Epidemiology, Trends, Utilization Disparities, and Outcomes of Catheter Ablation and Its Association With Coronary Vasospasm Amongst Patients With Non-valvular Atrial Fibrillation: A Nationwide Burden of Last Decade.

BACKGROUND: Catheter ablation (CA) is an important curative treatment for non-valvular atrial fibrillation (NVAF), however, nationwide data on its utilization and disparities is limited. Coronary vasospasm is a rare, life-threatening, peri-operative complication of CA with limited literature in Caucasians. METHODS: We performed a retrospective study on adult hospitalizations in the USA from 2007 to 2017 by obtaining the data from National Inpatient Sample. The primary endpoints of our study were to identify the utilization rate of CA, disparities in utilization, and study the outcomes associated with CA. The secondary endpoints of the study were to identify the incidence of coronary vasospasm amongst patients who underwent CA, evaluate their association, and identify the predictors of coronary vasospasm. RESULTS: From 35,906,946 patients with NVAF, 343641 (0.96%) underwent CA. Its utilization decreased from 1% in 2007 to 0.71% in 2017. Patients who underwent CA, compared to those without CA, fared better in terms of hospital length of stay, mortality rate, disability rate, and discharge to the non-home facility. Patients in the 50-75 years age group, Native Americans, those with private insurance, and median household income of 76-100th percentile were associated with higher odds of CA utilization. Urban teaching hospitals and large-bedded hospitals performed more ablations, while the Mid-West region fared lower than the South, the West, and the Northeast. The prevalence of coronary vasospasm was higher amongst CA in comparison without CA, however, in regression analysis, no significant association was demonstrated between CA and coronary vasospasm. CONCLUSION: CA is an important treatment modality that is associated with improved clinical outcomes. Identification of factors associated with lower utilization of CA and its disparities will help to mitigate the burden associated with NVAF.

A Comparison Between Histology and Rapid Urease Test in the Diagnosis of Helicobacter Pylori in Gastric Biopsies: A Systematic Review.

Helicobacter pylori (H. pylori) is a gram-negative aerobic pathogen that primarily colonizes the gastric mucosa. Peptic ulcer disease, atrophic gastritis, gastric cancer, and mucosal-associated lymphoid tissue lymphoma have all been linked to chronic H. pylori infection. Hence, it is critical to diagnose and treat it as early as possible. There are both invasive and noninvasive tests available to detect it. In this review, the diagnostic abilities of two invasive tests - histology and the rapid urease test (RUT) - are compared in a variety of clinical situations. This systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 checklist. We performed a literature search using the PubMed and Google Scholar databases in accordance with the eligibility criteria and ultimately selected eight articles for final analysis. The Newcastle-Ottawa scale adapted for cross-sectional studies, the Scale for the Assessment of Narrative Review Articles (SANRA), and the PRISMA 2020 checklist were used to assess the quality of selected articles for cross-sectional studies, traditional literature reviews, and systematic reviews, respectively. According to the findings of the review, both histology and the RUT have high sensitivity and specificity in diagnosing H. pylori though this varies depending on the clinical situation, making one test superior to the other. Neither of these tests can be considered the gold standard method on its own. Hence, using at least two diagnostic tests at the same time is critical for ensuring high sensitivity and specificity while accurately diagnosing the pathogen.

Detection and Diagnostic Accuracy of Cardiac Arrhythmias Using Wearable Health Devices: A Systematic Review.

Photoplethysmography (PPG) is the wearable devices' most widely used technology for monitoring heart rate. The systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and guidelines. This systematic review seeks to establish the effects of wearable health devices on cardiac arrhythmias concerning their impact on the personalization of cardiac management, their refining effect on stroke prevention strategies, and their influence on research and preventive care of cardiac arrhythmias and their re-evaluation of the patient-physician relationship. The population, exposure, control, outcomes, and studies (PECOS) criteria were used in the systematic review. This review considered studies that covered the tests conducted on individuals who presented with cardiovascular diseases (CVD) and also healthy people. The intervention for studies included wearable health devices that could detect and diagnose cardiac arrhythmias.  The study considered articles that reported on the personalization of cardiac management, stroke prevention strategies, influence in research and preventive care of cardiac arrhythmias, and the re-evaluation of the patient-physician relationship. Two independent researchers were used in the extraction of the data. In case of dispute, the issue was resolved using a third party. The study's quality analysis was conducted using AXIS. The management of atrial fibrillation (AF) lies heavily in the prevention of stroke. The accuracy being reported in the prediction of arrhythmias and the monitoring of heart rates makes wearable devices an efficient means to personalize health care. Personalization of health and treatment in preventing and managing arrhythmias becomes possible due to the portability of smart wearable devices. However, limitations may be observed due to the high costs incurred in their purchase and use. Using smart wearable devices for the detection of cardiac arrhythmias was very significant.

Efficacy of Vitamin D Supplementation in the Improvement of Clinical Status in Patients Diagnosed with Fibromyalgia Syndrome: A Systematic Review.

BACKGROUND: Fibromyalgia syndrome is characterised by extensive muscular pain and chronic fatigue. Among the pharmacologic and other nutrient supplements that have been studied, Vitamin D has garnered attention owing to the critical role it plays in inflammatory and pain pathways. We conducted a systematic literature review to examine the efficacy of vitamin D supplementation in improving the clinical status of the patients and alleviating the symptoms of fibromyalgia. METHODS: We searched Cochrane CENTRAL, PubMed, Science Direct, Scopus, grey literature (medrXiv and biorXiv) for observational studies, randomized controlled trials, case-control studies, and case reports published in English from January 2011 to May 2021, using the terms vitamin D and fibromyalgia or FMS. References were reviewed manually and articles were only included if they were specific about the diagnosis of fibromyalgia. RESULTS: 2651 studies were retrieved, with 12 studies fulfilling the inclusion criteria. 11 out of these 12 studies were of high quality and showed low risk of bias. 11 of these also demonstrated definitive improvement in clinical status and various outcome measures following supplementation with Vitamin D. CONCLUSION: Our study emphasises an association between supplementation of vitamin D and improvement of the clinical condition of fibromyalgia through a systematic review of high-quality studies. The study also identified areas for future scope for research needed for standardising the detection and treatment of this chronic condition through cost-effective supplements such as Vitamin D.

Cancer Prevalence in E-Cigarette Users: A Retrospective Cross-Sectional NHANES Study.

Background: It is well known that traditional smoking causes various types of cancer, leading to the current decline in traditional smoking among US adults from 20.9% in 2005 to 14.0% in 2019. Electronic cigarettes (e-cigarettes) are commonly marketed as a safe alternative and gaining popularity especially among never-smokers and adolescents. However, there is limited evidence of effects of e-cigarette on cancer. Hence, we aim to find the prevalence and association of e-cigarette and traditional smoking among cancer respondents. Methods: We conducted a retrospective cross-sectional study using the NHANES database from 2015 to 2018. We assessed history of cancer (MCQ220), type of cancers (MCQ230a), and smoking status (e-cigarette: SMQ900 or SMQ905 and traditional smoking: SMQ020) using questionnaires. We performed multivariable logistic regression models to find the association of e-cigarette use, traditional smoking, and no smoking with cancer after adjusting for confounding variables. Results: A total of 154,856 participants were included, of whom 5% were e-cigarette users, 31.4% were traditional smokers, and 63.6% were nonsmokers. There is a higher prevalence of e-cigarette use among younger participants, females (49 vs. 38) in comparison to traditional smokers (P < 0.0001). The e-cigarette users have lower prevalence of cancer compared to traditional smoking (2.3% vs. 16.8%; P < 0.0001), but they were diagnosed with cancer at a younger age. Among cancer subtypes, cervical cancer (22 vs. 2.6), leukemia (8.5 vs. 1.1), skin cancer (non-melanoma) (15.6 vs. 12.3), skin (other) (28 vs. 10) and thyroid (10.6 vs. 2.4) had higher prevalence of e-cigarette use compared to traditional smokers (P < 0.0001). Our regression analysis showed that e-cigarette users have 2.2 times higher risk of having cancer compared to non-smokers (odds ratio (OR): 2.2; 95% confidence interval (CI): 2.2 - 2.3; P < 0.0001). Similarly, traditional smokers have 1.96 higher odds of having cancer compared to nonsmokers (OR: 1.96; 95% CI: 1.96 - 1.97; P < 0.0001). Conclusion: In our study, e-cigarette users had an early age of cancer onset and higher risk of cancer. Hence, this is stepping stone for future research to evaluate the safety and effects of e-cigarettes in patients with cancer.

The Correlation Between Otitis Media With Effusion and Adenoid Hypertrophy Among Pediatric Patients: A Systematic Review .

Otitis media with effusion (OME) affects approximately 80% of children due to the middle ear being flooded with fluids, though with no microbial infection manifestations. Multiple issues can drive recurring pediatric OME, such as environment-based issues, previous medical issues, inherited vulnerability from family, contact time at childcare institutes, passive smoking, and more than three siblings together with atopy or allergic rhinitis. If OME is not promptly addressed, this could eventually result in hearing impairment or loss, with consequent negative repercussions on the child's communicative and behavioral patterns. OME diagnosis within the clinic is possible, with hearing capacity being assessed pre- and post-therapy. Adenoid hypertrophy (AH) represents a typical causative factor for middle-ear conditions, stemming from mechanical or anatomical issues. Consequently, adenoid size is paramount when determining tympanometry types and ear fluids. This systematic review investigated PubMed, Medline, Cochrane Library, and Science Direct databases in order to retrieve knowledge related to this issue, adopting inclusion and exclusion criteria and maintaining review quality through the employment of the Assessment of Multiple Systematic Reviews (AMSTAR), the Newcastle-Ottawa tool, and the Axis scale. This systematic review analyzed a previous review article, six observation-based investigations, and three cross-sectional investigations. Previous randomized controlled trials (RCTs) were not found within previous literature, suggesting such scarcity in this research niche and thus warranting future RCT investigations based on this compelling research niche.

The Efficacy of Sitz Baths as Compared to Lateral Internal Sphincterotomy in Patients with Anal Fissures: A Systematic Review.

An anal fissure is a common condition that affects patients of all ages. Its clinical presentation is a sharp pain on defecation with or without blood. It is treated by conservative or surgical means. This study aims to assess the efficacy of a sitz bath as compared to lateral internal sphincterotomy in the treatment of anal fissures. The search strategy used keywords related to the topic of study. Three databases were used: PubMed, Google Scholar, and Science Direct. A total of 551 articles were screened. A quality assessment check was done on the articles leaving 11 articles. Four aspects of sitz bath outcomes were evaluated in the articles. In terms of analgesia, articles showed conflicting evidence. However, the overall evidence supports the use of sitz baths for their analgesic properties. In terms of healing, most articles had similar recovery rates of around 80%. Much of the research supported the use of sitz baths as the primary treatment to heal acute fissures. When compared to lateral internal sphincterotomy, the recovery rates of lateral internal sphincterotomy are superior to those of conservative treatment, including sitz baths. However, studies showed incontinence as a side effect of lateral internal sphincterotomy, and no studies reported side effects from the sitz baths. To conclude, the results of the articles support the use of sitz baths to treat anal fissures. Sitz baths have been found to have analgesic properties, as well as a good healing time. But, compared to lateral internal sphincterotomy, there is a significant difference in the healing rate at the end stage of treatment, lateral internal sphincterotomy is found to be superior. With regards to the side effects, none have been reported from using a sitz bath.

Accuracy of Ultrasonography vs. Elastography in Patients With Non-alcoholic Fatty Liver Disease: A Systematic Review.

Ultrasonography and elastography are the most widely used imaging modalities for diagnosing non-alcoholic fatty liver disease. This study aimed to assess and compare the diagnostic accuracy in patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was done for the past seven years using Pubmed, Pubmed Central, Cochrane, and Google Scholar databases on Jun 29, 2022. Studies were included based on the following predefined criteria: observational studies, randomized controlled trial (RCT), comparative studies, studies using liver biopsy or MRI proton density fat fraction (MRI PDFF) as a reference standard, ultrasonography, and elastography with measures of their diagnostic accuracy like sensitivity (SN), specificity (SP), area under the receiver operating characteristic (AUROC) curve, and English language. The data were extracted on a predefined template. The final twelve eligible studies were assessed using the quality assessment of diagnostic accuracy tool (QUADS-2). Most studies focused on elastography techniques, and the remaining focused on quantitative ultrasonography methods like the controlled attenuation parameter (CAP) and attenuation coefficient (AC). Only one study was available for the evaluation of qualitative ultrasonography. MRI was generally found superior to other diagnostic tests for determining liver stiffness through magnetic resonance elastography (MRE) and steatosis through MRI PDFF. Data assessing the comparative diagnostic accuracy of the two tests were inconclusive.

Vitamin D: The Missing Nutrient Behind the Two Deadly Pandemics, COVID-19 and Cardiovascular Diseases.

The coronavirus (COVID-19) pandemic is claiming millions of lives and creating an additional burden on health care, which is already affected by the rise of non-communicable diseases (NCDs). The scientific community, on the other side, is enormously engaged with studies to best identify the characteristics of the virus and minimize its effect while supporting the fight to contain NCDs, mainly cardiovascular diseases (CVDs), which are contributing hugely to the global death toll. Hence, the roles of vitamin D in COVID-19 immunity and cardiovascular health are gaining traction recently.  This literature review will mainly focus on summarizing pertinent studies and scientific publications which highlight the association of vitamin D levels with the various outcomes of COVID-19 and CVDs. It will also address how low vitamin D correlates with the epidemiology of CVDs and the inflammatory mechanisms attributed to COVID-19 severity. We believe that our review may open up hindsight perspectives and further discussions among the physicians in tapping the potential of vitamin D supplementation to tackle the morbidity, mortality, and health care cost of the two deadly diseases, COVID-19 and CVDs.

Diagnostic Accuracy of Elastography and Liver Disease: A Meta-Analysis.

Background: Ultrasound-based transient elastography (TE) is a non-invasive alternative to liver biopsy for the staging of hepatic fibrosis due to various chronic liver diseases. This meta-analysis aims to assess the diagnostic accuracy of TE for detecting liver cirrhosis (F4) and severe fibrosis (F3) in patients with chronic liver diseases, in comparison to the gold standard liver biopsy. Methods: A systematic search was performed using PubMed search engine following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines from inception to May 2021. The meta-analysis studies evaluating the diagnostic accuracy of TE for severe fibrosis and cirrhosis were identified. We conducted a meta-meta-analysis to generate pooled estimates of the sensitivity, specificity, and diagnostic odds ratios (ORs) for F3 and F4 fibrosis stage. Results: We included five studies with a total of 124 sub-studies and 20,341 patients in our analysis. Three studies have reported the diagnostic accuracy of TE in detecting F3/severe fibrosis stage and found 81.9% pooled sensitivity (95% confidence interval (CI): 79.9-83.7%; P < 0.001) (I2 = 0%), 84.7% pooled specificity (95% CI: 81.3-87.6%) (I2 = 81%; P = 0.02). All five studies reported the diagnostic accuracy of TE in detecting F4/liver cirrhosis stage. We found 84.8% pooled sensitivity (95% CI: 81.4-87.7%) (I2 = 86.4%; P < 0.001), 87.5% pooled specificity (95% CI: 85.4-89.3%) (I2 = 90%; P < 0.001) and pooled diagnostic OR (41.8; 95% CI: 3.9 - 56.5) (I2 = 87%; P < 0.001). Conclusions: Ultrasound-based TE has excellent diagnostic accuracy for identifying cirrhosis and liver fibrosis stages 3. Future studies should focus on estimating the diagnostic accuracy of other fibrosis stages in chronic liver disease patients. This will eventually decrease the risk associated with invasive liver biopsy.

Efficacy and Safety of Vedolizumab in Management of Moderate to Severe Ulcerative Colitis: A Systematic Review.

Ulcerative colitis (UC) is an inflammatory bowel disease and causes inflammation and ulcer of the colon. Vedolizumab is a newer biological agent with an inhibitory effect on α4ß7 integrin approved for moderate to severe UC patients. Our study reviewed the clinical response, clinical remission, and mucosal healing of vedolizumab in moderate to severe UC management. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a literature search in PubMed, Google Scholar, and Science Direct, and nine studies were included in the systematic review. At week six, vedolizumab showed a significant clinical response. At week 52, vedolizumab showed significant mucosal healing and clinical remission. The most commonly associated adverse effects are nasopharyngitis, oropharyngeal infection, and gastrointestinal infection. However, additional clinical trials and observational studies with longer follow-ups are required to study the efficacy and safety of the drug.

The Relationship Between Vitamin D and Asthma Exacerbation.

Asthma is a chronic airway inflammatory condition that affects millions of people worldwide. It presents with reversible bronchoconstriction that makes it difficult for patients to breathe. Asthma flare-ups have several triggers, but the symptoms are similar, including wheezing, coughing, shortness of breath, and chest tightness. Severe asthma exacerbation is described as symptomatic asthma that is unresponsive to inhaled asthma medications and is only responsive to steroids in oral or intravenous forms. Asthma-related deaths occur during episodes of asthma exacerbation. Vitamin D is a steroid-derived vitamin produced by the body and found in some foods. Administration of doses of vitamin D can also help maintain an adequate level of the vitamin. Vitamin D plays a vital role in regulating the level of calcium in the body and bone remodeling processes. It also has an immunomodulatory effect on innate and adaptive immunity within the body and that partially explains its links to inflammation-induced epithelial changes seen in asthma. We conducted this literature review by selecting articles from PubMed and Cumulated Index to Nursing and Allied Health Literature (CINAHL) Plus databases to investigate the relationship between vitamin D level and asthma exacerbation. From the studies, we found that asthmatic patients have low vitamin D levels during an asthma exacerbation. However, supplementing vitamin D may not reduce the rates of asthma exacerbation except in adult asthmatic patients with low levels of vitamin D.

Sofosbuvir/Velpatasvir - A Promising Treatment for Chronic Hepatitis C Virus Infection.

Hepatitis C virus (HCV) infection is a disease that affects millions of people worldwide and has an enormous global public health impact. Chronic HCV is a long-term infection that goes unnoticed until the virus destroys the liver enough to induce liver disease symptoms. The inadequate and poorly tolerated treatment contributes to the burden of chronic HCV. Treatments have improved over time - direct-acting antivirals (DAAs) that targeted different hepatitis C virus genomic sites have shown to be more effective and well-tolerated. Patients recover to a greater extent following a treatment regimen based on DAAs. We conducted this literature review to investigate the effectiveness of these medications in treating chronic HCV infection. Relevant articles were identified by searching PubMed and Google scholar databases. Our primary goal was to analyze the efficacy and safety of the DAA, sofosbuvir plus velpatasvir, with or without ribavirin, in cirrhotic or non-cirrhotic, naïve or previously treated, chronic HCV patients. We found that treating patients with sofosbuvir-velpatasvir for 12 weeks was highly effective with fewer adverse events, including those with compensated cirrhosis. The outcomes aided in improving HCV treatment, lowering the disease's burden and fatality rate.

Cannabis Use Disorders Lead to Hospitalizations for Peptic Ulcer Disease: Insights From a Nationwide Inpatient Sample Analysis.

Objectives In this study, we aimed to explore the independent association between cannabis use disorders (CUD) and peptic ulcer disease (PUD)-related hospitalization, and then to delineate the demographic differences among PUD inpatients with versus without CUD. Methodology We conducted a cross-sectional study using the Nationwide Inpatient Sample of 50,444,133 patients. We then subgrouped them into PUD and non-PUD cohorts. We compared non-PUD and PUD cohorts using bivariate analysis to delineate the differences in demographics and comorbid risk factors (chronic lung disease, chronic kidney disease, liver disease, diabetes, chronic nonsteroidal anti-inflammatory drug use, tobacco abuse, and alcohol abuse). We used logistic regression analysis to measure the odds ratio (OR) of the association between CUD and PUD-related hospitalization. Results The prevalence of PUD was 0.14% (N = 70,898) among the total inpatient population. It was more prevalent in whites (65%) and males were at higher odds (OR: 1.11; P < 0.001) of being hospitalized for PUD. After controlling for potential comorbid risk factors and demographic confounders, the odds of association between CUD and PUD-related hospitalization were statistically significant (OR: 1.18; P < 0.001). Conclusions CUD was associated with a modest but significant increase of 18% in the likelihood of hospitalization for PUD. With the legalization of cannabis use and its increasing and problematic consumption, it is imperative to understand the impact of cannabis use on the physical health of patients and the related gastrointestinal problems.

Persistent Cannabis Abuse and Risk for Hospitalization for Acute Pancreatitis: A Cross-Sectional Study in United States Hospitals.

Objectives To explore the independent association between cannabis abuse and subsequent hospitalizations for acute pancreatitis (AP) and delineate the demographic differences among AP in patients with and without persistent cannabis abuse. Methods We conducted a retrospective cross-sectional study using the nationwide inpatient sample and included 50,444,133 patients (age 18-50 years) with a primary discharge diagnosis for medical illnesses and further grouped by presence of AP (N = 666,248). We used the logistic regression model to measure the odds ratio (OR) of the association between cannabis abuse and hospitalization for AP and adjusted it for demographic confounders and comorbid risk factors. Results Cannabis abuse significantly increases the odds for AP-related hospitalization (OR 2.12, P <0.001). When the regression model was controlled for potential risk factors (gall stones, cystic fibrosis, hypertriglyceridemia, hypercalcemia, hyperparathyroidism, abdominal surgeries, tobacco abuse, and alcohol abuse), cannabis abuse did not increase the odds for AP-related hospitalization (OR 0.72, P <0.001) due to the significant effect caused by gallstones (OR 30.98, P <0.001) and alcohol abuse (OR 12.69, P <0.001). AP inpatients with cannabis abuse were younger compared to non-cannabis abusers (mean age, 35.7 vs. 37.9 years), and majorly male (70.9% vs. 53.8%). AP was considerably more prevalent in whites (60.6%), followed by blacks (18.3%) and Hispanics (15.2%). Conclusion Cannabis abuse increased the unadjusted odds for AP-related hospitalization by two times, but after controlling for potential risk factors the adjusted odds of association significantly reduced. Cannabis-induced AP can be treated if a problematic recreational cannabis use pattern is discontinued at an earlier stage. Therefore, awareness campaigns and early supportive therapy among cannabis abusers might help diagnose and treat the comorbidity and improve the quality of life.

The Impact of Rheumatoid Arthritis on Bone Loss: Links to Osteoporosis and Osteopenia.

Rheumatoid arthritis (RA) is an autoimmune chronic connective tissue disease that produces persistent systemic inflammation, with joint inflammation leading to function loss and joint destruction. Low bone mass causes skeletal bone loss, commonly referred to as osteopenia or osteoporosis.  We conducted this literature review to examine the relationship between RA and osteoporosis and the variables contributing to this connection. We used articles from the US National Library of Medicine (PubMed), Google Scholar, Science Direct to access the required information. Eventually, our results concluded that RA could result in local periarticular and generalized bone loss. Many risk factors contribute to this association, such as chronic joints inflammation, glucocorticoid use, genetics, and estrogen hormone effects. Still, it is not clear yet whether this is due to a consequence of treatment, immobility, or the activity of the disease. There are many recommendations by the American College of Rheumatology for RA patients during the disease course to reduce the risk of osteoporosis development, which include early starts of disease-modifying anti-inflammatory drugs (DMARDs), doing a dual-energy x-ray (DXA) or quantitative ultrasound (QUS) for identifying a patient at risk of osteoporosis, taking vitamin D, calcium, and bisphosphonates. Further prospective studies and clinical trials are essential to provide a solid evidence-based recommendation that will help to prevent bone loss in RA patients.

Magic of a Common Sugar Pill in Cancer: Can Metformin Raise Survival in Pancreatic Cancer Patients?

Pancreatic cancer is one of the common cancers globally, with a poor survival outcome. Metformin, a popular anti-diabetic drug, has gained popularity for its use in the chemoprevention of cancer. However, results regarding the survival benefit of metformin in pancreatic cancer have been unpredictable. In this review, we aim to analyze the use of metformin in pancreatic cancer patients with pre-existing diabetes mellitus for survival benefit. We systematically conducted a literature search in PubMed, Science Direct, and Scopus databases to collect the relevant articles and reviewed them. Eventually, 11 quality appraised articles were included accessing overall survival as the primary outcome. Our results concluded that metformin can efficaciously improve survival in pancreatic cancer patients with coexisting diabetes mellitus, but the results are still incongruent. Hence, further prospective studies and clinical trials are essential to provide a strong evidence-based recommendation that will help prolong the lifespan of patients.

Stem Cell Therapy for the Treatment of Myocardial Infarction: How Far Are We Now?

Myocardial infarction is one of the leading causes of death worldwide. Poor functional recovery of the myocardium is noticed after an event of myocardial infarction. Researchers and clinicians around the world have been engaged to regenerate the damaged human heart for a long time. Stem cell therapy is an exciting newer therapy to treat cardiovascular diseases. Various types of stem cells have been used to revive the damaged myocardium after myocardial infarction, and they have overall demonstrated safety and moderate efficacy. The specific mechanisms by which these cells help in improving cardiac function are still not completely known. There is growing evidence that intracoronary bone marrow cell transplantation in patients with myocardial infarction beneficially affects the remodeling of the damaged myocardium. Our systematic review article aims to assess the effects and the future of stem cell therapy in patients with myocardial Infarction. We searched articles in PubMed, ScienceDirect, and Google Scholar. Thirty-one studies that included 2171 patients in total were analyzed. Most of these studies showed stem cell therapy is safe and well tolerated in patients, and modest improvements are seen in left ventricular functions with no major adverse effects. However, some studies showed no positive and clinically significant outcomes. So, more high-quality studies on a larger scale are required to support and confirm its efficacy in remodeling damaged myocardium after myocardial infarction. We should also perform studies to determine the timing of cell delivery that is best suited for stem cell therapy.

Utilization of Left Ventricular Assist Device for Congestive Heart Failure: Inputs on Demographic and Hospital Characterization From Nationwide Inpatient Sample.

Objectives The first goal of the study is to provide a descriptive overview of the utilization of left ventricular assist device (LVAD) for the treatment of congestive heart failure (CHF) and determine the rates of LVAD use stratified by patients' demographic and hospitals' characteristics in the United States. Next, is to measure the hospitalization outcomes of length of stay (LOS) and cost in inpatients managed with LVAD. Methods We conducted a cross-sectional study using the nationwide inpatient sample and included 184,115 patients (age ≥65 years) with a primary discharge diagnosis of hypertensive and non-hypertensive CHF and was further classified by inpatients who were managed with LVAD. We compared the distributions of demographic and hospital characteristics in CHF inpatients with versus without LVAD by performing Pearson's chi-square test for categorical variables, and independent sample t-test for continuous variables. Results The inpatient utilization of LVAD was 0.93% (1690 out of 184,115) in CHF patients. The LVAD cohort were younger compared to non-LVAD group (mean age, 69.9 years vs. 79.4 years). The utilization rate of LVAD was also almost four times higher in males (1.50%) compared to females (0.36%). Although whites (78.5%) accounted for majority of LVAD recipients, the rate of LVAD utilization was highest in blacks (1.04%) and lowest in Hispanics (0.58%) with whites having utilization rate of 0.89%. Medicare was the dominant primary payer to cover the LVAD inpatients (91.1%), though the rate of LVAD utilization is highest in private (2.22%) and lowest in those covered by public insurance (medicaid/medicare). CHF patients in public hospitals (1.79%) were more than twice more likely to receive LVAD than in private hospitals (0.83%) due to higher utilization rate. LVAD utilization rate was approximately 55 times higher in teaching hospitals (1.67%) compared to non-teaching hospitals (0.03%), and 20 times higher in large bed hospitals (1.41%) compared to small bed-size hospitals (0.07%). CHF patients that received LVAD had a significantly longer LOS (34.6 days vs 9.8 days) and higher inpatient treatment costs ($802,118 vs. $86,302) compared to non-LVAD group. Conclusion The inpatient utilization of LVAD was in CHF patients is higher in males, blacks and private health insurance beneficiaries. In terms of hospital characteristics, the utilization of LVAD for CHF management was higher in large bed sized, and public type and teaching hospitals compared to their counterparts. This data will allow us to devise strategies to improve LVAD utilization and increase its outreach for heart failure patients, especially those on the transplant waiting list. Despite its effectiveness, aggressive usage of LVAD is restricted due to cost-effectiveness and lack of technical confidence among medical professional due to complications.

Association of Helicobacter Pylori With Development of Peptic Ulcer Disease Among Cirrhotic Patients: An Evidence From Population-Based Study.

BACKGROUND:  Helicobacter pylori (H. pylori) plays an important role in causing peptic ulcer disease (PUD) in the general population. However, the role of H. pylori in cirrhotic patients for causing PUD is obscure. There are various studies evaluating H. pylori association with PUD in cirrhotic patients, but the results have been controversial. We sought to analyze the association of H. pylori with the development of PUD in cirrhotic patients from the largest United States population-based database. METHODS:  We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data from 2017. Adult hospitalizations due to cirrhosis were identified by previously validated ICD-10-CM codes. PUD and H. pylori were identified with the presence of ICD-10-CM codes in primary and secondary diagnosis fields, respectively. We performed weighted analyses using Chi-Square and paired Student's t-test to compare the groups. Multivariable survey logistic regression was performed to find an association of H. pylori with PUD in cirrhotic patients. RESULTS:  Our study showed that the prevalence of H. pylori infection was 2.2% in cirrhotic patients with PUD. In regression analysis, H. pylori was found to be associated with PUD in cirrhotic patients (OR 15.1; 95% CI: 13.9-16.4; p <0.001) and non-cirrhotic patients (OR 48.8; 95% CI: 47.5-50.1; p <0.001). In the studied population, H. pylori was more commonly seen in the age between 50 and 64 years (49.4% vs 44.1%; p <0.0001), male (63.4% vs 59.9%; p <0.0413), African American (16.3% vs 10.6%; p <0.0001), and Hispanic (26.2% vs 14.9%; p <0.0001). H. pylori is more likely to be associated with complicated PUD hospitalizations (51.2% vs 44.2%; p <0.0067). Alcoholism and smoking were more common in H. pylori group compared to those without (43.6% vs 35.8%; p <0.0001 and 33.7% vs 24.8% p <0.0001, respectively). Factors associated with increased odds of H. pylori infection include African American (OR 2.3, 95% CI: 1.5-3.6), Hispanic (OR 2.6, 95% CI: 1.7-4.0), and smoking (OR 1.5, 95% CI: 1.1-2.2). CONCLUSION:  H. pylori are associated with PUD and concurrent cirrhosis, although it is less prevalent than general population. African American, Hispanic, and smoking were independently associated with increased odds of H. pylori infection. Further studies are required to better understand the epidemiology and confirm our findings.