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Objective: The study aims to discuss the assessment methods used for the incidence of in-hospital postoperative delirium (IHPOD) in transcatheter aortic valve replacement (TAVR) patients and explore possible strategies for preventing and reducing postoperative complications in the geriatric population. Methodology: An electronic search of PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials was conducted up to August 2021, to identify studies on the IHPOD following TAVR in patients above 70 years. The primary objective of the study was to determine the incidence of delirium following TAVR and procedures like transfemoral (TF) and non-TF approaches. The secondary objectives were to determine the incidence of stroke and incidence according to the confusion assessment method (CAM) diagnostic tool. The authors only included studies published in English and excluded patients with comorbidities and studies with inaccessible full-text. Results: Among the selected 42 studies with 47 379 patients, the incidence of IHPOD following TAVR was 10.5% (95% CI: 9.2-11.9%, I2=95.82%, P<0.001). Incidence based on CAM was 15.6% (95% CI: 10.5-20.7%, I2=95.36%, P<0.001). The incidence of IHPOD after TF-TAVR was 9.3% (95% CI: 7.6-11.0%, I2=94.52%, P<0.001), and after non-TF TAVI was 25.3% (95% CI: 15.4-35.1%, I2=92.45%, P<0.001). The incidence of stroke was 3.7% (95% CI: 2.9-4.5%, I2=89.76%, P<0.001). Meta-regression analyses between mean age (P=0.146), logistic EuroSCORE (P=0.099), or percentage of participants treated using the TF approach (P=0.276) were nonsignificant while stroke (P=0.010) was significant. When considering these variables, the residual heterogeneity remained high indicating that other variables influence the heterogeneity. Conclusion: IHPOD following TAVR was observed in 10.5% of individuals and in 15.6% using CAM. Its incidence was found to be three times higher after non-TF TAVR (25.3%) compared to TF TAVR (9.3%). Stroke showed an incidence of 3.7% after TAVR and was found to be significantly associated with the risk of developing delirium following TAVR. Further studies are needed to evaluate possible causes and risk factors responsible for delirium and to assess the role of anesthesia and cerebral embolic protection in preventing delirium after TAVR.
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Domperidone is an antagonist of the peripheral dopamine (D2) receptor. It works as an antiemetic by blocking D2-receptors at the chemoreceptor trigger zone and as a gastroprokinetic drug by blocking GI tract D2-receptors. According to research, using domperidone significantly raises the risk of cardiac arrhythmia and sudden cardiac death by 70%, most likely through prolonging the QT interval. Blockade of hERG voltage-gated potassium channels is thought to be the reason. Here in Pakistan, this drug is being prescribed by every other physician and even patients frequently self-medicate themselves with it. Due to the serious side effects of this medication, extreme caution should be exercised when prescribing it, especially to the elderly, those who have underlying QT prolongation, those taking medications known to prolong QT, and even more so in pregnant women as there is some evidence that domperidone crosses into breast milk in small amounts and causes an irregular heartbeat in the baby. At least we, on our part, can limit the usage of the drug only with a prescription and, where necessary, if not completely, stop it.
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Autoimmune hemolytic anemia (AIHA) is a type of hemolytic anemia in which autoantibodies attack the membrane antigens of red blood cells, causing cell rupture (lysis). Hemolysis stimulates compensatory RBC production by boosting erythropoietin levels; however, this response is often insufficient to restore normal hemoglobin blood levels, resulting in anemia. It is a rare disease, with an annual incidence of one case in every 80 000 live births. Infants of any age can be affected, though neonatal incidence is unusual. Here, the authors report a rare case of AIHA in the neonatal period with concomitant atrial septal defect, ventricular septal defect, and patent ductus arteriosus. Case presentation: A one-hour-old male neonate weighing 3 kg who was born at 38 weeks of gestation presented to the pediatric department with the complaint of respiratory distress. Examination revealed obvious respiratory distress with subcostal and intercostal recessions and a continuous grade 2 murmur at the left upper chest; the liver was palpable 1 cm below the right subcostal margin with a palpable splenic tip. Laboratory investigations were ordered, which showed hemoglobin was decreasing continuously and bilirubin was raised, suspecting AIHA. A positive blood culture, tachycardia, tachypnea, and a raised leukocyte count showed that the baby was in sepsis. The baby improved clinically, and the complete blood count showed improved Hb. Cardiac examination findings and a second-grade continuous murmur at the left upper chest were further investigated through echocardiography, which showed a grade 2 atrial septal defect, a muscular ventricular septal defect, and a patent ductus arteriosus. Clinical discussion: Childhood AIHA is a rare and underrated disease that differs from the adult form. The disease's initial manifestation and subsequent course are both poorly understood. It affects mostly young children, and a high prevalence (21%) is found in infants. In some patients, there is a genetic predisposition to the development of this disease, and there is underlying immune deregulation in more than half of the cases, necessitating long-term homogeneous multidisciplinary follow-up. It is of two types, primary and secondary, and according to the study conducted in France, AIHA is associated not only with other autoimmune diseases but with some systemic diseases as well, like neurological, digestive, chromosomal abnormalities, and cardiac diseases, as in our case. Conclusion: There is a scarcity of data on clinical management and treatment strategies. More research should be done to know the environmental factors that can trigger the immune response against red blood cells. Moreover, a therapeutic trial is essential for a better outcome and helps prevent serious complications.
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Introduction: Preterm birth is linked to various complications in both infancy and adulthood. We assessed the association between preterm birth and hypertension in adulthood. Materials and Methods: PubMed, EMBASE, and Cochrane CENTRAL Register were searched for randomized controlled trials (RCT) comparing systolic and diastolic blood pressures in individuals born preterm and those born full-term, from inception till April 11th, 2022. Data were extracted, pooled, and analyzed. Forest plots were created for a visual demonstration. Results: Twenty-eight studies were included in our meta-analysis. SBP and DBP across all categories (Mean, Ambulatory, Daytime, and Nighttime) were higher in the preterm group compared to the term group. Mean SBP, mean ambulatory SBP, mean daytime SBP and mean nighttime SBP were 4.26 mmHg [95% CI: 3.09-5.43; P < 0.00001], 4.53 mmHg [95% CI: 1.82-7.24; P = 0.001], 4.51 mmHg [95% CI: 2.56-6.74; P < 0.00001], and 3.06 mmHg [95% CI: 1.32-4.80; P = 0.0006] higher in the preterm group, respectively. Mean DBP, mean ambulatory DBP, mean daytime DBP, and mean nighttime DBP were 2.32 mmHg [95% CI: 1.35-3.29; P < 0.00001], 1.54 mmHg [95% CI 0.68-2.39; P = 0.0004], 1.74 mmHg [95% CI: 0.92-2.56; P < 0.0001], and 1.58 mmHg [95% CI: 0.34-2.81; P = 0.01] higher in the preterm group, respectively. Conclusion: Our observations suggest that individuals who were born preterm may have higher blood pressures as compared to those who were born full-term.
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Monkeypox virus, Orthopoxvirus of the Poxviridae family which was first isolated from pox lesions of monkeys, hence named monkeypox. Fever, rash, and enlarged lymph nodes are common symptoms, but it can also lead to a variety of medical complications, including secondary infections, bronchopneumonia, sepsis, encephalitis, and corneal infection with vision loss. The current outbreak doesn't follow previous pattern of transmission through animals but person to person transmission. We highlight several studies including WHO stats for protective role of small pox vaccine and recommend potential strategies for current and future disease eliminations.