increased in women who got PRP vs women who received placebo after the intervention (P ≤0.001). PRP may be an alternate therapeutic approach for individuals with thin endometrium and RIF, according to the findings of this comprehensive study. To determine the subgroup that would benefit the most from PRP, more prospective, big, and high-quality randomized controlled trials (RCTs) are needed.

THE RENIN ANGIOTENSIN SYSTEM BLOCKADE DOES NOT SIGNIFICANTLY REDUCE THE RISK OF CARDIOVASCULAR EVENTS IN DIALYSIS PATIENTS: A META-ANALYSIS OF 5 RCTS

Objective: Angiotensin-converting-enzyme-inhibitors (ACEIs) and/or angiotensin-receptor-blockers (ARBs) are recommended by guidelines as first-line therapies for the management of hypertension in the general population. However, the cardioprotective benefit of these agents among patients on chronic dialysis remains uncertain. This meta-analysis aimed to explore the effect of ACEIs/ARBs on cardiovascular events in this high-risk patient population. Design and method: We searched Medline/PubMed and Cochrane database of clinical trials from inception through February 2022 to identify randomized controlled trials (RCTs) comparing the effect of ACEIs/ARBs relative to placebo or no add-on treatment in patients receiving dialysis. RCTs were eligible in quantitative data synthesis, if they were assessing fatal or non-fatal cardiovascular events as a primary efficacy endpoint. Results: We identified 5 RCTs including a total of 1,582 dialysis patients. As compared with placebo or no add-on treatment, the use of ACEIs/ARBs was not associated with a significantly lower risk of cardiovascular events [risk ratio (RR): 0.79; 95% confidence interval (CI): 0.57-1.11; I2 = 73%, P = 0.005]. Furthermore, there was no benefit of ACEIs/ARBs on cardiovascular mortality (RR: 0.82; 95% CI: 0.59-1.14; I2 = 6%, P = 0.37) and all-cause mortality (RR: 0.86; 95% CI: 0.64-1.15; I2 = 44%, P = 0.13). These results were consistent, when the included RCTs were stratified into subgroups according to the hypertension status and ethnicity of patients, sample size, duration of follow-up and method quality. Conclusions: The present meta-analysis showed that among patients on dialysis, the use of ACEIs/ARBs is not associated with a significantly lower risk of cardiovascular events and all-cause mortality as compared with placebo or no add-on treatment.

The effect of ball versus locator attachment system on the performance of implant supported overdenture: A systematic review.

This systematic review was aimed to compare ball and locator attachment system on the basis of clinical and biomechanical performance of implant supported overdenture as well as biological and patient related outcomes. Open and free electronic and manual searches were performed in digital databases including MEDLINE via PubMed, the Cochrane Database of Clinical Trials, and Scopus along with some other reliable sources. From the 667 retrieved records, 11 full-text controlled trials were included in this study. Risk of bias was assessed according to RoB 2.0 except for one RCT (economic evaluation), only assessed by CASP checklist. From the 11 retrieved studies, total 183 locator and 219 ball attachments were identified in 452 subjects of 30yrs-95yrs of age. Studies provided data about prosthodontic complications or maintenance (replacement or the activation of matrix and patrix part, loss of retention, fracture and relining of the prosthesis, fracture of the attachment and the survival probability), oral health impact profile, soft tissue parameters and periodontal complications, marginal bone loss, patient related outcome and cost of the attachment systems. Only 5 studies were assessed at low risk bias, while other 6at moderate to high risk of bias. Locator attachment system show lesser complications including loss of retention and lower maintenance appointments, lesser soft tissue, and periodontal complications than the ball attachment. Ball is better in terms of cost effectiveness. In other related outcomes, no significant differences were noted between ball and locator attachment.

Comparative efficacy and safety of JAK inhibitors and leflunomide in rheumatoid arthritis: A protocol for systematic review and meta-analysis.

Rheumatoid arthritis is the most prevalent systemic autoimmune disease among the rheumatic inflammatory musculoskeletal diseases. Currently, there is no reliable evidence regarding the comparisons of anti-rheumatic effects between leflunomide and Janus kinase inhibitors. We performed a protocol for systematic review and meta-analysis to compare the efficacy and safety of Janus kinase inhibitors and leflunomide in rheumatoid arthritis. This review has been reported following the preferred reporting items for systematic reviews and meta-analyses protocol. We will search 7 electronic databases to identify relevant studies from inception to November, 2022, which includes PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database. Risk of bias will be assessed according to the Cochrane Risk of Bias Tool. The Grading of Recommendations Assessment, Development and Evaluation system will be used to judge the overall quality of evidence supporting outcomes in this work. Data analysis was performed using Reviewer Manager 5.4. The results of this systematic review will be published in a peer-reviewed journal. This systematic review will provide evidence to judge whether Janus kinase inhibitors is superior to leflunomide in patients with in rheumatoid arthritis.

Acupuncture for treating chronic spinal pain: A systematic review and meta-analysis protocol

Chronic spinal pain is one of the most leading causes of disability among adults worldwide and is associated with significant health care use. The effect of acupuncture on chronic spinal pain seems controversial based on evidence-based perspective. Thus, we performed a protocol for systematic review and meta-analysis to evaluate the effectiveness of acupuncture for treatment of chronic spinal pain. This systematic review has been registered in PROSPERO (CRD42019120665), which will be conducted in accordance with preferred reporting items for systematic review and meta-analysis protocols 2015 statement. We will search 7 electronic databases to identify relevant studies from inception to November, 2022, which includes PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database. Cochrane "bias risk" tool is used to assess the bias risk of the quality of the included literature. RevMan V.5.3 software will be used to analyze all data. A synthesis of current evidence of acupuncture for treating chronic spinal pain will be provided in this protocol. This review will provide directions and recommendations for future research and clinical practices of acupuncture for treating chronic spinal pain.

The efficacy and safety of platinum-based chemotherapy for ovarian cancer in pregnancy: A protocol for systematic review and meta-analysis.

Ovarian cancer during pregnancy is a rare event. Little is known about the treatment of this condition due to lack of high level evidence. Therefore, we performed a protocol for systematic review and meta-analysis to evaluate the efficacy and safety of platinum-based chemotherapy for the treatment of ovarian cancer during pregnancy. This systematic review has been registered in PROSPERO (CRD42022370709), which will be conducted in accordance with preferred reporting items for systematic review and meta-analysis protocols 2015 statement. We will search 7 electronic databases to identify relevant studies from inception to October, 2022, which includes PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database. The Cochrane Handbook for systematic reviews of interventions will be performed to assess a broad category of biases in the included studies. The Grading of Recommendations Assessment, Development and Evaluation system will be used to judge the overall quality of evidence supporting outcomes in this work. Data are analyzed with the Review Manager Version 5.3 software. The results of this meta-analysis would be submitted to peer-reviewed journals for publication. This paper will provide high-quality synthesis to assess the efficacy and safety of platinum-based chemotherapy for ovarian cancer in pregnancy.

The role of [18F]FDG-PET/CT in gram-positive and gram-negative bacteraemia: A systematic review.

Bacteraemia is associated with significant morbidity and mortality. [18F]FDG-PET/CT is increasingly used to detect infectious metastatic foci, however there remains international variation in its use. We performed a systematic review assessing the impact of [18F]FDG-PET/CT in adult inpatients with gram-positive and Gram-negative bacteraemia. The systematic review was performed according to PRISMA guidelines. Studies published between 2009 and December 2021 were searched in MEDLINE, EMBASE and Cochrane clinical trials database. Data extraction and quality assessment was performed using ROBINS-I and GRADE. Eligible study designs included randomised-controlled trials, clinically-controlled trials, prospective trials, retrospective trials, case-control studies, and non-controlled studies. Studies solely assessing adult inpatients with blood-culture confirmed bacteraemia with one cohort of patients receiving [18F]FDG-PET/CT were included. primary outcomes were mortality, identification of metastatic foci and relapse rate. Studies not examining any of the pre-specified outcomes were excluded. Ten studies were included, of which five had a non-PET/CT control arm. Overall, there was low quality of evidence that [18F]FDG-PET/CT is associated with reduced mortality, improved identification of metastatic foci and reduced relapse rate. Six studies assessed Staphylococcus aureus bacteraemia (SAB) only; nine studies included Gram-positive bacteraemia only, and one study included data from Gram-negative bacteraemia. Two studies compared outcomes between patients with different types of bacteraemia. Four studies identified a statistically significant difference in mortality in [18F]FDG-PET/CT recipients and controls. Relapse rate was significantly reduced in patients with SAB who received [18F]FDG-PET/CT. Studies identified significantly higher detection of metastatic foci in [18F]FDG-PET/CT recipients compared to controls. [18F]FDG-PET/CT was the first to identify an infectious site in 35.5% to 67.2% of overall foci identified. Further research is required to establish the role of [18F]FDG-PET/CT in bacteraemia, and its impact on management and mortality.

Can Hyperbaric Oxygen Therapy Be Used to Treat Children after COVID-19? A Bibliographic Review.

The coronavirus disease (COVID-19) epidemic is a public health emergency of international concern. It was believed that SARS-CoV-2 virus was much less likely affect children. Statistics show that children account for 2-13% of all COVID-19 patients in individual countries. In the youngest population, acute respiratory failure is not as serious a problem as complications after COVID-19, mainly pediatric inflammatory multisystem syndrome (PIMS, MIS-C). This study used a bibliography review. The Medline database (using the PubMed platform) and the Cochrane Clinical Trials database were searched using the following keywords: hyperbaric oxygen therapy for children, treatment of children with COVID-19, and use of HBOT in the treatment of children following COVID-19. Thirteen publications that quantitatively and qualitatively described the efficacy of HBOT application in the treatment of pediatric diseases were eligible among the studies; those relating to the use of HBOT in the treatment of children with COVID-19 and its complications were not found. The bibliographic review showed that hyperbaric oxygen therapy can be used in the treatment of children after carbon monoxide poisoning, with soft tissue necrosis, bone necrosis, after burns, or after skin transplant. No evidence supported by research has been found in scientific journals on the effectiveness of the use of hyperbaric oxygen therapy in children with a history of COVID-19 infection. Research data are needed to develop evidence-driven strategies with regard to the use of HBOT therapy in the treatment of children and to reduce the number of pediatric patients suffering because of complications after COVID-19.

Noninvasive electrical stimulation as an adjunct to fusion procedures: a systematic review and meta-analysis.

Noninvasive electrical stimulation represents a distinct group of devices used to augment fusion rates. However, data regarding outcomes of noninvasive electrical stimulation have come from a small number of studies. The goal of this systematic review and meta-analysis was to determine outcomes of noninvasive electrical stimulation used as an adjunct to fusion procedures to improve rates of successful fusion. PubMed, Embase, and the Cochrane Clinical Trials database were searched according to search strategy and PRISMA guidelines. Random-effects meta-analyses of fusion rates with the three main modalities of noninvasive electrical stimulation, capacitively coupled stimulation (CCS), pulsed electromagnetic fields (PEMFs), and combined magnetic fields (CMFs), were conducted using R version 4.1.0 (The R Foundation for Statistical Computing). Both retrospective studies and clinical trials were included. Animal studies were excluded. Risk-of-bias analysis was performed with the Risk of Bias 2 (RoB 2) and Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tools. Searches of PubMed, Embase, and the Cochrane Clinical Trials database identified 8 articles with 1216 participants meeting criteria from 213 initial results. There was a high overall risk of bias identified for the majority of randomized studies. No meta-analysis could be performed for CCS as only 1 study was identified. Meta-analysis of 6 studies of fusion rates in PEMF did not find any difference between treatment and control groups (OR 1.89, 95% CI 0.36-9.80, p = 0.449). Meta-analysis of 2 studies of CMF found no difference in fusion rates between control and treatment groups (OR 0.90, 95% CI 0.07-11.93, p = 0.939). Subgroup analysis of PEMF was limited given the small number of studies and patients, although significantly increased fusion rates were seen in some subgroups. This meta-analysis of clinical outcomes and fusion rates in noninvasive electrical stimulation compared to no stimulation did not identify any increases in fusion rates for any modality. A high degree of heterogeneity between studies was noted. Although subgroup analysis identified significant differences in fusion rates in certain groups, these findings were based on a small number of studies and further research is needed. This analysis does not support routine use of these devices to augment fusion rates, although the data are limited by a high risk of bias and a small number of available studies.

The better surgical timing and approach for orbital fracture: a systematic review and meta-analysis.

BackgroundA large number of empirical studies on the surgical timing and approach of orbital fracture have been published, but which surgical timing and approach is better is still a dispute. We use a systematic review and meta-analysis to solve this problem.MethodsWe performed a systematic search in the databases of PubMed, Cochrane Clinical Trials Database, Embase, and Web of Science for relevant literature. The search terms included those concerning or describing orbital fracture, timing, and approach, which are based on population, intervention, control, outcome, and study (PICOS) framework. The statistical software packages RevMan 5.4 and Stata 14.0 were used for data analysis. We sought to evaluate postoperative complications, and results were expressed as odds ratio (OR) with 95% confidence interval (CI). Forest plots, sensitivity analysis, funnel plots, Egger’s test, and risk bias analysis were also performed on the included articles by using the Newcastle-Ottawa scale (NOS).ResultsA total of 7 trials involving 1,283 patients compared the surgical timing of ≤14 days versus >14 days, and another 14 trials involving 1,768 patients compared the surgical strategy of transconjunctival approach (TCA) with that of subciliary approach (SCA) for orbital fracture. The quality of all articles was higher than 7 points, which means all articles were at low risk of bias. Surgery conducted within 14 days significantly reduced the incidence of diplopia (OR: 0.53, 95% CI: 0.34 to 0.83, P=0.005) and enophthalmos (OR: 0.32, 95% CI: 0.12 to 0.83, P=0.02); TCA had a significantly lower incidence of ectropion (OR: 0.20, 95% CI: 0.10 to 0.38, P<0.00001), scleral show (OR: 0.22, 95% CI: 0.12 to 0.38, P<0.00001), and visible scar (OR: 0.15, 95% CI: 0.03 to 0.65, P=0.33) compared to SCA, but had a significantly higher incidence of entropion (OR: 5.41, 95% CI: 1.83 to 15.96, P=0.002). There was no significant publication bias among our included studies.ConclusionsThe operation in ≤14 days is better than that in >14 days. However, regarding the choice of surgical approach, TCA and SCA have their advantages and disadvantages, the exploration of which requires further research.

The Efficacy of Adjuvant Targeted Therapy in Patients with Advanced Renal Cell Carcinoma: A Systematic Review and Meta-Analysis.

Background The aim of this systematic evaluation and meta-analysis was to analyze the efficacy and adverse effects of adjuvant targeted therapy regimens in advanced or metastatic renal cell carcinoma (RCC). Methods Studies eligible for the efficacy of adjuvant targeted therapy regimens in advanced or metastatic RCC published before December 2021 in PubMed, Embase, Cochrane Clinical Trials Database (CENTRAL), and Web of Science were searched for (1) patients with locally advanced renal cell carcinoma (RCC) who received adjuvant postoperative targeted therapy versus those not receiving active treatment; (2) primary endpoint outcomes of disease-free survival (DFS), overall survival (OS), and adverse events (AEs); and (3) design: randomized controlled trial (RCT) as inclusion criteria. Data on DFS and OS were extracted or recalculated by meta-analysis as hazard ratios (HRs), and AEs were compared using a dominance ratio (OR). Result This systematic evaluation will provide evidence on the effectiveness and adverse effects of adjuvant targeted therapy in patients with advanced RCC. The results of meta-analysis showed that all of the three adjuvant targeted therapeutic drugs (sorafenib, sunitinib, and pazopanib) did not benefit from the adjuvant targeted therapy for DFS and OS and even increase the incidence of AEs compared to the placebo. Conclusions The aim of this study was to summarize data on DFS, OS, and AEs in patients with advanced RCC treated with targeted therapies. The evidence provided by this systematic evaluation and meta-analysis will help guide clinical decision-making and provide insight into the future management of patients with advanced RCC.

Outcomes of Telehealth for Wound Care: A Scoping Review.

To synthesize the literature on delivering wound care via telehealth and compare clinical, healthcare utilization, and cost outcomes when wound care is provided via telehealth (telewound) modalities compared with in-person care. An electronic search of PubMed, CINAHL, and Cochrane Clinical Trials databases for articles published from 1999 to 2019 was conducted using the following MeSH search terms: telewound, wound, wound care, remote care, telehealth, telemedicine, eHealth, mobile health, pressure injury, and ulcer. Articles were included if they were a scientific report of a single study; evaluated a telehealth method; identified the type of wound of focus; and provided data on clinical, healthcare utilization, or cost outcomes of telewound care. In total, 26 articles met these criteria. Data were extracted and grouped into 13 categories, including study design, wound type, telehealth modality, treatment intervention, and outcomes measured, among others. Of the 26 studies, 19 reported on clinical outcomes including overall healing and healing time; 17 studies reported on healthcare utilization including hospitalizations and length of stay; and 12 studies reported costs. Evidence regarding the use of telewound care is weak, and findings related to the impact of telewound care on outcomes are inconsistent but indicate that it is not inferior to in-person care. Greater use of telehealth as a result of the COVID-19 pandemic points to further development of navigation and education models of telehealth for wound care. However, additional studies using rigorous research design and leveraging robust sample sizes are needed to demonstrate value.

Meta-Analysis of Catheter Ablation versus Medical Therapy for Heart Failure Complicated with Atrial Fibrillation.

Objective To compare the efficacy of catheter ablation and medical therapy in patients with heart failure and atrial fibrillation. Methods We searched randomized controlled trials comparing catheter ablation versus medical therapy for heart failure and atrial fibrillation through PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, and China National Knowledge Infrastructure. Articles were investigated for their methodological quality using the Cochrane Collaboration risk of the bias assessment tool. Forest plots, funnel plots, and sensitivity analysis were also performed on the included articles. Results were expressed as risk ratio (RR) and mean difference (MD) with 95% confidence intervals. Results Nine (9) studies were included in this study with 1131 patients. Meta-analysis showed a reduction in all-cause mortality from catheter ablation compared with medical therapy (RR = 0.53, 95% CI = 0.37 to 0.76; P=0.0007) and improved left ventricular ejection fraction (LVEF) (MD = 6.45, 95% CI = 3.49 to 9.41; P < 0.0001), 6-minute walking time (6MWT) (MD = 28.32, 95% CI = 17.77 to 38.87; P < 0.0001), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (MD = 8.19, 95% CI = 0.30 to 16.08; P=0.04). Conclusion Catheter ablation had a better improvement than medical treatment in left ventricular ejection fraction, cardiac function, and exercise ability for atrial fibrillation and heart failure patients.

Prevalence and risk factors associated with repeat positive SARS-CoV-2 nucleic acid test results among discharged COVID-19 patients: A protocol for systematic review and meta-analysis.

Background:The COVID-19 (coronavirus disease 2019) pandemic continues to have an immense impact on the world at large. COVID-19 patients who meet the discharge criteria, may subsequently exhibit positive viral RNA test results upon subsequent evaluation. This phenomenon has been a major source of research and public health interest, and poses a major challenge to COVID-19 prevention, treatment, and standardized patient management.Methods:We will search the PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, China National Knowledge Infrastructure, Wanfang Database, Chinese Science Journal Database, and China Biology Medicine databases for all studies published as of November 2021. Data will be extracted independently by two researchers according to the eligibility criteria. Finally, RevMan 5.3.0 will be implemented for statistical analyses.Results:The results of this study will show the prevalence and risk factors associated with repeat positive SARS-CoV-2 nucleic acid test results among discharged COVID-19 patients.Conclusions:This study will provide a reliable evidence-based for the prevalence and risk factors associated with repeat positive SARS-CoV-2 nucleic acid test results among discharged COVID-19 patients.Trial registration number:CRD42021272447.

Results of Gastrojejunal Plication for Inadequate Weight Loss follow Roux-en-Y Gastric Bypass

Abstract Background Obesity is a serious global epidemic and poses a significant health threat to humans. The prevalence of obesity is increasing not only in adults, but also among children and adolescents. Non-operative treatment of obesity has commonly been ineffective, and bariatric surgery has been shown to be effective in achieving substantial weight loss and improving obesity related comorbidities in the long-term. Aim of the Work Our objective in this study is to assess the effectiveness of Gastro-jejunal stomal plication (GJP) for inadequate weight loss follow Roux-en-Y gastric bypass surgery (RYGB). Patients and Methods The study will use the following search tools and databases: PubMed, Google Scholar, Cochrane Clinical Trials Database, Cochrane Review Database, EMBASE, and Allied and Complementary Medicine. Search terms included Revisional Surgery, inadequate weight loss And Roux en Y gastric bypass, then gastro-jejunal plication. These studies were published from (2009-2017). Results Eleven studies were included and these studies worked on 420 patients. Comparisons between these were done according to age, sex, time interval between (RYGB) &amp; GJP, weight loss after GJP, laparoscopic vs open technique and overall complications of revisional surgery (GJP). Conclusion The exact reasons for weight loss failure after RYGB remain incompletely elucidated and are probably multifactorial. Pouch resizing could be a valuable option for weight loss failure or regain in selected patients with a dilated gastric pouch after RYGB in the short term. Careful selection of candidates for this procedure through psychiatric and nutritional evaluations and volumetric measures of the gastric pouch, preferably using CT, is mandatory to identify those patients most likely to benefit from revision.

Burden of illness in infants and young children hospitalized for respiratory syncytial virus: A rapid review.

Respiratory syncytial virus (RSV) infections are common among young children and represent a significant burden to patients, their families and the Canadian health system. Here we conduct a rapid review of the burden of RSV illness in children 24 months of age or younger. Four databases (Medline, Embase, Cochrane Database of Clinical Trials, ClinicalTrials.gov from 2014 to 2018), grey literature and reference lists were reviewed for studies on the following: children with or without a risk factor, without prophylaxis and with lab-confirmed RSV infection. Of 29 studies identified, 10 provided within-study comparisons and few examined clinical conditions besides prematurity. For infants of 33-36 weeks gestation (wGA) versus term infants, there was low-to-moderate certainty evidence for an increase in RSV-hospitalizations (n=599,535 infants; RR 2.05 [95% CI 1.89-2.22]; 1.3 more per 100 [1.1-1.5 more]) and hospital length of stay (n=7,597 infants; mean difference 1.00 day [95% CI 0.88-1.12]). There was low-to-moderate certainty evidence of little-to-no difference for infants born at 29-32 versus 33-36 wGA for hospitalization (n=12,812 infants; RR 1.20 [95% CI 0.92-1.56]). There was low certainty evidence of increased mechanical ventilation for hospitalized infants born at 29-32 versus 33-35 wGA (n=212 infants; RR 1.58, 95% CI 0.94-2.65). Among infants born at 32-35 wGA, hospitalization for RSV in infancy may be associated with increased wheeze and asthma-medication use across six-year follow-up (RR range 1.3-1.7). Children with versus without Down syndrome may have increased hospital length of stay (n=7,206 children; mean difference 3.00 days, 95% CI 1.95-4.05; low certainty). Evidence for other within-study comparisons was of very low certainty. In summary, prematurity is associated with greater risk for RSV-hospitalization and longer hospital length of stay, and Down syndrome may be associated with longer hospital stay for RSV. Respiratory syncytial virus-hospitalization in infancy may be associated with greater wheeze and asthma-medication use in early childhood. Lack of a comparison group was a major limitation for many studies.

Sodium Valproate Versus Dopamine Antagonists for Acute Migraine in the Emergency Department: A Systematic Review.

Migraine is a common primary headache disorder diagnosed in the emergency department (ED). This systematic review sought to compare the efficacy of sodium valproate (SV) to dopamine antagonists (DA) in relieving pain due to acute migraine. Two research librarians helped create a search strategy including Embase, Ovid Medline, and the Cochrane Database of Clinical Trials from inception to June 1, 2020, updated May 19, 2021. Two investigators identified randomized control trials (RCTs) including adult patients with acute migraine presenting to the ED or acute clinical setting comparing SV to a DA with the aim of relieving pain. Primary outcome was headache relief at 1 hour from treatment. Secondary outcomes included pain relief at 24 hours, relief of associated symptoms (e.g. nausea, photo-/phonophobia, etc.), and need for rescue analgesia. Meta-analysis was performed and presented as odds ratios. Four RCTs with 470 patients were identified from an initial pool of 454 titles. Two studies compared SV to a DA alone and two compared SV to a DA plus one other agent (sumatriptan or dihydroergotamine). Three studies were included for meta-analysis. Pain relief had a pooled odds ratio of 1.14 at 1 hour and 0.42 at 24 hours. Three articles reporting the need for rescue analgesia had pooled odds ratio of 2.76. Sodium valproate is not more effective than DA at reducing migraine headache pain at 1 hour and less effective at 24 hours. Dopamine antagonists should be used over SV for the management of patients with acute migraine.