Intravenous iron therapy for heart failure and iron deficiency: An updated meta-analysis of randomized clinical trials.

Heart failure (HF) patients frequently exhibit iron deficiency, which is associated with a poor prognosis. Although various trials have been conducted, it is uncertain if intravenous (IV) iron replenishment improves clinical outcomes in HF patients with iron deficiency. A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, and the Cochrane Library from inception till 15 September 2023 to retrieve randomized controlled trials (RCTs) that compared IV iron therapy with placebo or standard of care in patients with HF and iron deficiency. Clinical outcomes were assessed by generating forest plots using the random-effects model and pooling odds ratios (ORs) or weighted mean differences (WMDs). Fourteen RCTs with 6651 patients were included. IV iron therapy showed a significantly reduced incidence of the composite of first heart failure hospitalization (HHF) or cardiovascular (CV) mortality as compared with the control group (OR = 0.73, 95% CI: 0.58 to 0.92). The IV iron therapy resulted in a trend towards lower CV mortality (OR = 0.88, 95% CI: 0.76 to 1.01), 1-year all-cause mortality (OR = 0.85, 95% CI: 0.71 to 1.02), and first HHF (OR = 0.73, 95% CI: 0.51 to 1.05), and an improved left ventricular ejection fraction (LVEF) (MD = 4.54, 95% CI: -0.13 to 9.21). Meta-regression showed a significant inverse moderating effect of baseline LVEF on the first HHF or CV death. In patients with HF and iron deficiency, IV iron therapy reduced the incidence of composite of first HHF or CV mortality. There was a trend of lower overall CV and 1-year all-cause mortality, first HHF, and improved LVEF with IV iron therapy.

Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention: A meta-analysis of randomized controlled trials.

Background: Optical Coherence Tomography (OCT), a high-resolution imaging modality, guides stent implantation during percutaneous coronary intervention (PCI). However, OCT-guided PCI safety and efficacy data is limited. Methods: MEDLINE, Embase, and Cochrane Central were searched for randomized controlled trials (RCTs) comparing OCT-guided PCI to Angiography-guided PCI from inception to August 2023. A random-effects model was used to pool risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) for clinical endpoints. Results: Our analysis included 5,139 patients from 11 studies. OCT-guided PCI resulted in a higher minimum stent area (MD = 0.35 [95 % CI, 0.21-0.49]; p < 0.00001), significantly reduced risk of cardiovascular mortality (RR = 0.56 [95 % CI, = 0.32-0.99]; p = 0.04), stent thrombosis (RR = 0.56 [95 % CI, 0.32-0.96]; p = 0.04), stent malapposition RR = 0.79 [95 % CI, 0.71-0.88]; p = < 0.0001) and major edge dissection (RR = 0.47 [95 % CI, 0.34-0.65]; p = <0.00001). However, no statistically significant difference was observed for all-cause mortality (RR = 0.71; p = 0.06), major adverse cardiovascular events (MACE) [RR = 0.80; p = 0.10], myocardial infarction (MI) [RR = 0.84; p = 0.16], target lesion revascularization (TLR) [RR = 0.94; p = 0.68], and target vessel revascularization (TVR) [RR = 0.91; p = 0.52]. Conclusion: OCT-guided PCI led to an increased MSA and decreased cardiovascular mortality, stent thrombosis, stent malapposition, and major edge dissection. The incidence of all-cause mortality, MACE, MI, TLR, and TVR remained comparable across the two groups.

The Presence of Chronic Total Occlusion in Noninfarct-Related Arteries Is Associated With Higher Mortality and Worse Patient Outcomes Following Percutaneous Coronary Intervention for STEMI: A Systematic Review, Meta-Analysis and Meta-Regression.

Reperfusion therapy with percutaneous coronary intervention improves outcomes in patients with ST-elevation myocardial infarction. We conducted a meta-analysis to assess the impact of chronic total occlusion (CTO) in noninfarct-related artery on the outcomes of these patients. Comprehensive searches were performed using PubMed, Google Scholar, and EMBASE. The primary endpoint was the 30-day mortality rate, with secondary endpoints including all-cause mortality, repeat myocardial infarction, and stroke. Forest plots were created for the pooled analysis of the results, with statistical significance set at P < 0.05. A total of 19 studies were included in this meta-analysis, with 23,989 patients (3589 in CTO group and 20,400 in no-CTO group). The presence of CTO was associated with significantly higher odds of 30-day mortality [18.38% vs 5.74%; relative risk (RR), 3.69; 95% confidence intervals (CI), 2.68-5.07; P < 0.00001], all-cause mortality (31.00% vs 13.40%; RR, 2.79; 95% CI, 2.31-3.37; P < 0.00001), cardiovascular-related deaths (12.61% vs 4.1%; RR, 2.61; 95% CI, 1.99-3.44; P < 0.00001), and major adverse cardiovascular events (13.64% vs 9.88%; RR, 2.08; 95% CI, 1.52-2.86; P < 0.00001) than the non-CTO group. No significant differences in repeated myocardial infarction or stroke were observed between the CTO and non-CTO groups. Our findings underscore the need for further research on the benefits and risks of performing staged or simultaneous percutaneous coronary intervention for CTO in the noninfarct-related artery in patients with ST-elevation myocardial infarction.

Video Versus Direct Laryngoscopy for Intubation: Updated Systematic Review and Meta-Analysis.

Direct laryngoscopy (DL) is a modality commonly used in endotracheal intubation (EI). Video laryngoscopy (VL) was introduced to further facilitate the procedure with enhancement in glottic views, which captures the video image of the vocal cords to be projected onto a screen, providing enhanced visualization. This real-time video projection aids in accurately placing the endotracheal tube (ETT) through the vocal cords. In emergency and critical care settings, both laryngoscopes are used for intubations. This study assesses the efficacy of both modalities by comparing success rates in first-attempt tracheal intubation in critically ill patients.  PubMed, EMBASE, and Scopus were searched and all randomized controlled trials (RCTs) and observational studies until 2023 were included. Studies included patients in critical care settings undergoing EI under the guidance of either DL or VL. The primary outcome was the first attempt at successful tracheal intubation. The secondary outcomes assessed the comparative safety of DL and VL by comparing the rates of severe hypoxemia, severe hypotension, and cardiac arrest occurring during each modality. P-values were considered of statistical significance if below 0.05. Statistical analysis was performed using RevMan v5.4 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). The results were displayed in the form of forest plots.  A total of eight studies were included with a total of 5348 patients, with 1780 in the DL group and 3568 in the VL group. Analysis revealed that in emergency situations, the success rate of intubation on the first attempt was significantly higher for VL than DL [81.5% vs 68%; RR= 1.19; 95% CI: 1.10, 1.29; p <0.00001; I2=70%]. There was no significant correlation between VL and severe hypoxemia [13.4% vs 11.6%; RR= 0.99; 95% CI: 0.74, 1.33; p =0.97; I2=46%], severe hypotension [6.09% vs 4.78%; RR:1.19; 95% CI: 0.83, 1.72; p =0.35, I2-15%], and cardiac arrest, [0.8% vs 0.4%; RR= 1.17; 95% CI: 0.37, 3.70]; p =0.79; I2=0%]. Our meta-analysis confirmed that VL has a higher success rate for first-pass intubation than DL. Furthermore, our analysis has shown no significant evidence linking VL to any adverse events.

Racial disparities among patients with cardiac sarcoidosis and arrhythmias in the United States: A propensity matched-analysis from the national inpatient sample database 2016-2020.

BACKGROUND: Cardiac sarcoidosis (CS) is frequently associated with conduction abnormalities and arrhythmias. In this study, we aim to evaluate racial disparities in the frequency of arrhythmias, and associated co-morbidities, among patients with CS. METHODS: White and African American (AA) patients diagnosed with CS were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models. RESULTS: A total of 7,935 patients with CS were included in the study. The propensity-matched sample comprised of 5,570 patients, of whom 2,785 were White and 2,785 were AA. AA patients had a longer mean length of hospital stay (LOS) (7.84 vs. 6.94, p<0.01), a higher mean Charlson Comorbidity Index (CCI) score (3.10 vs. 2.84, p<0.01), and significantly higher incidences of cardiogenic shock [(9.2% vs 6.3%, p<0.01), aOR 1.45 (95% CI 1.17-1.78), p<0.01] and acute kidney injury (AKI) [(34.3% vs. 26.9%, p<0.01), aOR 1.41 (95% CI 1.24-1.61), p<0.01]. From an arrhythmia perspective, AA CS patients were shown to have a lower frequency of: (1) ventricular tachycardia (32.5% vs. 37.9%, p<0.01), (2) ventricular fibrillation (5.4% vs.7.2%, p<0.01), (3) first-degree AV block (1.8% vs. 4.1%, p<0.01), (4) complete AV block (6.3% vs. 14.2%, p<0.01), and (5) atrial fibrillation (31.8% vs. 34.8%, p=0.016) when compared to Whites with CS. Mortality remained higher for AAs (3.8% vs. 2.7%, p=0.024). CONCLUSION: Our study demonstrates a higher incidence of cardiac arrhythmias among White patients but a higher incidence of cardiogenic shock, AKI, mean LOS, and mortality among AA patients with cardiac sarcoidosis.

The impact of chronic total occlusion in non-infarct related arteries on patient outcomes following percutaneous coronary intervention for STEMI superimposed with cardiogenic shock: A pilot systematic review and meta-analysis.

INTRODUCTION: Chronic total occlusion (CTO) is defined as a near-total blockage of a coronary artery and often occurs in arteries that are not directly responsible for the event, known as non-infarct-related arteries (NIRA). Cardiogenic shock (CS) is a complication of ST-elevated myocardial infarction (STEMI) that carries significant mortality. We performed a meta-analysis to find an association between mortality in patients undergoing PCI for STEMI that have superimposed CS, with the presence of CTO in the NIRA. MATERIALS AND METHODOLOGY: A comprehensive literature search was conducted using PubMed, EMBASE, Google Scholar and clinicaltrials.gov from inception till October 2023 to retrieve studies that compare the presence of CTO with the absence of CTO in NIRA in STEMI with CS patients undergoing PCI. The primary endpoint was 30-day mortality and the secondary endpoints were risk of all-cause mortality (ACM) and repeat myocardial infarction (MI). Forest plots were generated using the random effects model by pooling odds ratios (ORs) with a 95 % confidence interval. Statistical significance was set at p < 0.05. RESULTS: 5 observational studies with a total of 5186 patients (1031 with CTO in NIRA and 4155 with no CTO in NIRA) were included. The presence of CTO in NIRA was associated with higher odds of 30-day mortality [OR: 3.10; 95 % CI: 1.52, 6.32; p < 0.002], and ACM [OR: 2.37; 95 % CI: 1.83, 3.08; p < 0.00001]. The odds of repeat MI were comparable between the two groups [OR: 1.61, 95 % CI: 0.03, 74.36, p = 0.81]. CONCLUSIONS: The presence of CTO in the NIRA serves as an independent indicator of unfavorable clinical outcomes including increased risk of 30-day mortality and all-cause mortality. The risk of repeat MI was comparable between the two groups. Large-scale, multicenter trials are warranted to identify the most effective management approach for these patients.

External Auditory Canal Carcinoma With An Unusually Extensive Invasion.

External auditory canal carcinoma, while starting out as a seemingly benign condition, if left untreated can have an aggressive course of disease and involve multiple lower cranial nerves. Squamous cell carcinoma remains the most frequent histological type of malignant neoplasm of the external auditory canal and temporal bone. Here we describe a patient with a history of chronic suppurative otitis media with an extensive spread, the tumour was reaching from the skull base to the oropharynx involving neurovasculature along with soft tissues and bones, as well as the cerebellum. The involvement of the recurrent laryngeal and hypoglossal nerves were the most unusual presentation here. The case differed from all previous reported cases as the spinal accessory nerve was to spared. Surgery and radiotherapy are the treatment options but for the inoperable cases presenting with an already poor prognosis, concomitant radiotherapy is the only choice.