Efficacy of thoracic endovascular aortic repair versus medical therapy for treatment of type B aortic dissection.

BACKGROUND: Techniques in endovascular therapy have evolved to offer a promising alternative to medical therapy alone for Type B aortic dissections (TBADs). AIM: The aim of this meta-analysis was to compare mortality and overall complications between thoracic endovascular aortic repair (TEVAR) and best medical therapy (BMT) in patients with TBADs. METHODS: We included randomized control trials and prospective or retrospective cohort studies that compared TEVAR and BMT for the treatment of type B aortic dissection. Multiple electronic databases were searched. RESULTS: Thirty-two cohort studies including 150,836 patients were included. TEVAR was associated with a significantly lower 30-day mortality rate than BMT (RR = 0.79, CI = 0.63, 0.99, P = 0.04), notably in patients ≥ 65 years of age (RR = 0.78, CI = 0.64, 0.95, P = 0.01). The TEVAR group had a significantly prolonged hospital stay (MD = 3.42, CI = 1.69, 5.13, P = 0.0001) and ICU stay (MD = 3.18, CI = 1.48, 4.89, P = 0.0003) compared to the BMT. BMT was associated with increased stroke risk (RR = 1.52, CI = 1.29, 1.79, P < 0.00001). No statistically significant differences in late mortality (1, 3, and 5 years) or intervention-related factors (acute renal failure, spinal cord ischemia, myocardial infarction, respiratory failure, and sepsis) were noted between the groups. CONCLUSION: Our meta-analysis revealed a significant association between the TEVAR group and a decreased mortality rate of TBAD compared to the medical treatment group, especially in patients aged 65 years or older. Further randomized controlled trials are needed to confirm our findings.

Comparison of the effect of open-box versus closed-box prostheses on blood loss following total knee arthroplasty: a meta-analysis.

Purpose: Postoperative blood loss is a common complication following total knee arthroplasty (TKA). The authors aimed to analyze the significance of open versus closed-box prostheses in reducing blood loss after TKA. Methods: PubMed, Cochrane, Scopus, and Web of Science were searched. Observational studies and clinical trials comparing the effect of open-box versus closed-box prostheses on blood loss following TKA were included. The primary outcome was total blood loss following TKA. Secondary outcomes included average transfused units and total operation time. Continuous data were represented as mean difference (MD) and CI, while dichotomous data were presented as odds ratio (OR) and CI. RevMan software version 5.4 was used to conduct the analysis. Results: Four studies with a total number of 687 patients were included. The pooled analysis showed a statistically significant association between closed-box and decreased total blood loss following TKA compared with open-box (MD=173.19, 95% CI=88.77-257.61, P value <0.0001). Similar findings were reported in unilateral TKA (MD=190.63, 95% CI=70.91-310.35, P value=0.002), and bilateral TKA (MD=160.79, 95% CI=61.70-359.86, P value=0.001). There was no significant difference between open and closed-box regarding average transfused units (MD=0.02, 95% CI=-0.07-0.11, P value=0.68), blood transfusion rate (OR=1.38, 95% CI=0.85-2.26, P value=0.20), length of stay (MD=0.06, 95% CI=-0.27 to 0.38, P value=0.74), and total operation time (MD=1.08, 95% CI=-4.62 to 6.79, P value=0.71). Conclusion: Closed-box reduces the total blood loss following unilateral and bilateral TKA. More studies are warranted to explore the benefits of Closed-box in patients with high bleeding susceptibility.

The risk of bone fractures in dementia patients receiving acetylcholinesterase inhibitors: a meta-analysis.

Aim: The authors aimed to conduct a meta-analysis to determine if acetylcholinesterase inhibitors may pose a direct threat, increasing the incidence of fractures in dementia patients. Methods: PubMed, Scopus, and Cochrane Library were searched. Inclusion criteria were any original studies that demonstrated the link between acetylcholinesterase inhibitors and the incidence of fracture in patients with dementia. RevMan(5.4) was used. Results: Seven observational studies were included. The total number of patients included in the acetylcholinesterase inhibitors group is 274 332 and 290 347 in the control group. The pooled analysis showed that the risk of bone fracture was not statistically different between dementia patients who received acetylcholinesterase inhibitors and those who did not receive them (odds ratio=1.44, CI 0.95, 2.19, P=0.09). Subgroup analysis showed no statistically significant difference between dementia patients who took acetylcholinesterase inhibitors, and those who didn't take acetylcholinesterase inhibitors in those more than or equal to 80 years old and those less than 80 years old (P=0.44) and (P=0.34) respectively. However, our results showed a statistically significant association between dementia patients who received acetylcholinesterase inhibitors and decreased fracture risk in those receiving the treatment for more than or less than 2 years (risk ratio=0.48, CI= 0.45, 0.51, P<0.00001) and (risk ratio=0.84, CI 0.70, 0.99, P=0.04), respectively. Conclusion: Our study revealed no role for acetylcholinesterase inhibitors in increasing the risk of fracture compared with controls. Hence, based on our analysis, they might have a protective role against fracture when used for long periods considering their positive action on bone growth and development. Therefore, Acetylcholinesterase inhibitors could be considered a safe option for improving cognitive functions in elderly demented patients without carrying any additional risks.

Association of aortic dissection and lipoprotein (a): a meta-analysis.

Some studies reported a positive relation between aortic dissection (AD) and increased lipoprotein (a) (LP(a)), while other studies reported no association, so the authors aimed to do a meta-analysis to establish the relation between AD and high levels of LP(a). Methods: PubMed, Scopus, Web of Science, SAGE, EMBASE, Science Direct, and Cochrane Library were searched. The inclusion criteria were any randomized control trials or observational studies that measured the levels of LP(a) in AD patients and healthy controls. The authors excluded case reports, case series, noncontrolled studies, reviews, editorials, and animal studies. Results: After a search of the literature, four studies were included in the meta-analysis with 678 patients included in the analysis. The pooled analysis showed a statistically significant association between the AD group and increased levels of LP(a), decreased levels of TG, low-density lipoprotein cholesterol, and TC compared with the control group (MD=11.71, 95% CI=4.11-19.32, P-value=0.003), (MD=-0,32, 95% CI=-0.48 to -0.16, P-value<0.0001 ), (MD=-0,21, 95% CI=-0.42 to -0.1, P-value=0.04), (MD=-0,58, 95% CI=-0.62 to -0.54, P-value<0.00001), respectively. Conclusion: Our study showed that AD is significantly associated with increased levels of LP(a). The significant increase in LP(a) in AD was associated with decreased levels of TG, low-density lipoprotein cholesterol, and TC. Future clinical trials testing Lp (a) targeting medications could be useful in the primary, or secondary prevention of AD in high risk patients.

Herpes Zoster virus infection and the risk of developing dementia: A systematic review and meta-analysis.

BACKGROUND: Herpes Zoster, commonly known as shingles, is a viral infection that affects a significant portion of the adult population; however, its potential role in the onset or progression of neurodegenerative disorders like dementia remains unclear. METHODS: We searched the following databases: PubMed, Scopus, Cochrane library, and Web of Science. We included any randomized control trials and controlled observational studies as Cross-sectional, prospective, or retrospective cohort and case-control studies that investigated the prevalence of dementia in Herpes Zoster Virus (HZV)-infected patients and HZV-free control group or if the study investigated the prevalence of HZV in demented patients. Also, if the studies measured the levels of dementia biomarkers in patients with HZV compared with a healthy control group. RESULTS: After the complete screening, 9 studies were included in the meta-analysis. In the outcome of the incidence of HZV, the pooled analysis showed no statistically significant difference between the dementia group and the No dementia group (RR = 1.04% CI = 0.86-1.25, P = .70). In the outcome of incidences of dementia and Alzheimer's disease, the pooled analysis showed no statistically significant difference between the HZV group and the incidence of dementia (RR = 0.99, 95% CI = 0.92-1.08, P = .89), (RR = 3.74, 95% CI = 0.22-62.70, P = .36) respectively. In the outcome of incidences of Herpes Zoster ophthalmicus (HZO), the generic inverse variance showed a statistically significant association between patients who have HZO and increased incidence of dementia (RR = 6.26, 95% CI = 1.30-30.19, P = .02). CONCLUSION: Our study showed no significant association between HZV and the incidence of dementia or Alzheimer's disease, but it shows a significant association between HZO and the incidence of dementia. More multicenter studies are needed to establish the actual association between the HZV and dementia.

Cyclophilin C as a Novel Diagnostic and Prognostic Biomarker of Coronary Artery Diseases. A Systematic Review and Meta-Analysis.

We aimed to perform a meta-analysis to investigate the value of Cyclophilin C as a diagnostic and prognostic biomarker in Coronary Artery Disease. PubMed, Web of Science, Scopus and Cochrane library databases were searched. The inclusion criteria were any randomized control trials or controlled observational studies that measured the levels of Cyclophilin C in Coronary Artery disease patients and healthy controls. We excluded case reports, case series, reviews, editorials and animal studies. After search of the literature, 4 studies were included in the meta-analysis with a total number of 454 individuals included in the study. The pooled analysis showed a significant association between CAD group and increased levels of Cyclophilin C (MD = 28.94, 95% confidence interval (CI) = 19.28-38.60, P-value < 0.00001). Subgroup analysis showed a significant association between acute and chronic CAD group with increased levels of cyclophilin c compared with the control group (MD = 35.98, 95% CI = 19.84-52.11, P-value < 0.0001) and (MD = 26.36, 95% CI = 21.87 to 30.85, P-value < 0.00001), respectively. The pooled effect estimate showed that the ROC area for the cyclophillin c as a diagnostic biomarker of CAD was (ROC= 0.880, 95% CI =0.844-0.917, P-value < 0.001). Our study revealed a significant association between acute and chronic coronary artery disease with increased levels of Cyclophilin C. Cyclophilin C could be used as a novel diagnostic and prognostic biomarker in acute and chronic CAD. More research is warranted to support our results.

Comparison of monocyte distribution width and Procalcitonin as diagnostic markers for sepsis: Meta-analysis of diagnostic test accuracy studies.

AIM: We aimed to perform a meta-analysis to find out whether PCT and MDW could be used as accurate diagnostic markers for sepsis. METHODS: We searched PUBMED, WOS, and SCOPUS databases. Inclusion criteria were any observational or clinical trials that compared monocyte Distribution Width [MDW] with Procalcitonin [PCT] as diagnostic markers in a patient with sepsis. Case reports, editorials, conference abstracts, and animal studies were excluded. RevMan software [5.4] was used to perform the meta-analysis. RESULTS: After the complete screening, 5 observational studies were included in the meta-analysis. The total number of patients included in the meta-analysis in the sepsis group is 565 and 781 in the control group. The pooled analysis between the sepsis group and controls showed a statistically significant association between sepsis and increased levels of MDW and PCT [MD = 3.94, 95% CI = 2.53 to 5.36, p-value < 0.00001] and [MD = 9.29, 95% CI = 0.67 to 17.91, p-value = 0.03] respectively. Moreover, the subgroup analysis showed that the p-value of MDW levels [< 0.00001] is more significant than the p-value of PCT levels = 0.03, the p-value between the two subgroups [< 0.00001]. Additionally, the overall ROC Area for MDW [0.790] > the overall ROC Area for PCT [0.760]. CONCLUSION: Our study revealed a statistically significant association between sepsis and increased MDW and PCT levels compared with controls and the overall ROC Area for MDW is higher than the overall ROC Area for PCT, indicating that the diagnostic accuracy of MDW is higher than PCT.MDW can be used as a diagnostic marker for sepsis patients in the emergency department. More multicenter studies are needed to support our findings.

Effect of early metoprolol before PCI in ST-segment elevation myocardial infarction on infarct size and left ventricular ejection fraction. A systematic review and meta-analysis of clinical trials.

AIM: This meta-analysis aims to look at the impact of early intravenous Metoprolol in ST-segment elevation myocardial infarction (STEMI) before percutaneous coronary intervention (PCI) on infarct size, as measured by cardio magnetic resonance (CMR) and left ventricular ejection fraction. METHODS: We searched the following databases: PubMed, Scopus, Cochrane library, and Web of Science. We included only randomized control trials that reported the use of early intravenous Metoprolol in STEMI before PCI on infarct size, as measured by CMR and left ventricular ejection fraction. RevMan software 5.4 was used for performing the analysis. RESULTS: Following a literature search, 340 publications were found. Finally, 18 studies were included for the systematic review, and 8 clinical trials were included in the meta-analysis after the full-text screening. At 6 months, the pooled effect revealed a statistically significant association between Metoprolol and increased left ventricular ejection fraction (LVEF) (%) compared to controls (mean difference [MD] = 3.57, [95% confidence interval [CI] = 2.22-4.92], p < .00001), as well as decreased infarcted myocardium(g) compared to controls (MD = -3.84, [95% [CI] = -5.75 to -1.93], p < .0001). At 1 week, the pooled effect revealed a statistically significant association between Metoprolol and increased LVEF (%) compared to controls (MD = 2.98, [95% CI = 1.26-4.69], p = .0007), as well as decreased infarcted myocardium(%) compared to controls (MD = -3.21, [95% CI = -5.24 to -1.18], p = .002). CONCLUSION: A significant decrease in myocardial infarction and increase in LVEF (%) was linked to receiving Metoprolol at 1 week and 6-month follow-up.