Updated Review Research Articles

Tranexamic acid in endoscopic sinus surgery: an updated systematic review and meta-analysis of randomized controlled trials.

To conduct an updated meta-analysis evaluating the efficacy and safety of tranexamic acid (TXA) versus control during endoscopic sinus surgery. Six databases were screened until July 7, 2024, and the quality of included randomized controlled trials (RCTs) was assessed. Endpoints were summarized as mean difference (MD) with 95% confidence intervals (CIs) using a random-effects model. A total of 23 RCTs, including 29 arms and 1597 patients, were analyzed. The overall quality was rated as low-risk in 15 RCTs, high-risk in five RCTs, and of some concern in three RCTs. TXA significantly reduced intraoperative blood loss (n = 22 arms, MD = -68.87ml, 95% CI -79.66, -58.07) and operative time (n = 21 arms, MD = -13.93min, 95% CI -17.49, -10.37) compared to control. TXA also improved surgical field quality (measured on a 5-point Boezaart scale, n = 22 arms, MD = -0.61, 95% CI -0.88, -0.34) and surgeon satisfaction scores (n = 9 arms, MD = 0.85, 95% CI 0.53, 1.17). No thromboembolic events were reported in either group. Leave-one-out sensitivity analyses confirmed the robustness of all endpoints, and no publication bias was detected. Subgroup analyses by route of administration (intravenous, topical, and oral) showed equal effectiveness. Additionally, analyses by sinus pathology demonstrated effectiveness in patients with severe chronic rhinosinusitis with nasal polyposis (CRSwNP). Trial sequential analysis showed conclusiveness for all outcomes. Perioperative TXA, whether administered systemically or topically, correlates with decreased intraoperative blood loss, shortened operating times, and enhanced surgical visualization compared to control interventions. However, these findings are constrained by significant heterogeneity and varying reporting quality among studies.

Integrated Approaches for the Delivery of Maternal and Child Health Services with Childhood Immunization Programs in Low- and Middle-Income Countries: Systematic Review Update 2011–2020

Background: The integration of maternal and child health services (MCH) with routine immunization is an important global health strategy, particularly in low- and middle-income countries (LMICs). However, evidence is lacking regarding the best practices for service integration and the effect of integration on immunization and linked health service outcomes. Methods: We searched publication databases and gray literature for articles published between 2011 and 2020 that include approaches to integrating MCH services with immunizations during the first two years of life in LMICs. Abstracts and full-text articles were screened for eligibility. For the included articles, data extraction and analysis examined the descriptive characteristics of studies, outcomes, and implementation considerations. Results: Among the 16,578 articles screened, 44 met the criteria for inclusion, representing 34 studies, of which 29 were from Africa. The commonly linked MCH services were family planning (24%), human immunodeficiency virus (HIV) diagnosis or care (21%), and malaria prevention or control (21%). Multiple integration strategies were typically used; the co-location of linked services (65%), the provision of extra services by immunization staff (41%), and/or the provision of extra information by immunization staff (41%) were the most common. In general, integration improved MCH service outcomes (76%) and was either beneficial (55%) or neutral for immunization (35%), with some examples in family planning, malaria, and HIV where integrated services were not beneficial. Important implementation considerations included the careful matching of target populations in service re-design, ensuring support from policy, logistics, and information systems, the provision of adequate training and support of staff to avoid overload, clear client communication regarding service integration, and the need to address community concerns. Conclusions: Integrating MCH services with routine immunization can expand linked services and improve immunization coverage. This study has identified key implementation considerations relevant to both childhood and adult vaccination programs. More research is needed regarding costs and client preferences.

Bempedoic Acid's Chemistry, Pharmacological Characteristics and Bioanalytical Techniques: An Updated Review

Background: Elevated blood cholesterol has been established as a major risk factor for atherosclerotic cardiovascular disease (ASCVD). Adults with hyperlipidemia have a significantly increased risk of developing cardiovascular diseases (CVD). First-line treatments for hyperlipidemia include statins, which help raise HDL-C levels in cases of severe and familial hypercholesterolemia and decrease LDL-C and TG levels. Numerous adverse effects on muscles have been associated with statins, such as asymptomatic elevations in blood creatine kinase activity and potentially fatal rhabdomyolysis. Non-statin drugs are advised for people whose very high cardiovascular risk or heterozygous familial hypercholesterolemia make statin therapy insufficient. A novel lipid-lowering medication with a distinct mode of action is bempedoic acid. Elevated blood cholesterol is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD). Individuals with hyperlipidemia are at a higher risk for developing cardiovascular diseases. Statins are the primary treatment for hyperlipidemia, raising HDL-C levels and lowering LDL-C and TG levels. However, statins can adversely affect muscles, including muscle-related complications like increased blood creatine kinase activity and rhabdomyolysis. Therefore, nonstatin drugs may be recommended for individuals. Bempedoic acid is a brand-new, first-in-class, oral small molecule that inhibits cholesterol manufacturing like statins, consequently reducing lowdensity lipoprotein cholesterol (LDL-C) through activating LDL receptors. Methods: This study offers helpful information on how to utilize bempedoic acid to decrease LDLC, as well as recommendations for which individuals could benefit and safety monitoring tips during therapy. A novel family of drugs called bempedoic acid is identified as a prodrug that becomes bempedoyl- CoA in the liver via an enzyme called very longchain consisting of acyl-CoA synthetase 1. Bempedoic acid can control cholesterol metabolism. Low-density lipoprotein cholesterol levels appeared to be dramatically reduced by bempedoic acid, according to clinical investigations. The toleration of bempedoic acid was good. Results: A cardiovascular outcomes trial is now evaluating bempedoic acid to determine its impact on major cardiovascular events in patients with or at high risk for cardiovascular disease and statin intolerance. Conclusion: This review describes the chemistry, mechanism of action, pharmacokinetics, analytical potential, and safety of bempedoic acid. Bempedoic acid is an effective and often well-tolerated drug used to further reduce LDL-C levels in patients taking the maximum dosage of tolerated statins or to control LDL-C levels in persons who can not take statins. The results of the clear Outcomes research, which is looking into whether bempedoic acid might reduce the frequency of serious cardiovascular events, are expected in 2025.

The Clinical Usefulness of Evaluating the Lens and Intraocular Lenses Using Optical Coherence Tomography: An Updated Literature Review

The Lens Dysfunction Syndrome includes two widespread ocular disorders: presbyopia and cataract. Understanding its etiology, onset, progression, impact, prevention, and treatment remains a significant scientific challenge. The lens is a fundamental structure of the ocular dioptric system that allows for focus adjustment or accommodation to view objects at different distances. Its opacification, primarily related to aging, leads to the development of cataracts. Traditionally, lens alterations have been diagnosed using a slit lamp and later with devices based on the Scheimpflug camera. However, both methods have significant limitations. In recent years, optical coherence tomography (OCT) has become a valuable tool for assessing the lens and pseudophakic intraocular lenses (IOLs) in clinical practice, providing a highly detailed non-invasive evaluation of these structures. Its clinical utility has been described in assessing the shape, location or position, and size of the lens, as well as in determining the degree and type of cataract and its various components. Regarding pseudophakic IOLs, OCT allows for the accurate assessment of their position and centering, as well as for detecting possible complications, including the presence of glistening or IOL opacification. Furthermore, OCT enables the evaluation of the posterior capsule and its associated pathologies, including late capsular distension syndrome. This review highlights the key applications of OCT in the assessment of the lens and pseudophakic IOLs.

Machine learning-assisted literature screening for a medication-use process-related systematic review.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This article summarizes a novel methodology of applying machine learning (ML) algorithms trained with external training data to assist with article screening for 2 annual review series related to the medication-use process (MUP) generally and the MUP in ambulatory care settings (ACMUP) specifically. As the literature review for these 2 series grew over time, it became essential for the authors to develop methods to be efficient while still capturing most of the relevant literature. The ML model can be used to predict whether search results are likely to be relevant or not relevant. Results least likely to be relevant can then be excluded without manual screening, allowing research teams to save time that would otherwise be spent reviewing a portion of the search results for inclusion. ML models require a large training dataset typically derived from the unclassified corpus. In this study, the authors demonstrate the efficacy of training the ML model using external training data, which is possible in scenarios such as a systematic review update or ongoing review series such as those for the MUP and ACMUP. The authors ran 3 simulations using screening decisions from previous publications and in-process manuscripts for the MUP and ACMUP review series to test the efficacy of the approach. The simulations were compared to actual manual screening decisions made by the research teams to include or exclude articles using title and abstract text. For each simulation, the authors developed a training dataset using a sample of screening decisions from previous years to predict article relevance in an "unclassified" corpus. In this case, the screening decisions for the unclassified corpus were actually known, allowing us to calculate recall (percent of relevant articles captured) and time saved using the number of articles that would be excluded without manual review. Combined, the ML approach correctly labeled 187 of 192 relevant studies. The 3 simulations included 17,227 unique studies, and using ML the authors demonstrated that 13,201 studies could have been excluded without manual screening while still maintaining recall of relevant articles of 95% or greater. This novel approach is applicable to systematic reviews and ongoing review series, including those for the MUP and ACMUP. Pharmacists have a duty to review and incorporate best practices into their organizations to improve the efficiency and cost of care, optimally utilize technology, and reduce the potential for medication errors. This methodology will allow evidence syntheses for the MUP and other disciplines in pharmacy practice to be published more expeditiously by saving significant time during the article screening step.

Extracorporeal liver support systems in patients with acute-on-chronic liver failure: An updated systematic review and meta-analysis.

The utilization of extracorporeal liver support systems is increasingly prevalent for the management of acute-on-chronic liver failure in clinical settings. Yet, the efficacy of these interventions in terms of tangible clinical benefits for patients remains a matter of debate, underscoring the need for meta-analysis. An updated meta-analysis was performed to elucidate the relationship between the application of extracorporeal liver support versus standard pharmacological treatment and the prognostic endpoints of patient survival, specifically assessing 1-month and 3-month mortality rates, as well as the incidence of complications such as hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome. Literature were searched via PubMed, EMBASE, and Web of Science. The meta-analysis revealed the following: the odds ratio for 1-month mortality was 0.63 (95% confidence interval [CIs]: 0.51-0.76), for 3-month mortality was 0.70 (95% CI: 0.61-0.81), for hepatic encephalopathy was 0.81 (95% CI: 0.67-0.97), for spontaneous bacterial peritonitis was 0.66 (95% CI: 0.44-0.99), and for hepatorenal syndrome was 0.68 (95% CI: 0.51-0.92). These results suggest that patients with acute-on-chronic liver failure undergoing extracorporeal liver support system therapy have significantly better survival rates and lower complication incidences compared to those receiving conventional drug therapy. Further subgroup analysis indicated that patients with lower model for end-stage liver disease (MELD) scores and reduced total bilirubin (Tbil) levels demonstrated greater benefits from extracorporeal hepatic support. This study establishes that in the management of acute-on-chronic liver failure, extracorporeal liver support systems confer a survival advantage and reduce complications relative to standard pharmacotherapy.

Exosome applications for the diagnosis and treatment of pancreatic ductal adenocarcinoma: An update (Review).

Pancreatic ductal adenocarcinoma (PDAC) is a malignant neoplasm that typically manifests with subtle clinical manifestations in its early stages and frequently eludes diagnosis until the advanced phases of the disease. The limited therapeutic options available for PDAC significantly contribute to its high mortality rate, highlighting the urgent need for novel biomarkers capable of effectively identifying early clinical manifestations and facilitating precise diagnosis. The pivotal role of cellular exosomes in both the pathogenesis and therapeutic interventions for PDAC has been underscored. Furthermore, researchers have acknowledged the potential of exosomes as targeted drug carriers against regulatory cells in treating PDAC. The present article aims to provide a comprehensive review encompassing recent advancements in utilizing exosomes for elucidating mechanisms underlying disease development, patterns of metastasis, diagnostic techniques and treatment strategies associated with PDAC.

Intestinal duplication in an adult presenting as acute small bowel obstruction with malrotation and volvulus: Case report and updated review of the literature

Intestinal duplication in an adult presenting as acute small bowel obstruction with malrotation and volvulus: Case report and updated review of the literature

Prevalence of Dementia in the Geriatric Population Residing in a Long-term Care Facility: An Updated Systematic Review and Meta-Analysis

Background: The global rise in the geriatric population is increasing dementia cases, imposing significant burdens on families and society, making long-term care facilities (LTCFs) essential. Thus, updated dementia prevalence data are crucial for effective health-care planning and policy-making. Methodology: A systematic review and meta-analysis, updating Fagundes et al. (2021), included articles post-August 2, 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were selected based on predefined criteria, and data extraction was independently performed by two reviewers, focusing on dementia prevalence rates, assessment tools used, and regional variations. Meta-analytic techniques estimated pooled dementia prevalence rates and assessed study heterogeneity, focusing on assessment tools and regional variations. Results: The review included 38 studies, with 18 new ones since the previous review. The pooled dementia prevalence in LTCFs was 57.8% (confidence interval 51.63–63.98; P < 0.01), up from 53%. Europe had the highest rate, while other regions showed variability. High heterogeneity suggests diverse factors, such as diagnostic criteria and population characteristics, influence prevalence estimates. Discussion: The rising dementia prevalence in LTCFs highlights the need for specialized care, improved health policies, and resource allocation. Regional prevalence variations may be due to differences in diagnostic criteria, health-care infrastructure, and societal factors, with high heterogeneity reflecting diverse methodologies and populations. Increased public awareness and ongoing research are essential for developing innovative, tailored care models for dementia patients in LTCFs. Conclusion: This updated review shows a higher dementia prevalence in LTCFs, highlighting the need for targeted interventions and policy adjustments to improve care quality and outcomes. Further research is needed to explore regional prevalence factors and develop standardized care practices.

Assessing the impact of calcium ionophore on pregnancy outcomes in artificial oocyte activation cycles: a 10-year update of systematic review and meta-analysis.

The objective is to evaluate the effectiveness and safety of calcium ionophore as an artificial oocyte activation (AOA) method on pregnancy outcomes in different groups of intracytoplasmic sperm injection (ICSI) patients, providing potential evidence to establish consensus on the indications of AOA. A systematic comprehensive search was performed in Medline, Embase, the Cochrane Library, and Google Scholar databases. Studies published from January 2014 to June 2024 were searched for analysis. All studies that compared ICSI with AOA-ICSI in routine indications composing impaired fertilization or embryo developmental arrest in previous cycles, or male-factor infertility were included. Twelve studies were included in the meta-analysis. AOA-ICSI was associated with the increase in the overall fertilization rate (OR 1.99, 95% CI 1.16-3.41) and live birth rate (OR 4.58, 95% CI 1.52-13.80). All secondary outcomes including cleavage, blastocyst, high-quality embryo, implantation, biochemical pregnancy, clinical pregnancy presented superiority or equivalence in AOA-ICSI. And the use of calcium ionophore did not increase the miscarriage rate (OR 0.43, 95% CI 0.08-2.43). In subgroup analysis, AOA-ICSI exhibited a more significant effect on patients with indications of no or low fertilization. However, in patients with non-fertilization factors, no statistically significant improvements were observed in all outcomes. Calcium ionophore is an effective artificial oocyte activation approach to improving pregnancy outcomes after ICSI, particularly in cases with indications of fertilization factors, providing further support for the application of AOA in specific populations. Further validation is needed to comprehensively establish the safety of AOA. PROSPERO registration number CRD42024551481.

The Association Between Cadmium Exposure and Prostate Cancer: An Updated Systematic Review and Meta-Analysis.

Prostate cancer (PCa) is a common cancer among men, and it has a multifactorial etiology. Cadmium (Cd), a toxic heavy metal classified as a carcinogen by the IARC, can cause various acute and chronic effects. This systematic review and meta-analysis aims to update previous findings on the association between Cd exposure and PCa. We carried out a literature search in PubMed, Web of Science, and Scopus up to May 2024, identifying eight new articles. The effect size from the highest and lowest exposure categories were extracted and analyzed using a random-effects model. Heterogeneity was assessed with the I2 test, and publication bias was evaluated using funnel plot asymmetry. Overall, the effect size for PCa associated with Cd exposure, combining previous and new articles, was 1.11 (95% CI 0.85-1.45). Heterogeneity was high, but no significant publication bias was detected. For studies from Europe, the effect size was 1.47 (95% CI 1.00-2.17). Notably, 11 articles from the previous systematic review and meta-analysis highlighted that higher Cd exposure is significantly associated with more aggressive histopathological types of PCa (OR 1.50, 95% CI 1.08-2.07). These findings suggest a potential public health concern, indicating the need for further research to clarify the risk associated with Cd exposure.

Current Review of Comorbidities in Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) is a heterogenous disease with a significant impact on patient quality of life and a substantial economic burden. CRS is associated with several systemic inflammatory conditions. We provide an updated review of CRS comorbidities as a springboard for future comorbidity mapping and potential therapeutics. The link between environmental allergies and CRS is most evident for central compartment atopic disease (CCAD) and allergic fungal rhinosinusitis (AFRS) subtypes but remains inconclusive for CRS overall. The association between asthma and CRS, reinforced by the unified airway theory, is evidenced by their response to similar biologic therapies. Another lower respiratory tract disease, COPD, has up to a 50% co-occurrence with CRS and warrants careful screening and treatment. Eosinophilic esophagitis and CRS share eosinophilic inflammation in different sites, meriting further research. Obesity not only presents physiological challenges but also correlates with a more severe subset of CRS. Diabetes mellitus is associated with CRSwNP, possibly secondary to therapeutics with steroids. Autoimmunity may contribute to nasal polyp formation through cytokines such as B-cell activating factor (BAFF), offering potential for future therapeutics. This review illustrates the need to employ a macroscopic approach in clinical decision making and treatment of CRS. Comorbidities may contribute to an overall proinflammatory state, magnify severity of symptoms, be a source of treatment resistance, and even an opportunity for future therapeutics.

Severe acute recoil following transcatheter aortic valve replacement with a self-expanding prosthesis in a heavily calcified bicuspid aortic valve.

Bicuspid aortic valve (BAV) is one of the most common congenital valvular heart diseases occurring in 0.5-2% of the general population, in 2-6% of patients with severe aortic stenosis (AS) and up to 20% of octo/nonagenarians undergoing surgery. In this regard, Transcatheter aortic valve replacement (TAVR) has emerged as a therapeutic alternative. At the present time, there is not enough evidence to determine which is the best therapeutic approach for AS in BAV. We report a severe acute recoil following TAVR with a self-expanding prosthesis in heavily calcified BAV. In addition, we provide an updated review of the clinical significance of prosthesis underexpansion in the medium-term.

A Systematic Review of the Association of Elastosis Perforans Serpiginosa and Congenital Disorders

Background: Elastosis perforans serpiginosa (EPS) is a skin condition marked by transepidermal elimination of abnormal elastic fibers, with a classical presentation of papules or plaques arranged in serpiginous, annular, or arcuate patterns on the neck, face, arms, or other flexural regions. A previous review of the literature reported that approximately 1/4 of EPS cases are associated with congenital disorders, including Down syndrome, Ehlers-Danlos syndrome, Marfan syndrome, osteogenesis imperfecta, and pseudoxanthoma elasticum. To the knowledge of these authors, no review examining the association of EPS and congenital disorders has been performed since 1968. Objective: The primary objective of this paper is to perform an updated review of the literature focused on the associations between EPS and congenital disorders. Methods: We searched electronic databases (Medline, Web of Science, PubMed) for literature pertaining to EPS and Down syndrome, Ehlers-Danlos syndrome, Marfan syndrome, osteogenesis imperfecta, and pseudoxanthoma elasticum. Results: Evidence for the association of EPS and congenital disorders is 57 cases from 48 published papers. Conclusions: Our results suggest an association between EPS and congenital disorders. However, current evidence is limited to case reports, underscoring the need for future research investigating the relationship between EPS and congenital disorders.

An Updated Review on the Mechanisms, Pre‐Clinical and Clinical Comparisons of Nicotinamide Mononucleotide (NMN) and Nicotinamide Riboside (NR)

ABSTRACTThe study of nicotinamide adenine dinucleotide (NAD+) biology has gained popularity recently. Research discovered that two NAD+ biosynthesis intermediates, nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN), are biosynthetic precursors of NAD+, an essential chemical for metabolism. Many studies show that NAD+ levels fall considerably with aging, with NAD+ regeneration in aging animals increasing longevity and enhancing health. According to research on the two molecules, NMN and NR, supplementation with either raises NAD+ levels during aging. The objective of this review is to highlight current developments in the biology of NAD+ in relation to NR or NMN supplement. This review highlightings significant discoveries about NR and NMN supplementation in relation to NAD+ biological activities and health benefits.

Brain Drug Delivery- An Updated Review Article for Mechanism and Recent Technologies

Brain Drug Delivery- An Updated Review Article for Mechanism and Recent Technologies

Long-term outcomes comparison of Bentall-De Bono-versus valve-sparing aortic root replacement: An updated systematic review and reconstructed time-to-event meta-analysis

BackgroundFor patients with aortic root dilatation and a structurally normal aortic valve (AV) undergoing composite aortic valve-graft (Bentall-De Bono) versus valve-sparing aortic root replacement (VSARR) procedures there are conflicting data regarding early and long-term benefits. We undertook a study-level meta-analysis to compare the results of both procedures. MethodsThree databases were assessed, and both randomized trials and observational studies were considered eligible. Kaplan-Meier curves of long-term survival and reoperation risk were reconstructed and compared with Cox linear regression and incidence rate ratios (IRR) with 95 % confidence intervals (CI). Landmark analysis and time-varying hazard ratio (HR) were analyzed. Odds ratios (OR) were calculated for early mortality, postoperative stroke, and re-exploration for postoperative bleeding. A random effects model was used. Sensitivity analyses included leave-one-out-analysis, meta-regression and subgroups analysis. Results1456 articles were identified, including 39 observational studies, totaling 14,651 patients (Bentall-De Bono = 9557 and VSARR = 5094). Twelve studies were adjusted. The mean weighted follow-up was 5.05 ± 3.7 years. VSARR was associated with significantly greater survival (HR = 0.50; 95 % CI, 0.45–0.57; p < 0.0001) at 15-year follow-up. The reoperation risk was higher following VSARR (HR = 1.30; 95 % CI, 1.03–1.63; p = 0.02.), although time-varying HR model and landmark analysis reported an increased risk of reoperation within 5 years after VSARR (HR = 1.57; 95 % CI, 1.23–2.01; p < 0.001), after which the difference disappeared. Subgroups analysis of studies excluding aortic dissection showed a comparable rate of late reoperation. ConclusionsVSARR is associated with improved long-term survival compared to Bentall-De Bono. The risk of late reoperation is higher within 5 years following VSARR, after which the two procedures are comparable.

Update and narrative review of avian influenza (H5N1) infection in adult patients.

The avian influenza is a serious infection caused by influenza virus that is native to birds. Avian influenza remains a global challenge due to high transmission and mortality rates. The highly pathogenic strain of H5N1 resulted in significant outbreaks and deaths globally since the late 1800s. The most recent outbreaks in wild birds, domestic birds, and cows with some genetic variations and mutations among H5N1 strains has raised major concerns about potential transmission and public health risks. Symptoms range from asymptomatic to mild flu-like illness to severe illness that requires hospitalization. There are multiple vaccines in development for humans to protect against avian influenza, specifically the H5N1 virus. This includes a cell-based vaccine approved by the FDA for people aged 6 months and older who are at higher risk of exposure to the H5N1 virus called Audenz. Chemoprophylaxis against avian influenza following a suspected exposure should be started as soon as possible or no later than 48 h, and it is recommended to be continued for 7 days. The majority of avian influenza viruses are susceptible to neuraminidase inhibitors and cap-dependent endonuclease inhibitor. Neuraminidase inhibitors are the mainstay of the avian influenza treatment and includes oseltamivir, peramivir, and zanamivir. Baloxavir marboxil is a cap-dependent endonuclease inhibitor. This clinical review aims to highlight the background, epidemiology, clinical presentation, complications and current treatment and prevention strategies for avian influenza H5N1.

Preventive effects of nitric oxide donors in contrast-induced nephropathy in patients undergoing coronary artery angiography: an updated systematic review and meta-analysis of 13 randomized controlled trials.

Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the preventive effects of nitric oxide (NO) donors in CIN patients undergoing CAG/PCI. We conducted a comprehensive systematic review and meta-analysis of RCTs from PubMed, Web of Science, Scopus, Embase, and Cochrane searches until May 5th, 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3). Our analysis included 13 RCTs encompassing 3,550 patients. NO donors were significantly associated with a decreased incidence of CIN compared to placebo either as an oral administration (RR: 0.33 with 95% CI [0.26, 0.42], P < 0.01) or IV infusions (RR: 0.56 with 95% CI [0.40, 0.78], P < 0.01). Moreover, NO donors were significantly associated with decreased serum creatinine levels compared to placebo either as an oral administration (MD: - 0.07 with 95% CI [- 0.10, - 0.04], P < 0.01) or IV infusions (MD: - 0.07 with 95% CI [- 0.09, - 0.04], P < 0.01). In terms of safety, NO donors were significantly associated with a decreased incidence of major adverse cardiac events (MACE) compared to placebo as an oral administration (RR: 0.64 with 95% CI [0.45, 0.89], P < 0.01). However, there was no significant difference between NO donors as IV infusions and placebo in MACE (RR: 0.68 with 95% CI [0.38, 1.21], P = 0.18). Finally, NO donors were significantly associated with a decreased incidence of all-cause mortality compared to placebo as an oral administration (RR: 0.58 with 95% CI [0.36, 0.94], P = 0.03). Nevertheless, there was no statistically significant difference in all-cause mortality between IV infusions of NO donors and placebo (RR: 1.84 with 95% CI [0.40, 8.52], P = 0.44). NO donors as adjunct therapy are associated with reduced incidence of CIN and decreased serum creatinine levels, either as an oral or IV administration. They were also associated with reduced incidence of MACE, all-cause mortality, and recurrent myocardial infarction as an oral administration, which makes this simple, low-cost intervention an important therapeutic option in patients undergoing CAG/PCI.

Perioperative direct oral anticoagulant management during cardiac implantable electronic device surgery: an updated systematic review and meta-analysis.

Patients undergoing cardiovascular implantable electronic device (CIED) implantation are often on direct oral anticoagulation (DOAC). However, the evidence on whether to continue or temporarily discontinue DOAC therapy during the perioperative period in these patients is unclear. We conducted a comprehensive literature review using PubMed, Embase, and Cochrane databases through July 2024. We included studies comparing uninterrupted versus interrupted perioperative DOAC therapy in patients undergoing CIED procedure- primary implants, pulse generator replacement, and device upgrades. Primary outcomes were clinically significant device-pocket hematoma and thromboembolic events. Secondary outcomes included any device-pocket hematoma, all-cause mortality, major bleeding, and any bleeding. A total of 1,607 patients from 8 studies were included. The mean age was 73.2years, with atrial fibrillation as the indication for DOAC therapy in most patients. The mean CHA2DS2-VASc was 3.4. Among the included studies, 2 were randomized control trials (RCTs), while the others were observational cohort studies, including one that was propensity score matched. Our meta-analysis found both strategies to be similar in terms of clinically significant pocket hematoma (RR 1.70; 95%CI 0.84-3.45; p = 0.14; I2 = 0%), thromboembolic complications (RR 0.35; 95%CI 0.04-3.32; p = 0.36; I2 = 19%), any pocket hematoma, all-cause mortality and any bleeding with a higher risk of major bleeding with uninterrupted anticoagulation. This meta-analysis shows that uninterrupted DOAC therapy is comparable to interrupted therapy for CIED procedures, with a potential increase in major bleeding risk but low overall complication rates. Further research is needed to confirm the best approach of periprocedural anticoagulation in these patients.