Role of N-Acetylcysteine to Prevent Contrast-Induced Nephropathy: A Meta-analysis.

It is unclear whether N-acetylcysteine is useful in preventing contrast-induced nephropathy in patients undergoing coronary angiography. Because of different inclusion and exclusion criteria and different definitions of studied parameters, various studies have reported different outcomes. A systematic search was done using PubMed, Ovid, and the Cochrane library, and studies were pooled after strict inclusion and exclusion criteria. Separate analysis was conducted for all endpoints including only studies that used an N-acetylcysteine (NAC) dose of 600 mg, and another separate analysis was conducted for all endpoints including only studies that used oral route NAC to study how the dose and route of administration of NAC affect the outcomes. The results of the pooled analysis significantly favored the use of NAC to prevent contrast-induced nephropathy in patients undergoing coronary angiography but failed to show any significant benefit in terms of creatinine levels preangiography and postangiography, need for dialysis, and all-cause mortality. The effects of route and dose of NAC did not show any significant difference except in respect to incidence of postcatheterization nephropathy. This study shows that NAC may not have any impact on clinical outcomes after peripheral or coronary artery catheterization and that dose and route do not seem to have any effect on these outcomes.

Determining bronchial morphology for the purposes of segregating so-called heterotaxy.

UNLABELLED: Introduction Heterotaxy is a unique clinical entity in which lateralisation of the thoraco-abdominal organs is abnormal, typically with isomerism of the bronchial tree and atrial appendages. This study was carried out to determine whether routine clinical imaging such as chest radiographs, angiographic images, and CT/MRI can determine bronchial isomerism, and how sidedness of bronchial isomerism correlates with overall features anticipated in hearts with isomeric atrial appendages. Methods and results We identified 73 patients with heterotaxy, in whom imaging clearly demonstrated the bronchial tree, seen at our institution since 1998. We calculated bronchial angles and lengths using all the available imaging modalities to determine the presence and sidedness of bronchial isomerism. This was then compared with the anticipated presence of isomeric atrial appendages based on the overall clinical findings, as the appendages themselves had not specifically been imaged. The ratio of bronchial lengths revealed bronchial isomerism in all patients, with bronchial angles permitting distinction of right as opposed to left isomerism. We noted discordances between the identified bronchial isomerism and the presumed arrangement of the atrial appendages in nearly 20% of the patients in our cohort. CONCLUSION: Routine clinical imaging with chest radiographs, angiographic imaging, and CT/MRI can determine the presence of bronchial isomerism in patients with so-called heterotaxy. Right as opposed to left isomerism can be distinguished based on bronchial angles. The finding of bronchial isomerism correlates well, but not totally, with the presumed isomerism of the atrial appendages as predicted from the identified intra-cardiac morphology.

Effects of music on systolic blood pressure, diastolic blood pressure, and heart rate: a meta-analysis.

There are a handful of studies that have been done investigating the effect of music on various vital signs, namely systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Many studies have also assessed effects of music on self-reported anxiety level, attributing some degree of music-induced anxiety relief to the beneficial impacts of music on vital signs. Several randomised studies have shown varying effects of music on these vital parameters and so a meta-analysis was done to compare the effect of music on them. The fixed effects model was used as studies were homogenous. A two-sided alpha error < 0.05 was considered to be statistically significant. Compared to those who did not receive music therapy, those who did receive music therapy had a significantly greater decrease in SBP before and after (difference in means, -2.629, confidence interval (CI), -3.914 to -1.344, P < 0.001), a significantly greater decrease in DBP (difference in means, -1.112, CI, -1.692 to -0.532, P < 0.001), and a significantly greater decrease in HR (difference in means, -3.422, CI, -5.032 to -1.812, P < 0.001).

Calcified lymph nodes in the setting of head and neck squamous cell carcinoma: A predictor of HPV positivity?

PURPOSE: Human papillomavirus (HPV) is an important cause of head and neck squamous cell carcinoma (HNSCC) and accounts for a large majority of new cases. The purpose of this study is to determine whether there is an association between nodal calcification and HPV positivity in the setting of metastatic HNSCC. METHODS: Consecutive patients with HNSCC who underwent CT were retrospectively identified. Patients were then divided into two groups: those with HPV-positive HNSCC and those with HPV-negative HNSCC. Demographic, clinical, and CT data were compared between the two groups to determine factors associated with HPV-positive HNSCC. RESULTS: A total of 179 patients with HNSCC were included in the final analyses, 104 (58%) of whom had HPV-positive tumors. Univariate analyses demonstrated that those with HPV-positive HNSCC were more likely to have calcified lymph nodes (p = 0.044). Analyses also confirmed previously known associations with male gender (p = 0.001), primary oropharyngeal tumors (p < 0.001), and cystic lymph nodes (<0.001). The HPV-positive HNSCC group was also less likely to have necrotic lymph nodes (p < 0.001). CONCLUSION: In addition to known clinical and imaging factors associated with HPV-positive metastatic HNSCC, such as male gender, oropharyngeal primary location, and cystic lymph nodes, the presence of calcifications within cervical lymph nodes, although infrequent, provides an additional useful feature to predict HPV positivity in HNSCC. Additionally, if calcified lymph nodes are present, then a primary oropharyngeal tumor site should be considered.

Radiologic Considerations in Heterotaxy: The Need for Detailed Anatomic Evaluation.

So-called "heterotaxy" is a laterality defect characterized by isomerism of the thoracic organs and random arrangement of the abdominal organs. These findings go beyond anatomic curiosity and have functional implications. It is, thus, of the utmost importance to be able to properly identify these findings. Radiologic studies can be invaluable in determining anomalies in the central nervous, pulmonary, cardiovascular, gastrointestinal, genitourinary, and immunologic systems in patients with isomerism. Here, we review findings associated with isomerism and their importance in the setting of isomerism with the aim of ensuring that radiologists effectively describe findings in these patients and that cardiologists understand the wide variety of congenital malformations that may be present.

Fetal Magnetic Resonance Imaging of Malformations Associated with Heterotaxy.

Magnetic resonance imaging (MRI) is increasingly used as an investigation during fetal life, particularly for assessment of intracranial masses, congenital diaphragmatic hernia, myelomeningocele, and abdominal masses. As the number of scans increases, so is the variety of congenital malformations being recognized. It is axiomatic that interpretation of the findings is enhanced when attention is paid to the likely findings in the setting of known syndromes, this information then dictating the need for additional acquisition of images. One such syndrome is so-called "visceral heterotaxy", in which there is typically an isomeric, rather than a lateralized, arrangement of the thoracic and abdominal organs. Typically associated with complex congenital cardiac malformations, heterotaxy can also involve the central nervous system, and produce pulmonary, gastrointestinal, immunologic, and genitourinary malformations. In this review, we discuss how these findings can be demonstrated using fetal MRI.

Cardiothoracic ratio for prediction of left ventricular dilation: a systematic review and pooled analysis.

Increased cardiothoracic ratio noted on chest radiographs often prompts concern and further evaluation with additional imaging. This study pools available data assessing the utility of cardiothoracic ratio in predicting left ventricular dilation. A systematic review of the literature was conducted to identify studies comparing cardiothoracic ratio by chest x-ray to left ventricular dilation by echocardiography. Electronic databases were used to identify studies which were then assessed for quality and bias, with those with adequate quality and minimal bias ultimately being included in the pooled analysis. The pooled data were used to determine the sensitivity, specificity, positive predictive value and negative predictive value of cardiomegaly in predicting left ventricular dilation. A total of six studies consisting of 466 patients were included in this analysis. Cardiothoracic ratio had 83.3% sensitivity, 45.4% specificity, 43.5% positive predictive value and 82.7% negative predictive value. When a secondary analysis was conducted with a pediatric study excluded, a total of five studies consisting of 371 patients were included. Cardiothoracic ratio had 86.2% sensitivity, 25.2% specificity, 42.5% positive predictive value and 74.0% negative predictive value. Cardiothoracic ratio as determined by chest radiograph is sensitive but not specific for identifying left ventricular dilation. Cardiothoracic ratio also has a strong negative predictive value for identifying left ventricular dilation.

Influenza vaccination and cardiovascular morbidity and mortality: analysis of 292,383 patients.

Studies have documented an association between influenza vaccination and risk reduction in myocardial infarction, all-cause mortality, and major adverse cardiac events. This meta-analysis pooled data from 5 trials with a total of 292 383 patients. Influenza vaccination was found to be associated with significant reductions in myocardial infarction, all-cause mortality, and major adverse cardiac events. The risk reduction afforded by vaccination and the lack of major adverse events related to the influenza vaccination makes it particularly important to vaccinate those with a known cardiovascular disease or those at high risk of developing cardiovascular disease.

Thigh-length versus knee-length compression stockings for deep vein thrombosis prophylaxis in the inpatient setting.

Deep vein thrombosis may be a complication of extended length hospital stays. Immobilized patients, such as patients in the postoperative period, are at particularly high risk of developing a deep vein thrombosis, which can be associated with high levels of morbidity and mortality. Due to this, prevention of deep vein thrombosis is of great importance in the inpatient setting. Compression stockings have proven to play an important role in prophylaxis and may be used in their knee-length or thigh-length variety. Although randomized trials have studied the efficacy of both varieties in prevention of deep vein thrombosis, selection is often made without regard to evidence. This meta-analysis pools the findings of current studies comparing knee-length and thigh-length compression stockings for deep vein thrombosis prophylaxis. A fixed effects model was used for this study with a two-sided α-error less than 0.05 considered to be statistically significant. When both varieties of compression stockings are compared, thigh-length stockings offer a risk reduction in deep vein thrombosis development when compared with knee-length (odds ratio 1.197, confidence interval 0.983-1.458). This, however, is an insignificant finding. This analysis concludes that current data does not favor either thigh-length or knee-length compression stockings when it comes to prophylaxis of deep vein thrombosis.

The developing role of fetal magnetic resonance imaging in the diagnosis of congenital cardiac anomalies: A systematic review.

Advances in the fetal magnetic resonance imaging (MRI) over the last few years have resulted in the exploring the use of fetal MRI to detect congenital cardiac anomalies. Early detection of congenital cardiac anomalies can help more appropriately manage the infant's delivery and neonatal management. MRI offers anatomical and functional studies and is a safe adjunct that can help more fully understand a fetus' cardiac anatomy. It is important for the obstetricians and pediatric cardiologists to be aware of the recent advancements in fetal MRI and it`s potential utility in diagnosing congenital cardiac anomalies.

Association of atrial tachyarrhythmias with atrial septal defect, Ebstein's anomaly and Fontan patients.

The number of adults with congenital heart disease is increasing as medical and surgical palliation for congenital heart lesions improves. With this comes long-term complications of congenital heart disease such as the increased risk of atrial tachyarrhythmias. Atrial septal defect, Ebstein's anomaly and post-Fontan patient subsets are particularly important to focus on due to their unique characteristics and association with atrial tachyarrhythmias. Reviews, randomized controlled trials, and meta-analyses were obtained using electronic search strategies such as Medline and the Cochrane Library. References of electronically obtained studies were then used to obtain additional relevant studies. Sources were deemed relevant if they discussed the relationship between atrial septal defects/Ebstein's anomaly/Fontan procedure and atrial tachyarrhythmias in respect to incidence, mechanism, recurrence or treatment. Selected sources were then stratified on the basis of quality. Patients in these subsets of congenital heart disease are at increased risk of atrial tachyarrhythmias for a variety of reasons when compared with the general population. It is necessary for pediatric and adult cardiologists alike to understand these differences, as well as their implications in diagnosis and management of such occurrences.