Arrhythmic mitral valve prolapse: Diagnostic parameters for high-risk patients: A systematic review and meta-analysis.

BACKGROUND: Although frequently considered a benign condition, new evidence has shown that mitral valve prolapse (MVP) is associated with complex ventricular arrhythmias (VAs) and sudden cardiac death (SCD). Therefore, we conducted a systematic review and meta-analysis of the relevant studies to investigate the parameters that could identify MVP patients at higher risk of experiencing complex VAs. METHOD: We performed a systematic literature search of PubMed for potential studies between January 2010 and January 2021. Our meta-analysis included studies comparing MVP patients with complex VAs (A-MVP) and those without (NA-MVP). We used the fixed-effects model to obtain the odds ratio (OR), risk ratio (RR), or mean difference (MD) and 95% confidence interval (CI) for each analyzed parameter. RESULTS: Six studies with 848 individuals were included in the meta-analysis. As compared to the NA-MVP patients, A-MVP patients had a higher prevalence of inverted T-wave (OR: 2.73; 95% CI: 1.85-4.02; p < .00001) and longer QTc interval on the resting ECG (MD: 14.73; 95% CI: 9.39-20.08; p < .00001), longer anterior mitral leaflet length (MD: 2.67; 95% CI: 2.02-3.31; p < .00001), bi-leaflet prolapse (OR: 1.65; 95% CI: 1.22-2.24; p = .001), and mitral annulus disjunction (MAD) on echocardiogram (RR: 1.90; 95% CI: 1.50-2.40; p < .00001), and late gadolinium enhancement (LGE) on cardiac magnetic resonance (RR: 4.38; 95% CI: 1.77-10.86; p = .001). CONCLUSION: Our comprehensive meta-analysis suggests that risk factors related to A-MVP are T-wave inversion, longer QTc interval, bi-leaflet prolapse, longer anterior mitral valve leaflet, MAD, and LGE.

Post-Traumatic Seizures: A Deep-Dive Into Pathogenesis.

Post-traumatic seizures (PTS) have become an emerging challenge for neurologists worldwide with the rise of brain injuries. Trauma can lead to various outcomes, ranging from naive spasms to debilitating post-traumatic epilepsy (PTE). In this article, we will explore the pathogenesis of convulsions following a concussion. We will look at multiple studies to explain the various structural, metabolic, and inflammatory changes leading to seizures. Additionally, we will explore the association between severity and location of injury and PTE. PTE's pathophysiology is not entirely implicit, and we are still in the dark as to which anti-epileptic drugs will be useful in circumventing these attacks. The purpose of this narrative review is to explain the post-traumatic brain changes in detail so that such attacks can be either thwarted or treated more resourcefully in the future.

Subclinical Hypothyroidism in Geriatric Population and Its Association With Heart Failure.

Heart failure (HF) is one of the most common causes of hospitalization in the geriatric age group, above 65 years. It is associated with high morbidity, mortality, and bad prognosis. Subclinical hypothyroidism (SCH) is a common condition present in this age group that significantly affects the cardiovascular system. Thus, this review attempts to elaborate on the association between subclinical hypothyroidism and heart failure in terms of their prevalence, pathogenesis, prognosis, and possible management in a geriatric age group. Among the various published literature on this topic on PubMed, PubMed Central, and Google Scholar, 36 relevant studies were selected to correlate this association. We found that both SCH and HF can be present concurrently in this age group. Especially in the geriatric population with thyroid-stimulating hormone (TSH) higher than ten mIu/L, there is an increased incidence of heart failure and a worse prognosis with preexisting heart failure. However, randomized controlled trials will be needed to explore further whether treatment is warranted or not in this age group.