Cardiovascular outcomes of sodium-glucose Co-transporter 2 inhibitors use after myocardial infarction: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Patients who had acute myocardial infarction are at high risk of negative cardiac outcomes and previous SGLT2i landmark trials excluded these patients. It therefore remains unclear if SGLT2i is safe and confers beneficial cardiovascular outcomes after acute myocardial infarction. METHODS: We systematically reviewed randomized controlled trials that evaluated the outcomes of adding SGLT2i to conventional post-myocardial infarction care. Random-effects model meta-analysis via RevMan 5.4 was done on data extracted from pooled 11,204 patients. RESULTS: SGLT2i use after acute myocardial infarction was significantly associated with reduced heart failure hospitalization (OR: 0.77, 95%CI: 0.62-0.96, p=0.02), but was not associated with a reduction in all-cause mortality (OR: 1.05, 95%CI: 0.77-1.43, p=0.75), cardiac-related death (OR: 1.04, 95%CI: 0.83-1.30, p=0.76), or major adverse cardiac events (OR: 0.90, 95%CI: 0.77-1.05, p=0.18). CONCLUSION: SGLT2 inhibitor therapy after acute myocardial infarction is safe and is associated with a reduced risk of heart failure hospitalization, but not with all-cause mortality.

Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care for the management of choledocholithiasis but carries risk of complications which may result in significant morbidity and mortality. While currently available guidelines endorse the use of ERCP for the management of symptomatic common bile duct stones, the need for ERCP in incidentally found asymptomatic choledocholithiasis is more controversial, and practice varies on a geographic and institutional level. This systematic review and meta-analysis is conducted to compare post-ERCP adverse events between asymptomatic and symptomatic choledocholithiasis patients. METHODS: We searched PubMed/Embase/Web of Science databases to include all studies comparing post-ERCP outcomes between asymptomatic and symptomatic choledocholithiasis patients. The primary outcome was post-ERCP pancreatitis (PEP), while secondary outcomes included post-ERCP cholangitis, bleeding, and perforation. We calculated pooled risk ratios (RR) and 95% confidence intervals (CIs) using the Mantel-Haenszel method within a random-effect model. RESULTS: Our analysis included six observational studies, totaling 2,178 choledocholithiasis patients (392 asymptomatic and 1786 symptomatic); 53% were female. Asymptomatic patients exhibited a higher risk of PEP compared with symptomatic patients (11.7% versus 4.8%; RR 2.59, 95% CI 1.56-4.31, p ≤ 0.001). No significant difference was observed in post-ERCP cholangitis, bleeding, or perforation rates between the two groups. CONCLUSIONS: Asymptomatic patients with choledocholithiasis appear to have a higher risk of PEP than symptomatic patients, while the risk of other post-ERCP adverse events is similar between the two groups. Interventional endoscopists should thoroughly discuss potential adverse events (particularly PEP) with asymptomatic patients before performing ERCP and utilize PEP-prevention measures more liberally in this subgroup of patients.

Quivering hand and heart: Parkinson's disease is not associated with increased in-hospital mortality in atrial fibrillation hospitalizations: A nationwide analysis.

Background: Autonomic dysfunction in Parkinson's disease (PD) includes cardiovascular dysregulations which may manifest as an increased risk of atrial fibrillation (AF). However, data on the impact of PD in AF patients is lacking. Our study aimed to investigate the differences in in-hospital mortality of patients admitted for AF with underlying PD versus those without PD. Methods: We examined the National Inpatient Sample (NIS) database from 2016 to 2019 for hospitalizations of AF as a principal diagnosis with and without PD as a secondary diagnosis. The primary outcome was inpatient mortality. The secondary endpoints were ventricular tachycardia (VT), ventricular fibrillation (VF), acute heart failure (AHF), cardiogenic shock (CS), cardiac arrest (CA), total hospital charge (THC), and length of stay (LOS). Results: Of 1,861,859 A F hospitalizations, 0.01% (19,490) had coexisting PD. Cohorts of PD vs No-PD had a mean age of 78.1 years [CI 77.9-78.4] vs 70.5 years [CI 70.4-70.5]; male (56.3% vs 50.7%), female (43.7% vs 49.3%). The PD category had similar in-hospital mortality with the no-PD category (ORAdj = 1.18 [0.89-1.57] P = 0.240). The PD group had a lesser incidence of AHF (ORAdj = 0.79 [0.72-0.86] P < 0.001) and VT (ORAdj = 0.77 [0.62-0.95] P = 0.015). Conclusion: Co-existing PD in patients admitted for AF was not associated with increased in-hospital mortality; however, there were lower odds of AHF and VT. The diminished arrhythmogenic neurohormonal axis may explain these cardiovascular benefits. Notwithstanding, to better understand the outcomes of AF in patients with PD, additional studies are required.

Renal diseases associated with multiple sclerosis: A narrative review.

The mechanisms of renal pathology in multiple sclerosis (MS) can be related to the disease itself or its treatment. Although kidney disease can be associated with MS, not much has been reported in the literature; hence, our study aimed to describe the prevalence and types of renal diseases and discuss their prognosis in patients with MS. A literature search (2012-2022) was performed using the Scale for the Assessment of Narrative Review Articles. The databases searched included MEDLINE (PubMed) and EMBASE. Fourteen articles from these databases met the inclusion criteria. The inclusion criteria were as follows: publications with full-text access. Articles published in English. Original articles related to renal diseases in MS. The prevalence of renal diseases in MS from the articles obtained ranged from 0.74% to 2.49%. Interferon beta (IFN-ß)-associated glomerulonephritis was common among the reviewed articles. Significant improvement and resolution of the pathology were observed after the discontinuation of the offending medication. Renal symptoms in 2 out of 4 cases with renal thrombotic microangiopathy (TMA) induced by interferon-beta progressed to chronic kidney disease, even after the drug was stopped. Other studied renal pathologies included nephrolithiasis secondary to urinary retention and urinary catheter use in patients with MS.

Clinical characteristics, predictors, and rates of hospitalized acute cholangitis patients in the United States.

Background: Acute cholangitis (AC) is a relatively uncommon condition, with a mortality rate of 50% without prompt treatment. Our study aimed to assess the impact of demographic and social factors on morbidity, mortality and healthcare utilization of patients with AC in the United States (US). Methods: We used data from the National Inpatient Sample (2016 and 2017). Our study population included all patients with a discharge diagnosis of AC, identified using the International Classification of Diseases, Tenth Revision (ICD-10) code K830. Results: A total of 18,649 patients were hospitalized with a diagnosis of AC, with rates higher among older persons. The incidence increased notably from 142.36 cases per million in 2016 to 144.3 in 2017. The majority (53%) of patients were on Medicare. Age >60 years was associated with greater mortality compared to 0-18 years (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.21-5.43). Hispanic race (OR 1.4, 95%CI 1.15-1.76) and Black race (OR 1.3, 95%CI 1.04-1.63) had an increased mortality compared to White race. Among the factors analyzed, age >60 (OR 3.72, 95%CI 2.93-4.70) and male sex (OR 0.91, 95%CI 0.86-0.98) were found to be significantly associated with endoscopic retrograde cholangiopancreatography (ERCP) during hospitalization. The total charge for hospitalizations in 2016 was $766 million, increasing to $825 million in 2017. Conclusions: The incidence of AC in the US increased slightly year over year. In patients presenting with AC, age and race were associated with mortality while age and sex were associated with the need for ERCP.