Acute venous thromboembolism plasma and red blood cell metabolomic profiling reveals potential new early diagnostic biomarkers: observational clinical study.

BACKGROUND: Venous thromboembolism (VTE) is a leading cause of cardiovascular mortality. The diagnosis of acute VTE is based on complex imaging exams due to the lack of biomarkers. Recent multi-omics based research has contributed to the development of novel biomarkers in cardiovascular diseases. Our aim was to determine whether patients with acute VTE have differences in the metabolomic profile compared to non-acute VTE. METHODS: This observational trial included 62 patients with clinical suspicion of acute deep vein thrombosis or pulmonary embolism, admitted to the emergency room. There were 50 patients diagnosed with acute VTE and 12 with non-acute VTE conditions and no significant differences were found between the two groups for clinical and demographic characteristics. Metabolomics assays identified and quantified a final number of 91 metabolites in plasma and 55 metabolites in red blood cells (RBCs). Plasma from acute VTE patients expressed tendency to a specific metabolomic signature, with univariate analyses revealing 23 significantly different molecules between acute VTE patients and controls (p < 0.05). The most relevant metabolic pathway with the strongest impact on the acute VTE phenotype was D-glutamine and D-glutamate (p = 0.001, false discovery rate = 0.06). RBCs revealed a specific metabolomic signature in patients with a confirmed diagnosis of DVT or PE that distinguished them from other acutely diseased patients, represented by 20 significantly higher metabolites and four lower metabolites. Three of those metabolites revealed high performant ROC curves, including adenosine 3',5'-diphosphate (AUC 0.983), glutathione (AUC 0.923), and adenine (AUC 0.91). Overall, the metabolic pathway most impacting to the differences observed in the RBCs was the purine metabolism (p = 0.000354, false discovery rate = 0.68). CONCLUSIONS: Our findings show that metabolite differences exist between acute VTE and nonacute VTE patients admitted to the ER in the early phases. Three potential biomarkers obtained from RBCs showed high performance for acute VTE diagnosis. Further studies should investigate accessible laboratory methods for the future daily practice usefulness of these metabolites for the early diagnosis of acute VTE in the ER.

Too Little, Not Enough: Impact of Safety Nets on Food Security Among Households with Disabled Members in Nigeria.

This study assessed the impact of safety nets on food insecurity in households with people with disabilities (PWD) in Nigeria. Using data from the 2019 Nigeria General Household Survey, we assessed the risk of experiencing food insecurity among households and the moderating role of safety nets using households without PWDs as a reference. PWD households were three times more likely to experience severe food insecurity compared to households without PWDs. The impact of the safety net program on the risk of food insecurity showed that receiving social benefits had little effect among households with disabled members experiencing severe food insecurity.

The impact of COVID-19 pandemic on anxiety and depression among physical therapists in Saudi Arabia: a cross-sectional study.

BACKGROUNDS: A physical therapist may become infected while treating a patient since they are in direct contact with them or within a two-meter radius. In addition, physical therapists may feel that they are more susceptible to COVID-19 infection when applying rehabilitation practices, which often involve direct contact with patients. The physical therapist were surveyed on their level of anxiety and depression due to the Coronavirus disease pandemic (COVID-19). METHODS: The physical therapists were asked to complete two reliable and validated scales, the Generalized Anxiety Disorder scale (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), to identify the presence of anxiety and depression in the participants. In addition, logistic regression models were used to determine the general characteristics of anxiety or depression. RESULTS: Among the 117 physical therapists who completed and participated in the study, 74 (63%) and 65 (55.5%) physical therapists reported having symptoms of anxiety and depression, respectively. The prevalence of overall anxiety levels was higher; mild (OR = 2.09; P = 0.08), moderate (OR = 2.26; P = 0.15), and severe levels six times as high (OR = 6.28; P = 0.1) in females compared to male physical therapists. Females, younger age, unmarried individuals, not having children, and not living with family showed a higher prevalence of anxiety and depression. Binary logistic regression analysis also revealed that the female gender, a single individual, and having no children were associated with anxiety and depression. CONCLUSIONS: A significant percentage of physical therapists reported symptoms of anxiety and depression, especially among females, younger age, single individuals, not having children, and not living with family. Thus, the mental health of physical therapists is suggested to be constantly and cautiously monitored, especially for those at high risk of developing psychological symptoms.

An insightful estimation of undergraduate medical students' experience about the Flipped Classroom.

BACKGROUND AND OBJECTIVE: The Flipped Classroom (FC) approach has become increasingly predominant and popular in medical education. This study aimed to explore the usefulness and the scope of FC based on medical students' experience, with their adaptation challenges. METHODS: The present study was a mixed-method accomplished during the academic years 2019-20, involving fourth-year students at the College of Medicine in Riyadh, Saudi Arabia. A self-administered questionnaire was used to seek their first experience and opinion of the FC. RESULTS: A total of 234 questionnaires were distributed to the students, and 214 students completed the survey (response rate of 91.45%). Out of this total, 68.2 % were males and 31.8% were females. Most of the students agreed 156 (72.9%) that the flipped classroom was more engaging than the traditional lecture, among them 100 (68.5%) males and 56 (82.3) females agreed. Almost ~79% of students liked FC as it enabled them knowing the material in advance, and the class time was spent clarifying the facts and principles with active interaction, as commented during focus group discussion "More chance for discussing with the doctors, and I got the chance to answer" (St. 6). CONCLUSION: The results showed that the students like the FC more than the conventional classroom. Suggestions were given by students to improve the active learning sessions within the FC modality.

Is COVID-19 pushing us to the Fifth Industrial Revolution (Society 5.0)?

The coronavirus disease 2019 (COVID-19) pandemic may further promote the development of Industry 4.0 leading to the fifth industrial revolution (Society 5.0). Industry 4.0 technology such as Big Data (BD) and Artificial Intelligence (AI) may lead to a personalized system of healthcare in Pakistan. The final bridge between humans and machines is Society 5.0, also known as the super-smart society that employs AI in healthcare manufacturing and logistics. In this communication, we review various Industry 4.0 and Society 5.0 technologies including robotics and AI being inspected to control the rate of transmission of COVID-19 globally. We demonstrate the applicability of advanced information technologies including AI, BD, and Information of Technology (IoT) to healthcare. Lastly, we discuss the evolution of Industry 4.0 to Society 5.0 given the impact of the COVID-19 pandemic in accordance with the technological strategies being considered and employed.

Breast milk interleukin-7 and thymic gland development in infancy.

PURPOSE: Interleukin-7 (IL-7) is known to be important for lymphocyte development. We sought to investigate the maternal breast milk IL-7 expression to explore its impact on thymus development in infants. METHODS: We conducted a prospective study on three groups of healthy infants classified into exclusively breast-fed (n = 19), formula-fed (n = 17) and mixed-fed (n = 19) infants. They were investigated at 2, 4 and 6 months of age for thymic indices by ultrasonography, T lymphocyte subsets enumeration by flowcytometry and breast milk IL-7 levels. RESULTS: Thymic indices were higher at the age of 2 and 6 months in the exclusively breast-fed infants (mean ± SD 22.4 ± 2.1, 26.2 ± 2.7 mm3, respectively) and mixed-fed infants (mean ± SD 22 ± 3.2, 25 ± 3.2, respectively) as compared to formula-fed infants (mean ± SD 17.9 ± 3.7, 21.6 ± 3.9 respectively); p < 0.001. In the exclusively breast-fed infants, IL-7 levels correlated positively to thymic indices and CD3+ T cell numbers at 2 months of age. Positive correlations were elicited in the mixed-fed group at 2, 4 and 6 months of age for thymic indices and at 6 months for CD3+ cells. CONCLUSION: Breast milk and/or its IL-7 content have a significant positive impact on thymic development. Our conclusions are limited by the sample size and short duration of follow-up. What is known is that breast milk has a trophic role in thymic development and contains IL-7. What is new is that there is positive correlation between breast milk IL-7 concentration and thymic development and lymphocyte output; variation of IL-7 levels with type of feeding (exclusive breast feeding/mixed breast and formula feeding) and with time postnatally.

Undergraduate medical students' perspectives of skills, uses and preferences of information technology in medical education: A cross-sectional study in a Saudi Medical College.

BACKGROUND: Information technology (IT) is widely used in medical education. However, there are not enough studies about IT uses and preferences among traditional and problem-based learning (PBL) medical students. AIM: To compare IT skills, uses and preferences for education between traditional and PBL medical students'. METHOD: A cross-sectional study; a modified Educause Center for Analysis and Research online survey was sent to traditional curriculum 5th and PBL 4th year medical students of King Saud University. RESULTS: Most of the responding 176 students prefer mobile devices and moderate amount of IT in education. Fourth and fifth year students perceived high academic value of Google (94.2 vs. 86.7%, p = 0.34), YouTube (90.7 vs. 92.2%, p = 0.83) and PubMed (83.7 vs. 86.7%, p = 0.06). More 4th year than 5th year students rated themselves as skilled in learning management system (54.7 vs. 21.1%, p = 0.0001) and Smartboard use (40.7 vs. 23.3%, p = 0.04). Most students rated faculty IT skills as effective. Students agreed that technology helps working faster (95.5%) and make learning creative (85.9%). CONCLUSIONS: More integration of information literacy and IT training in medical curricula is needed to enhance better utilization of full features of IT resources available for learning and problem solving. National multi-institutional studies are recommended.

Medical students' perception of the progress test as a quality-controlled assessment tool for improving learning and teaching, at a public sector medical college in Saudi Arabia.

Progress test's distinguishing characteristics make it pertinent worldwide. We explored medical students' perceptions and opinions about Progress Test (PT) with a view to identifying areas concomitant with it's execution. This cross-sectional study took place at College of Medicine, Saudi Arabia, during the academic year 2015-16. A questionnaire (14 items) was administered. Reason for majority n=96 (89.7%) of the total participants to take the PT was their keenness to compare their academic standing with their peers from other participating medical colleges. The majority of students were highly satisfied with PT implementation; i.e. its orientation (58.9%) and allocated time (90.7%). Students (76.6%) considered PT to offer academic support as future physicians. Students (75.7%) also agreed to participate in the future PT. Students being highly satisfied with the organization of PT. They found it to be a tool helping them to focus on improving the knowledge domain.

Principled physicians are not born-they are mentored: Medical students perception of the values and need of mentors at the College of Medicine, Saudi Arabia.

OBJECTIVE: To discuss the perception of medical students about mentoring at the medical school. METHODS: This cross-sectional descriptive study was conducted at the King Saud University, Riyadh, Saudi Arabia, from April 2015 to April 2016, and comprised medical students. A well-structured, bilingual (English and Arabic) quantitative questionnaire with 21 items was administered online via Google Docs to the students. SPSS 21 was used for data analysis. RESULTS: Of the 311 students who received the questionnaire, 296(95.17%) completed it. Of them, 257(86.8%) expressed an interest in having a mentor during their medical school career and 276(93.2%) selected the role of their mentor as a "guide". Moreover, 107(36.1%) students agreed that it was "not important at all" that their mentor should be of the same gender. CONCLUSIONS: Participants were interested in having a mentor during their medical school career.

Reprioritizing current research trends in medical education: a reflection on research activities in Saudi Arabia.

BACKGROUND: There are numerous national efforts to determine and develop research priorities of medical education in Saudi Arabia. These priorities were first proposed in 2010 by "Dr Al-Khuli's Chair for Developing Medical Education in Saudi Arabia". The proposed priority domains were: curriculum, students, faculty, and quality assurance and accreditation. AIM: To investigate publications in medical education at the national and international levels in areas relating to these proposed priorities. METHODS: Electronic search within PubMed database for papers relating to each domain of priority was conducted at national and international levels in the last three years, using the same keywords as the priority domains, but only confined to undergraduate medical education. RESULTS: Out of 3145 articles retrieved when searching with keyword as broad as "undergraduate medical curriculum" only 81 articles worldwide and 3 articles from Saudi Arabia were dealing with curriculum related issues as a whole. Further search on the sub-domains "effective strategies to manage undergraduate curriculum" and "undergraduate medical education models", resulted in the retrieval of few articles worldwide and none from Saudi Arabia. At the national level, there were 63 publications from Saudi Arabia that were either course (topic)-specific or could not be classified under the four domains specified by Dr Al-Khuli's Chair. CONCLUSION: Research activities in medical education in Saudi Arabia in the last 3 years showed diversity and lack of focus in the research priorities. Efforts of academic and research centers should continue to monitor and encourage these activities toward achieving the recommended priorities.

Research methodology workshops evaluation using the Kirkpatrick's model: translating theory into practice.

BACKGROUND: Qualitative and quantitative evaluation of academic programs can enhance the development, effectiveness, and dissemination of comparative quality reports as well as quality improvement efforts. OBJECTIVES: To evaluate the five research methodology workshops through assessing participants' satisfaction, knowledge and skills gain and impact on practices by the Kirkpatrick's evaluation model. METHODS: The four level Kirkpatrick's model was applied for the evaluation. Training feedback questionnaires, pre and post tests, learner development plan reports and behavioral surveys were used to evaluate the effectiveness of the workshop programs. RESULTS: Of the 116 participants, 28 (24.1%) liked with appreciation, 62 (53.4%) liked with suggestions and 26 (22.4%) disliked the programs. Pre and post MCQs tests mean scores showed significant improvement of relevant basic knowledge and cognitive skills by 17.67% (p ≤ 0.005). Pre-and-post tests scores on workshops sub-topics also significantly improved for the manuscripts (p ≤ 0.031) and proposal writing (p ≤ 0.834). As for the impact, 56.9% of participants started research, and 6.9% published their studies. The results from participants' performance revealed an overall positive feedback and 79% of participant reported transfer of training skills at their workplace. CONCLUSION: The course outcomes achievement and suggestions given for improvements offer insight into the program which were encouraging and very useful. Encouraging "research culture" and work-based learning are probably the most powerful determinants for research promotion. These findings therefore encourage faculty development unit to continue its training and development in the research methodology aspects.

Diagnostic accuracy of tests for tuberculous pericarditis: A network meta-analysis.

Tuberculous pericarditis (TBP) is a relatively uncommon but potentially fatal extrapulmonary manifestation of tuberculosis. Despite its severity, there is no universally accepted gold standard diagnostic test for TBP currently. The objective of this study is to compare the diagnostic accuracy of the most commonly used tests in terms of specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV), and provide a summary of their diagnostic accuracies. A comprehensive literature review was performed using Scopus, MEDLINE, and Cochrane central register of controlled trials, encompassing studies published from start to April 2022. Studies that compared Interferon Gamma Release Assay (IGRA), Xpert MTB/RIF, Adenosine Deaminase levels (ADA), and Smear Microscopy (SM) were included in the analysis. Bayesian random-effects model was used for statistical analysis and mean and standard deviation (SD) with 95% confidence intervals were calculated using the absolute risk (AR) and odds ratio (OR). Rank probability and heterogeneity were determined using risk difference and Cochran Q test, respectively. Sensitivity and specificity were evaluated using true negative, true positive, false positive, and false negative rates. Area under the receiver operating characteristic (AUROC) was calculated for mean and standard error. A total of seven studies comprising 16 arms and 618 patients were included in the analysis. IGRA exhibited the highest mean (SD) sensitivity of 0.934 (0.049), with a high rank probability of 87.5% for being the best diagnostic test, and the AUROC was found to be 94.8 (0.36). On the other hand, SM demonstrated the highest mean (SD) specificity of 0.999 (0.011), with a rank probability of 99.5%, but a leave-one-out analysis excluding SM studies revealed that Xpert MTB/RIF ranked highest for specificity, with a mean (SD) of 0.962 (0.064). The diagnostic tests compared in our study exhibited similar high NPV, while ADA was found to have the lowest PPV among the evaluated methods. Further research, including comparative studies, should be conducted using a standardized cutoff value for both ADA levels and IGRA to mitigate the risk of threshold effect and minimize bias and heterogeneity in data analysis.

Angiotensin-Neprilysin inhibition in heart failure with preserved ejection fraction: A meta-analysis of randomized controlled trials.

BACKGROUND: The effect of sacubitril/valsartan on patients with heart failure (HF) with preserved ejection fraction (HFpEF) is a topic of ongoing debate. METHODS: Medline was queried from inception through the last week of May 2023 for randomized studies assessing the effects of sacubitril/valsartan in patients with HFpEF. For continuous outcomes, we pooled either the geometric mean ratios (gMR) or weighted mean difference (WMD) with 95% confidence intervals (CI). For dichotomous outcomes, we pooled Risk ratios (RR) with 95% CI. RESULTS: Four trials were included (N=8,129). Compared to the control, sacubitril/valsartan was associated with a reduction in NT-proBNP levels (gMR: 0.84, 95% CI 0.80, 0.88) and improvement in KCCQ score (WMD: 0.85, 95% CI: 0.02, 1.67). We observed no differences for HF hospitalization (RR: 0.90, 95% CI: 0.79, 1.01), cardiovascular mortality (RR: 0.83, 95% CI: 0.52, 1.32), all-cause mortality (RR: 0.99, 95% CI: 0.86-1.13) and improvement (RR: 1.15, 95% CI: 0.93, 1.42) or worsening (RR: 0.92, 95% CI: 0.78, 1.09) of NYHA class between the sacubitril/valsartan and comparator group. Sacubitril/valsartan was generally safe, and patients were less likely to have a ≥50% decline in eGFR compared to control (RR: 0.60, 95% CI: 0.39, 0.92). CONCLUSION: Pooled analysis suggests that sacubitril/valsartan reduces natriuretic peptide levels and improves the quality of life in patients with HFpEF, which may translate into better clinical outcomes as observed by a numerical trend towards improvement in major HF outcomes with sacubitril/valsartan therapy.

Cerebral embolic protection for stroke prevention during transcatheter aortic valve replacement.

INTRODUCTION: Cerebral Embolic Protection Device (CEPD) captures emboli during Transcatheter Aortic Valve Replacement (TAVR). With recently published pivotal trials and multiple cohort studies reporting new data, there is a need to re-calibrate available statistical evidence. METHODS: A systematic literature search was conducted across databases from inception till February 2023. Dichotomous outcomes were pooled using Odds Ratio (OR), while continuous outcomes were pooled using Standardized Mean Difference (SMD) along with 95% corresponding intervals (95% CIs). RESULTS: Data was included from 17 studies (7 RCTs, 10 cohorts, n = 155,829). Use of CEPD was associated with significantly reduced odds of stroke (OR = 0.60, 95% CI = 0.43-0.85, p = 0.003). There was no significant difference in disabling stroke (p = 0.25), non-disabling stroke (p = 0.72), and 30-day mortality (p = 0.10) between the two groups. There were no significant differences between the two groups for Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) findings, acute kidney injury, risk of pacemaker implantation life-threatening bleed, major bleed, minor bleed, worsening National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and vascular complications (p > 0.05). CONCLUSIONS: The use of CEPD during TAVR reduced the incidence of all-stroke (p = 0.003); however, there were no significant differences in any of the other pooled outcomes (p > 0.05). REGISTRATION: The protocol of this meta-analysis was registered with the Open Science framework [https://doi.org/10.17605/OSF.IO/7W564] before data acquisition was started.

Gender disparities and predictors of in-hospital mortality with Takotsubo cardiomyopathy.

BACKGROUND: Takotsubo cardiomyopathy (TCM) is classically associated with significant gender disparities, such that it is more prevalent in females, but the clinical outcomes are worse for male patients. The goal of this study was to assess contemporary gender disparities in clinical outcomes of TCM hospitalizations and to determine predictors of male in-hospital mortality. METHODS: This was a retrospective analysis involving adult hospitalizations for TCM in the U.S between 2016 and 2020. Multivariable Logistic regression was used to estimate Odds Ratio (OR) for in-hospital mortality between the two genders. Univariable Cox regression was performed to identify predictors associated with in-hospital mortality for male hospitalizations. All factors from the univariable analysis with p < 0.20 were included in a multivariable Cox regression model. RESULTS: A total of 199,920 patients with TCM were identified. Female patients with TCM had 50% lower risk of in-hospital mortality compared to male patients (Adjusted OR 0.50, 95% CI 0.46-0.55, p < 0.001). Older age, higher Charlson comorbidity index, history of intracranial hemorrhage, cardiac arrest, need for vasopressor agents, mechanical intubation, and cardiogenic shock without the use of temporary mechanical circulatory support (MCS) were associated with higher in-hospital male mortality. CONCLUSIONS: Although TCM is more prevalent among females, gender disparities exist in the clinical outcomes of TCM patients. Cardiac arrest and cardiogenic shock without the use of temporary MCS were found to be the most significant predictors of male in-hospital mortality. Cardiogenic shock with use of temporary MCS did not lead to higher male in-hospital mortality.

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.

Assessing the Efficacy of RADPAD Protection Drape in Reducing Radiation Exposure to Operators in the Cardiac Catheterization Laboratory: A Systematic Review and Meta-Analysis.

One of the leading environmental hazards, ionizing radiation, is linked to several detrimental health consequences in the body. RADPAD (Worldwide Innovations & Technologies, Inc., Kansas City, Kansas) is a sterile, lead-free, lightweight, disposable radiation protection shield. We conducted a systematic review and meta-analysis to determine the effectiveness of RADPAD protection drapes in the cardiac catheterization lab and how they can aid interventional cardiologists in becoming subjected to less scatter radiation. PubMed, Embase, and Google Scholar were searched for studies discussing the efficacy of RADPAD protection drapes in reducing radiation exposure to operators in the cardiac catheterization laboratory. A random-effects model was used to pool odds ratios (ORs) and 95% confidence intervals (CIs) for endpoints: primary operator exposure dose, dose area product (DAP), relative exposure, and screening time. Our analysis included 892 patients from six studies. Compared to the No-RADPAD group, primary operator exposure dose (E) was significantly lower in the RADPAD group (OR: -0.9, 95% CI: -1.36 to -0.43, I2 = 80.5%, p = 0.0001). DAP was comparable between both groups (OR: 0.008, 95% CI: -0.12 to -0.14, I2 = 0%, p = 0.9066). There was no difference in the relative exposure (E/DAP) (OR: -0.47, 95% CI: -0.96 to 0.02, I2 = 0%, p = 0.90) and screening time (OR: 0.13, 95% CI: 0.08 to 0.35, I2 = 0%, p = 0.22) between the two groups. The interventional cardiology laboratory is exposed to significantly less scatter radiation during procedures owing to the RADPAD protective drape. Consequently, all catheterization laboratories could be advised to employ RADPAD protective drapes.

Meta-Analysis Comparing Drug-Coated Balloon Versus Plain Old Balloon Angioplasty for In-stent Restenosis of Coronaries.

BACKGROUND: Despite the advent of newer stents, in-stent restenosis has been a persistent and formidable challenge. Trials have demonstrated the superiority of drug-coated balloons (DCB) over plain-old balloon angioplasty (POBA). A recent AGENT IDE trial highlighted the need for a more comprehensive understanding hence we conducted a meta-analysis aimed at elucidating their respective clinical outcomes. METHODS: A literature search was conducted by 2 investigators (SS and MH) using MEDLINE (EMBASE and PubMed) using a systematic search strategy by PRISMA till November 01, 2023. CRAN-R software was used for statistical analysis. The quality assessment was performed using the Cochrane Risk of Bias tool (Supplemental Table 5). RESULTS: We included 6 studies with a total of 1171 patients. Our analysis showed decreased odds of multiple outcomes with statistically significant results including TVR (OR 0.33, CI 0.19-0.57), TVF (OR 0.30, CI 0.09-0.99), TLR (OR 0.22, CI 0.10-0.46), restenosis (OR 0.1343, CI 0.06-0.27), and MACE (OR 0.2 CI 0.12-0.37). Although MI and all-cause mortality showed decreased odds with all-cause mortality at 0.8 (95% CI: 0.363-2.09), and MI at 0.6 (95% CI: 0.0349-1.07), the reductions did not reach statistical significance. CONCLUSION: Our analysis by scrutinizing six RCTs favored DCB over POBA. However, extensive research for deeper understanding cannot be overemphasized.

Comparison of Drug-Coated Balloons With Drug-Eluting Stents in Patients With In-Stent Restenosis: A Systematic Review and Meta-Analysis.

In-stent restenosis (ISR) is the gradual narrowing of the stented coronary segment, presenting as angina or leading to an acute myocardial infarction. Although its incidence has decreased with the use of newer drug-eluting stents (DES), it still carries significant mortality and morbidity risks. We compared the 2 most common interventions for managing DES-related ISR: drug-coated balloons (DCBs) and DES. Electronic databases were searched to identify all randomized controlled trials comparing DCB with DES in patients with DES-ISR. The Mantel-Haenszel method with a random-effects model was used to calculate pooled risk ratios. Five trials comprising 1,100 patients (577 in DCB and 523 in DES group) were included in the final study. The mean follow-up was 42 months. DCB was found to have a higher risk for target lesion revascularization (risk ratio 1.41, p = 0.02) compared with DES. No difference was observed in all-cause mortality, target vessel revascularization, myocardial infarction, or stroke between the 2 intervention arms. In conclusion, management of DES-ISR with DCB has a higher risk of target lesion revascularization compared with re-stenting with DES. The 2 therapeutic interventions are comparable in terms of efficacy and safety profile.

Drug-eluting stent vs. Balloon angioplasty in patients with in-stent restenosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: In-stent restenosis (ISR) is seen in up to 20% of cases and is the primary cause of percutaneous coronary intervention (PCI) failure. With the use of re-stenting with a drug-eluting stent (DES), plain old balloon angioplasty (BA) use is decreasing. We aim to compare the efficacy and safety profile of DES over BA in the management of ISR. METHODS: Electronic databases were searched to identify all randomized controlled trials (RCTs) comparing DES to BA for coronary ISR. The mantel-Haenszel method with a random effects model was used to calculate pooled risk ratios (RR). RESULTS: Four trials comprising 912 patients (543 in DES and 369 in the BA group) were included in the final study. The mean follow-up was 45 months. DES was found to be superior with a lower requirement of target vessel revascularization (TVR) (RR: 0.45, 95% CI: 0.31-0.64, p-value <0.0001), and target lesion revascularization (TLR) (RR: 0.59, 95%CI: 0.44-0.78, p-value 0.0002) compared to BA. However, all-cause mortality, cardiovascular mortality, incidence of myocardial infarction (MI), and target lesion thrombosis were not different between the two intervention arms. CONCLUSION: DES was found to be superior to BA for the management of coronary ISR with a reduction in the risk of TLR and TVR. No difference in mortality, risk of MI, or target lesion thrombosis was observed between the two interventions.