Medical Literature Research Articles

Umeclidinium plus vilanterol versus fluticasone propionate plus salmeterol for chronic obstructive pulmonary disease: a meta-analysis of randomized, controlled trials.

Umeclidinium plus vilanterol (UMEC/VI) is an inhaled long-acting muscarinic antagonist/long-acting beta2-agonist (LAMA/LABA), recently approved as once-daily maintenance therapy for chronic obstructive pulmonary disease (COPD). This meta-analysis aims to assess the efficacy and safety of UMEC/VI compared with fluticasone propionate plus salmeterol (FP/SAL). A systematic search was conducted by a trained medical research librarian across MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Chinese Biomedical Literature Database (CBM) for randomized controlled trials comparing UMEC/VI with FP/SAL in COPD patients. Two reviewers independently assessed the risk of bias and extracted data. The primary outcome was 0-24h weighted mean (wm) forced expiratory volume in the first second (FEV1), trough FEV1. The secondary outcomes were other lung functions, symptoms, quality of life, and safety. Three studies with 2119 patients were included in the meta-analysis. UMEC/VI showed improvement in 0-24h wm FEV1 (mean difference (MD) 0.08L, 95% confidence interval (CI) 0.06 to 0.10, P < 0.01, moderate quality) and trough FEV1 (MD 0.09L, 95% CI 0.07 to 0.11, P < 0.01, moderate quality) in comparison with FP/SAL. UMEC/VI statistically significantly improved all other lung functions compared with FP/SAL. However, there were no significant differences between UMEC/VI and FP/SAL in rescue-medication use, symptomatic endpoints, and health outcomes. UMEC/VI also demonstrated fewer drug-related adverse effects (risk ratio 0.47, 95% CI 0.27 to 0.82, P = 0.01, low quality). UMEC/VI, when compared with FP/SAL, demonstrated significant improvements in lung functions with fewer drug-related adverse effects. However, the conclusion was limited by the scarcity of studies and long-term trials.

Percutaneous cholecystostomy in acute complicated versus uncomplicated cholecystitis; is there a difference in outcomes? A single-center experience.

Percutaneous cholecystostomy (PC) is a therapeutic intervention for acute cholecystitis. The benefits of cholecystostomy have been demonstrated in the medical literature, with up to 90% of acute cholecystitis cases shown to resolve postoperatively, and only 40% of patients subsequently undergoing an interval cholecystectomy. To compare the survival outcomes between acute complicated and uncomplicated cholecystitis in patients undergoing PC as an initial intervention, as there is a paucity of evidence in the literature on this perspective. A retrospective search was conducted of all patients who underwent PC for acute cholecystitis between August 2016 and December 2020 at a tertiary institution. A total of 100 patients were included in this study. The outcome, in the form of 30-day mortality, 90-day mortality, being alive after six months, and reintervention, was compared between complicated and uncomplicated cases using the chi-square test or Fisher's exact test. There was no statistically significant difference in any of the compared outcomes. The only variable that showed a statistically significant association with the risk of mortality was acute kidney injury (AKI) at admission. Patients who had stage 1, 2, or 3 AKI had a higher hazard for mortality as compared to patients with no kidney disease. Our results demonstrate that PC is a safe and effective procedure. Mortality is not affected by the presence of complications. The results have, however, highlighted the importance of recognizing and treating AKI, an independent risk factor affecting mortality.

Coenzyme Q10 and Autoimmune Disorders: An Overview.

Some 90 autoimmune disorders have been described in medical literature, affecting most of the tissues within the body. Autoimmune disorders may be difficult to treat, and there is a need to develop novel therapeutic strategies for these disorders. Autoimmune disorders are characterised by mitochondrial dysfunction, oxidative stress, and inflammation; there is therefore a rationale for a role for coenzyme Q10 in the management of these disorders, on the basis of its key role in normal mitochondrial function, as an antioxidant, and as an anti-inflammatory agent. In this article, we have therefore reviewed the potential role of CoQ10, in terms of both deficiency and/or supplementation, in a range of autoimmune disorders.

Lumbosacral transitional vertebrae in children and adolescents (literature review, illustrated with clinical observations)

Introduction An analysis of the medical literature devoted to various aspects of transitional lumbosacral vertebrae shows that there are very few publications covering the course of this disease in the pediatric and adolescent population.Aim To study the issues of epidemiology, diagnosis, treatment and prevention of transitional lumbosacral vertebrae in paediatric and adolescent patients based on the analysis of current medical literature and illustrate the material with our own clinical observations.Material and methods To analyze the literature on the topic, 75 papers published between 1984 and 2023 were selected. Among them, there were 7 (9.3 %) domestic literary sources, 68 (90.7 %) were foreign. In the process of searching for scientific articles, the resources of the electronic databases of current medical information PubMed and CyberLeninka were used.Results and discussion The incidence of transitional vertebrae in children and adolescents is 16.8 % of clinical observations, as reported. In the structure of the transitional vertebrae in children, type II of the disease predominates according to the classification Castellvi et al (1984), 43.2 % of cases. The main clinical symptom of the pathology is pain of lumbosacral location, the intensity of which on the visual analog scale in children corresponds to an average of 3.0 points. In adult patients with similar pathology, the average pain intensity measured with the same scale is 7.5 points. The most informative method for diagnosing the disease is computed tomography, which allows obtaining both 3D images and sections at the level of pseudarthrosis between the enlarged transverse process (or processes) of the suprasacral vertebra and the wing of the sacrum. To relieve pain in children with transitional vertebrae, both conservative and surgical methods are used. The most commonly used procedure is pseudarthrectomy. The study of long-term results one year after the intervention allowed us to record the absence of pain in children who underwent surgery. Prevention measures for transitional lumbosacral vertebrae have not been developed.Conclusion The analysis of the published literature shows that transitional vertebrae are a frequently diagnosed pathology in children and adolescents. Current methods of imaging are able to accurately detect not only the presence of the disease, but also to differentiate its type. The main clinical symptom of transitional vertebrae is pain in the lumbosacral spine which is difficult to relieve with conservative therapy. Pseudarthrectomy is the most frequent surgical method of treatment in children and adolescents that provides stable relief of vertebrogenic pain syndrome. Measures for specific prevention of the disease have not been developed.

Bullous pemphigoid and lichen planus pemphigoides in monozygotic twins with a long-standing history of psoriasis.

In the medical literature, occurrence of pemphigoid diseases in twins has rarely been reported in the literature. We report identical twins with a long-standing history of psoriasis who developed in their third decades bullous pemphigoid (BP) and lichen planus pemphigoides (LPP), respectively.

Orthopaedic complications of hemiparetic forms of cerebral palsy: problems of the lower extremities (literature review)

Introduction Spastic hemiplegia (a unilateral neurological disorder) is encountered more often in full-term infants. In most cases, the cause of the condition is intrauterine or perinatal stroke. Children with hemiparetic forms maintain cognitive and functional capabilities in combination with the ability to move independently. Among other forms of cerebral palsy, hemiparetic spastic forms range from 10.4 to 15.3 %. Types with mild motor impairments predominate according to the Gross Motor Function Classification System: 87.8 % are level I GMFCS, 7.1 % are level II GMFCS.The purpose of the work was to summarize information on the use of orthopaedic interventions for hemiparetic forms of cerebral palsy, both from the point of view of their planning and completeness of correction of anatomical disorders including lower limb length discrepancy, and assessment of functional results based on gait analysis.Materials and methods The search for publications was carried out in open electronic sources of medical literature PubMed, eLIBRARY, Scopus, Elsevier, Springer, Research Gate with a search depth of 20 years (2002–2022). The following inclusion criteria were used: systematic reviews of the literature, review articles, cohort studies on the topic of multilevel interventions for hemiparetic types of cerebral palsy.Results and discussion Lower limb length discrepancy of 1 cm or more affects the kinematics of the affected and intact contralateral limb. The unaffected limb is characterized by a compensatory flexion in the hip and knee joints and excessive dorsal flexion in the stance phase. On the affected side, the contribution of shortening to the development of pathological kinematics of the pelvis and spine is especially important. There is a high probability of equinus contracture after surgical correction due to unresolved discrepancy in the length of the lower extremities. Methods for correcting length discrepancy are conservative (compensation with shoes), and surgical lengthening of the lower leg, epiphyseodesis of the contralateral limb, shortening of the contralateral limb. There is no opinion in the literature about the preference of this or that method, and on the necessary magnitude of limb length correction.Conclusion The assessment of limb length discrepancy and contribution of this orthopaedic component to systemic movement disorders in spastic hemiparesis is based on computed tomography or magnetic resonance imaging, as well as on computer gait analysis. In the literature, the issue of limb length correction is considered separately from the complex of other orthopaedic interventions, while the features of correction with regard to spontaneous growth potential or after growth completion have not been defined. The advantage of equalizing the limb length in children with temporary epiphyseodesis over distraction osteogenesis is only supposed. There is not enough data on the effect of the limb length correction magnitude in patients with spastic hemiplegia on the parameters of computer gait analysis.

Inside the April 2024 Issue.

Dear Readers, We are thrilled to bring you the first issue of the ninth volume of POCUS Journal. Published since 2016, POCUS Journal is the only multi-disciplinary, peer-reviewed, POCUS-focused journal that is free for authors and readers alike. We are grateful for the vision of our founder Dr. Amer and for the support of CINQUILL Medical Publishers, Inc. as we enter our ninth year of publication. POCUS is an ever-changing field as clinicians seek out better and faster solutions for patient care at the bedside. We at POCUS Journal continue to evolve as well. Our editorial board is growing to meet the demands of our high volume and high-quality manuscript submissions. We welcome Dr. Andre Kumar of Stanford University and Dr. Manpreet Malik of Emory University to the Internal Medicine section. We also welcome Dr. Andrea of the University of Southern California to the Pediatrics section. Natalie joins us from Queen’s University as the Social media Editor. If you haven’t seen her high-yield on social media I highly encourage you to visit POCUS Journal on X and Instagram for summaries of research articles and other content published in our journal. A journal our size also needs help with statistics, and we are excited that Nicholas has joined our team from the University of Toronto as Statistical Editor. We also have a new Editorial Director of Artificial Intelligence, Dr. Bredon Crawford. We are the first journal to feature an AI bot on our website, which is thanks to Dr. Crawford. Its name is “PJ” and you can find it on the bottom right of our website: www.pocusjournal.com. And finally, we are excited to have had Kathryn Matsushita join our team as , helping us preserve our standard of high quality publishing as the volume of submitted articles and size of our issues continues to grow. With the addition of these new members, I also share the bittersweet news that our Managing Editor Braeden Hill will be leaving POCUS Journal to pursue MD/PhD studies at The University of Toronto. started at POCUS Journal in 2020 as Social Media Editor and his contributions these past few years have been remarkable. We welcome Laura Guzman of Queen’s University into the role of Managing Editor. Every issue I oversee at POCUS Journal strikes me as better than the last, with fascinating cases and important research that answers key questions related to point of care ultrasound. This issue is no exception. Please find our author guidelines here: https://pocusjournal.com/author-guidelines/ Sincerely, Benjamin T. Galen, MD Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY Editor-In-Chief POCUS Journal

Art therapies and cognitive function in elderly with subjective cognitive decline: a protocol for a network meta-analysis

IntroductionSubjective cognitive decline means a decline in the subjective perception of self-cognitive function, which is likely to evolve into mild cognitive impairment and dementia. The number of elderly with subjective...

Allergic Contact Dermatitis: Causes, Symptoms, and Specific Therapies

Objective: The present study aims to deepen understanding of Allergic Contact Dermatitis (ACD), exploring its etiology, immunological mechanisms, diagnostic methods, and updated therapeutic strategies to improve treatment and quality of life for patients. Theoretical Framework: The research is grounded in studies of the immunological processes involved in ACD, with an emphasis on the sensitization of memory T lymphocytes, and the diversity of causative agents, ranging from chemicals to natural substances. Method: A methodological approach that includes a systematic literature review and analysis of relevant case studies was adopted, with special attention to the use of the patch test as a diagnostic tool for identifying specific allergens. Results and Discussion: The findings highlight the importance of accurate diagnosis and correct identification of allergens via patch test, which are essential for effective disease management. Therapeutic options discussed range from topical corticosteroids to antihistamines, adjusted according to the severity of clinical manifestations. Research Implications: This study underscores the importance of a multidisciplinary and evidence-based management approach in addressing ACD, integrating the latest scientific advances into daily clinical practices. Originality/Value: The original contribution of this article lies in the integrative analysis and detailed practical recommendations for the treatment of ACD, providing new perspectives for the medical literature and clinical treatment of this complex condition.

The Disregard for the Use of Standardized Keywords in Turkish Medical Publishing

In Turkey, many medical academic journals require keywords to comply with "MeSH"(Medical Subject Headings) among their writing guidelines. However, there is currently no program or shortcut available to check the compatibility of Turkish language keywords or their English equivalents with MeSH. The purpose of this study is to determine and report the extent to which keywords used in the articles we examine are equivalent in MeSH. This study was conducted within the “DergiPark” system, which significantly supports national academic publishing. The scanning was completed between September and December 2023 by two researchers. The research focused on publications between January 1, 2022, and December 31,2022, encompassing a total of 43 journals and 1743 articles. Selection criteria for journals included a minimum of 3 years of academic publishing, issuance of at least 3 editions in 2022, printing of a minimum of 4 original articles per issue, and having English abstracts and keywords. Only those adhering to eligibility criteria in the scanned journals and publications were included in the study. Three types of articles were examined: original articles, case report, and review. The study found that 376 of the 1743 articles were 100% compatible with MeSH. In Turkish articles, it was found that there was a higher MeSH compliance compared to English articles. As a result, the research reveals the fact that the keywords of many articles do not comply with the MeSH terms. The study emphasizes the possible consequences of disregarding MeSH indexing rules.

Management of oronasal fistula using L-PRF and palatal flap due to residual cyst in maxilla: A case report

Study Design: Case Report. Oronasal communication can be a result of congenital disorders, pathological lesions, or inadequate treatment. It consists of abnormal communication between the nasal and oral cavities. Objective: This paper aims to present a case report of a female patient who intended for dental implants but was referred to the maxillofacial surgery department presenting a cone beam computed tomography with incidental finding in the anterior part of the maxilla. Methods: The first surgical procedure consisted of the resection of the lesion associated with bone graft with buccal fat pad flap and posterior histopathological study. After three months the patient developed an oronasal fistula. During the second surgical management, the authors chose platelet concentrates (L-PRF) to fill the bone defects associated with the palatal flap. Results: After one year of follow-up, the patient presented definitive soft tissue healing, no exposure of bone tissue, and the closure of oronasal communication. The new CT scan and panoramic x-ray showed satisfactory bone healing. Conclusion: The present study demonstrated the association of L-PRF with xenograft and palatal flap can be a viable method for the management of patients with oronasal fistula. This report adheres to the SCARE guidelines for the reporting of surgical cases in medical literature.

Multi-label text classification of cardiovascular drug attributes based on BERT and BiGRU

Extracting and digitizing drug attributes from medical literature is the first step to build a knowledge computing system for precision disease treatment. In order to build a cardiovascular drug knowledge base, this paper proposes a multi-label text classification method for cardiovascular drug attributes from the Chinese drug guideline. The drug attributes are characterized by a BERT pre-trained model, and a dual-feature extraction structure is proposed based on the BiGRU neural network to capture high-level semantic information. Label categorization of cardiovascular drug attributes, such as indications and mode of administration, is accomplished. The F1 score of 0.8431 was obtained using 5-fold cross-validation. Comparing KNN and Naïve bayes, and conducting CNN and BiGRU control experiments on the basis of Word2Vec characterization of medication guidelines, the proposed multi-label text classification method is effective and the F1 value is significantly improved. Proved by analysis of ablation and crossover experiments, the proposed method can achieve a high accuracy rate averaged at 0.8339.

Pineal gland cyst-to fight or not to fight?

Since professional boxing is associated with substantial risk of both acute and chronic traumatic brain injury, many athletic (boxing) commissions in the United States and abroad request a neuroimaging study of the brain to determine brain fitness to fight. Either magnetic resonance imaging (MRI) brain or computed tomography (CT) head is needed to obtain a license to compete in professional combat sports and periodically thereafter. The neuroimaging study helps to identify and/or exclude structural brain lesions that may pose a risk of rupture or bleeding from head impact exposures (HIEs) sustained during the course of the bout. Identification of structural brain lesions such as large tumors, vascular malformations such as aneurysms, arteriovenous malformations, and large cavernous malformations results in a denial of licensure to fight. Pineal gland cysts (PC) are usually benign cysts discovered on occasions incidentally in MRI scans of boxers. A 25-year-old asymptomatic boxer was found to have a 2 cm PC with intracystic hemorrhage on MRI scan done for licensure. The medical literature was reviewed to determine whether boxers with PC can safety compete in combat sports.

Plasma Concentrations of Tranylcypromine in Depressed Patients With Chronic Kidney Disease: Two Case Reports.

The prevalence of comorbid depression and chronic kidney disease (CKD) is high. The aim of this brief report was to review 2 cases of treatment with tranylcypromine (TCP) in patients with treatment-resistant depression (TRD) and CKD. Tests of the plasma concentration of TCP were included. Medical and psychiatric notes of the 2 patients were reviewed with plasma concentrations of TCP as a key aspect of the discussion. The data are evaluated in the context of relevant medical and pharmacokinetic literature. Plasma concentrations of TCP are highly variable both in patients with and without CKD. Plasma concentrations of TCP were not increased in the 2 cases with CKD as compared with literature data of patients without CKD. No signs of intoxication were detected in 2 cases with CKD that impaired continuous treatment of depression with TCP. TCP may be considered in selected cases of TRD with concomitant CKD. More clinical data and tests of plasma concentrations of TCP are needed in patients with CKD.

Effects of human milk odor stimulation on feeding in premature infants: a systematic review and meta-analysis

Previous studies suggested odor stimulation may influence feeding of premature neonates. Therefore, this systematic review and meta-analysis of randomized controlled trials was conducted to assess the effect of human milk odor stimulation on feeding of premature infants. All randomized controlled trials related to human milk odor stimulation on feeding in premature infants published in PubMed, Cochrane, Library, Medline, Embase, Web of science databases and Chinese biomedical literature databases, China National Knowledge Infrastructure, China Science and Technology Journal Database (VIP) and Wanfang Chinese databases were searched, and The Cochrane Handbook 5.1.0 was used to evaluate the quality and authenticity of the literature. Relevant information of the included studies was extracted and summarized, and the evaluation indexes were analyzed using ReviewManager5.3. The retrieval time was from the establishment of the database to July 28, 2022.12 articles were assessed for eligibility, and six randomized controlled studies were eventually included in the meta-analysis (PRISMA). A total of 6 randomized controlled studies with 763 patients were finally included in the study, and the quality evaluation of literatures were all grade B. Human milk odor stimulation reduced the transition time to oral feeding in premature infants [SMD = − 0.48, 95% CI (− 0.69, − 0.27), Z = 4.54, P < 0.00001] and shortened the duration of parenteral nutrition [MD = − 1.01, 95% CI (− 1.70, − 0.32), Z = 2.88, P = 0.004]. However, it did not change the length of hospitalization for premature infants [MD = − 0.03, 95% CI (− 0.41, 0.35), Z = 0.17, P = 0.86]. The implementation of human milk odor stimulation can reduce the transition time to oral feeding and the duration of parenteral nutrition in premature infants, but further studies are needed to determine whether it can reduce the length of hospital stay in premature infants. More high-quality, large-sample studies are needed to investigate the effect of human milk odor stimulation on the feeding process and other outcomes in premature infants.

Brain Wave Oscillations as an Objective Neurophysiological Biomarker of Homeopathic Subjective Well-Being.

Homeopathy uses the "similitude principle" to arouse a therapeutic reaction in the body against its own disorders. For this to occur optimally, the medicinal pathogenetic effects must present similarity with the totality of the individual's symptoms. To assess if this similarity has been successfully achieved, Hahnemann states that "improvement in the disposition and mind"-i.e., subjective well-being-is the most important parameter to consider. Our aim was to perform a narrative review of the literature, exploring what is known about subjective well-being as a marker of therapeutic action, and to formulate ways in which subjective well-being might be quantifiable and applied in future homeopathy research. The concept of subjective well-being has been extensively studied in the complementary and conventional medical literature. Improved well-being has been observed in clinical trials, including those in the fields of positive psychology and meditation. Positive subjective outcomes of this nature are supported by objective evidence through associated changes in brain oscillatory activity using electroencephalography and/or "brain mapping" by functional magnetic resonance imaging. Neurophysiological responses in the brain have been identified in subjects after they ingested a homeopathic medicine. The concept of subjective well-being is supported by a body of literature and is a measurable entity. When viewed from the perspective of electrophysiological changes, brain activity is an objective neurophysiological biomarker with a potential to quantify individual well-being in the context of homeopathy research.

Factors associated with social determinants of health mentions in PubMed clinical case reports from 1975 to 2022: A natural language processing analysis

Social determinants of health (SDoH) significantly influence health outcomes, accounting for nearly 40% of such outcomes globally. These determinants, pivotal in understanding health disparities, are insufficiently documented in clinical settings and academic clinical narratives. To address this gap, we examined clinical case reports from PubMed (1975&amp;ndash;2022) to identify mentions of six specific SDoH, employing a pre-trained named-entity recognition (NER) model from Spark natural language processing (NLP). Multivariate logistic regression was utilized to investigate associations between article characteristics and the documentation of SDoH. From 463,546 reports, 4.4% mentioned SDoH, with race/ethnicity being the most dominant mention. Race/ethnicity was often cited by sub-Saharan African authors (adjusted odds ratio [AOR]: 4.47) and in general medicine (AOR: 2.18). Marital status mentions appeared predominantly in psychiatry (AOR: 2.60) and gynecology (AOR: 2.47). Sexual orientation mentions were correlated with infectious diseases (AOR: 25.00) and varied by authorship regions, with stronger associations observed in South America (AOR: 4.04) and North America (AOR: 2.15), and comparatively weaker associations noted in the Indian subcontinent and the Middle East (AOR: 0.16). Immigrant status mentions were closely related to infectious diseases (AOR: 4.51), gynecology (AOR: 4.25), and certain geographies. Homelessness mentions were more prominent in forensic medicine (AOR: 14.92) and in both infections (AOR: 6.36) and mental disorders (AOR: 5.80). Spiritual belief mentions were more prominent with sub-Saharan authors (AOR: 9.17) and psychiatry (AOR: 7.61). SDoH mentions in medical literature were also determined by the diagnosis, cultural background, and journal type. The limited SDoH registration emphasized their overlooked significance. Disproportionate emphasis on specific relationships, such as sexual orientation with infectious diseases, can perpetuate biases and stereotypes. Innovative tools such as Spark NLP offer promise in advancing research using electronic health records (EHRs), but a standardized approach to SDoH reporting and vigilant AI training is crucial for unbiased health-care analysis.

Comparison Between the Protective Effect of Isoflurane and Propofol on Myocardium During Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Intravenous non-volatile anaesthetics like propofol are commonly used in cardiac surgeries across several countries. Volatile anaesthetics like isoflurane may help in protecting the myocardium and minimize ischaemia-reperfusion injury. Hence, we did this review to compare the cardioprotective effect of isoflurane and propofol among patients undergoing coronary artery bypass grafting (CABG). We conducted a search in the databases Medical Literature Analysis and Retrieval System Online (or MEDLINE), Embase, PubMed Central®, ScienceDirect, Google Scholar, and Cochrane Library from inception until April 2021. We carried out a meta-analysis with random-effects model and reported pooled risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI) depending on the type of outcome. We analysed 13 studies including 808 participants. Almost all were low-quality studies. For cardiac index, the pooled SMD was 0.14 (95% CI: -0.22 to 0.50); for cardiac troponin I, pooled SMD was 0.10 (95% CI: -0.28 to 0.48). For mortality, the RR was 3.00 (95% CI: 0.32 to 28.43); for MI, pooled RR was 1.58 (95% CI: 0.59 to 4.20); and for inotropic drug use, pooled RR was 1.04 (95% CI: 0.90 to 1.21). For length of intensive care unit stay, the pooled SMD was 0.13 (95% CI: -0.29 to 0.55), while pooled SMD for mechanical ventilation time was -0.02 (95% CI: -0.54 to 0.51). Isoflurane did not have significant cardioprotective effect compared to propofol following CABG. Hence, the anaesthetists need to check some viable alternatives to manage these patients and reduce the rate of postoperative complications.

Machine learning in cardiac stress test interpretation: a systematic review

Abstract Coronary artery disease (CAD) is a leading health challenge worldwide. Exercise stress testing is a foundational non-invasive diagnostic tool. Nonetheless, its variable accuracy prompts the exploration of more reliable methods. Recent advancements in machine learning (ML), including deep learning and natural language processing, have shown potential in refining the interpretation of stress testing data. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of ML applications in stress electrocardiogram (ECG) and stress echocardiography for CAD prognosis. Medical Literature Analysis and Retrieval System Online, Web of Science, and the Cochrane Library were used as databases. We analysed the ML models, outcomes, and performance metrics. Overall, seven relevant studies were identified. Machine-learning applications in stress ECGs resulted in sensitivity and specificity improvements. Some models achieved rates of above 96% in both metrics and reduced false positives by up to 21%. In stress echocardiography, ML models demonstrated an increase in diagnostic precision. Some models achieved specificity and sensitivity rates of up to 92.7 and 84.4%, respectively. Natural language processing applications enabled the categorization of stress echocardiography reports, with accuracy rates nearing 98%. Limitations include a small, retrospective study pool and the exclusion of nuclear stress testing, due to its well-documented status. This review indicates the potential of artificial intelligence applications in refining CAD stress testing assessment. Further development for real-world use is warranted.

Is Incentive Spirometry Superior to Standard Care in Postoperative Cardiac Surgery on Clinical Outcomes and Length of Hospital and Intensive Care Unit Stay? A Systematic Review with Meta-Analysis.

Cardiac surgery is a frequent surgical procedure and may present a high risk of complications. Among the prophylactic strategies studied to decrease the rates of negative outcomes, respiratory care seems to reduce pulmonary complications. Incentive spirometry (IS) is a low-cost, respiratory exercise technique, used for the prevention and treatment of postoperative pulmonary complications (PPC). The aim of this review was to evaluate whether IS is superior to respiratory care, mobilization exercises, and noninvasive ventilation on PPC, and clinical outcomes. Systematic review. Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase®, Cochrane Central Register of Controlled Trials (or CENTRAL), Physiotherapy Evidence Database (or PEDro), Cumulative Index of Nursing and Allied Health (or CINAHL®), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Allied, Scopus®, and OpenGrey databases, clinical trial registration sites, conferences, congresses, and symposiums were searched. Twenty-one randomized trials and one quasi-randomized trial (1,677 participants) were included. For partial pressure of oxygen (PaO2), IS was inferior to respiratory care (mean difference [MD] -4.48; 95% confidence interval [CI] -8.32 to -0.63). Flow-oriented IS was inferior to respiratory care on PaO2 (MD -4.53; 95% CI -8.88 to -0.18). However, compared to respiratory care, flow-oriented IS was superior on recovery vital capacity. This meta-analysis revealed that IS was not superior to standard respiratory care for PPCs and clinical outcomes, therefore its use should not be widely recommended until further studies with high quality be performed to ensure this clinical guidance.