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1.
Int. j. cardiovasc. sci. (Impr.) ; 37(suppl. 6)sept. 2024.
Artigo em Português | CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1571559

RESUMO

INTRODUÇÃO: A associação entre fibrilação atrial (FA) e condições de saúde mental é bem estabelecida na literatura médica, todavia o impacto da ablação por cateter em comparação à terapia médica sobre a saúde mental e qualidade de vida ainda permanece incerto. Esse trabalho tem como objetivo realizar uma meta-análise comparando os efeitos da ablação por cateter versus terapia médica na saúde mental e qualidade de vida em pacientes com FA. MÉTODOS: Foi realizado busca sistemática nas bases de dados PubMed, Scopus e Cochrane por ensaios clínicos randomizados (ECRs) que compararam a ablação por cateter com a terapia médica para o tratamento de FA. Foi posto em enfoque resultados relacionados a (1) indicadores de saúde mental, avaliados usando o resumo do componente mental do questionário SF-36 ou a pontuação HADS, e (2) qualidade de vida, avaliada através do resumo do componente físico do SF-36 (PCS SF-36) e pontuaçaõ AFEQT. Foi realizada análise de subgrupos com base no tipo de FA, comparando FA paroxística e persistente. Foi utilizado modelo de efeitos fixos ou aleatórios para calcular as diferenças médias (MD) ou diferenças médias padronizadas (SMD) com intervalos de confiança de 95% (IC). RESULTADOS: Dos 15 ECRs incluídos envolvendo 5.262 pacientes, 2.725 (51,7%) foram submetidos à ablação por cateter. A idade média era de 59 anos, 67,1% eram homens e o seguimento médio variou de 1 a 4 anos. Em comparação com o tratamento médico a ablação por cateter foi associada a uma melhoria significativa na saúde mental (SMD 0,34; IC 95% 0,05-0,63 pontos; p=0,02) e nos indicadores de qualidade de vida, avaliados tanto pelo PCS SF-36 (MD 2,64; IC 95% 1,06-4,26 pontos; p<0,01) quanto pelo AFEQT (MD 6,24; IC 95% 4,43-8,05 pontos; p<0,01). Não houve diferença nos escores de qualidade de vida entre os subgrupos de FA paroxística ou persistente. CONCLUSÃO: Com base em 15 estudos e 4.789 pacientes, observamos que a maioria dos submetidos à ablação por cateter são homens, com idade média de 59 anos, e seguimento de 1 a 4 anos. Esses pacientes apresentaram melhoras significativas na saúde mental e qualidade de vida comparados à terapia médica, com aumentos notáveis de 0,34 pontos na saúde mental e elevações de 2,64 e 6,24 pontos nos índices PCS SF-36 e AFEQT, respectivamente. Esses benefícios se mantiveram tanto para fibrilação atrial paroxísticaquanto persistente.


Assuntos
Fibrilação Atrial , Ensaios Clínicos Controlados Aleatórios como Assunto , Ablação por Cateter , Qualidade de Vida , Indicadores de Qualidade de Vida , Indicadores Básicos de Saúde
2.
Eur J Haematol ; 113(6): 798-809, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39171519

RESUMO

BACKGROUND: Chimeric antigen receptor T-cell (CAR-T) therapy has shown promise in treating hematologic malignancies, yet its potential cardiotoxic effects require thorough investigation. OBJECTIVES: We aim to conduct a systematic review and meta-analysis to examine the cardiotoxic effects of CAR-T therapy in adults with hematologic malignancies. METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting cardiovascular outcomes, such as arrhythmias, heart failure, and reduced left ventricle ejection fraction (LVEF). RESULTS: Our analysis of 20 studies involving 4789 patients revealed a 19.68% incidence rate of cardiovascular events, with arrhythmias (7.70%), heart failure (5.73%), and reduced LVEF (3.86%) being the most prevalent. Troponin elevation was observed in 23.61% of patients, while NT-Pro-BNP elevation was observed in 9.4. Subgroup analysis showed higher risks in patients with pre-existing conditions, such as atrial arrhythmia (OR 3.12; p < .001), hypertension (OR 1.85; p = .002), previous heart failure (OR 3.38; p = .003), and coronary artery disease (OR 2.80; p = .003). CONCLUSION: Vigilant cardiovascular monitoring is crucial for patients undergoing CAR-T therapy to enhance safety and treatment efficacy.Novelty Statements.


Assuntos
Cardiotoxicidade , Imunoterapia Adotiva , Humanos , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Cardiotoxicidade/epidemiologia , Cardiotoxicidade/etiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Neoplasias Hematológicas/imunologia , Neoplasias Hematológicas/terapia , Imunoterapia Adotiva/efeitos adversos , Imunoterapia Adotiva/métodos , Receptores de Antígenos Quiméricos/imunologia
3.
Eur. j. haematol ; 113(6): 798-809, dez.2024. tab
Artigo em Inglês | CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1567870

RESUMO

BACKGROUND: Chimeric antigen receptor T-cell (CAR-T) therapy has shown promise in treating hematologic malignancies, yet its potential cardiotoxic effects require thorough investigation. OBJECTIVES: We aim to conduct a systematic review and meta-analysis to examine the cardiotoxic effects of CAR-T therapy in adults with hematologic malignancies. METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting cardiovascular outcomes, such as arrhythmias, heart failure, and reduced left ventricle ejection fraction (LVEF). RESULTS: Our analysis of 20 studies involving 4789 patients revealed a 19.68% incidence rate of cardiovascular events, with arrhythmias (7.70%), heart failure (5.73%), and reduced LVEF (3.86%) being the most prevalent. Troponin elevation was observed in 23.61% of patients, while NT-Pro-BNP elevation was observed in 9.4. Subgroup analysis showed higher risks in patients with pre-existing conditions, such as atrial arrhythmia (OR 3.12; p < .001), hypertension (OR 1.85; p = .002), previous heart failure (OR 3.38; p = .003), and coronary artery disease (OR 2.80; p = .003). CONCLUSION: Vigilant cardiovascular monitoring is crucial for patients undergoing CAR-T therapy to enhance safety and treatment efficacy.Novelty Statements.


Assuntos
Arritmias Cardíacas , Neoplasias Hematológicas , Cardiotoxicidade , Receptores de Antígenos Quiméricos , Troponina , Linfócitos T , Imunoterapia Adotiva , Ventrículos do Coração
4.
Am J Cardiovasc Drugs ; 24(4): 509-521, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38734847

RESUMO

BACKGROUND: GLP-1 receptor agonists (GLP-1 RAs) have emerged as an effective therapeutic class for weight loss. However, the efficacy of these agents in reducing cardiovascular endpoints among patients living with obesity or overweight is unclear. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing GLP-1 RAs versus placebo in patients with obesity or overweight. We searched PubMed, Cochrane, and Embase databases. A random-effects model was used to calculate risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). RESULTS: A total of 13 RCTs were included, with 30,512 patients. Compared with placebo, GLP-1 RAs reduced systolic blood pressure (MD - 4.76 mmHg; 95% CI - 6.03, - 3.50; p < 0.001; I2 = 100%) and diastolic blood pressure (MD - 1.41 mmHg; 95% CI - 2.64, - 0.17; p = 0.03; I2 = 100%). GLP-1 RA significantly reduced the occurrence of myocardial infarction (RR 0.72; 95% CI 0.61, 0.85; p < 0.001; I2 = 0%). There were no significant differences between groups in unstable angina (UA; RR 0.84; 95% CI 0.65, 1.07; p = 0.16; I2 = 0%), stroke (RR 0.91; 95% CI 0.74, 1.12; p = 0.38; I2 = 0%), atrial fibrillation (AF; RR 0.49; 95% CI 0.17, 1.43; p = 0.19; I2 = 22%), and deep vein thrombosis (RR 0.30; 95% CI 0.06, 1.40; p = 0.13; I2 = 0%). CONCLUSIONS: In patients living with obesity or overweight, GLP-1 RA reduced systolic and diastolic blood pressure and the occurrence of myocardial infarction, with a neutral effect on the occurrence of UA, stroke, AF, and deep vein thrombosis. REGISTRATION: PROSPERO identifier number CRD42023475226.


Assuntos
Agonistas do Receptor do Peptídeo 1 Semelhante ao Glucagon , Obesidade , Sobrepeso , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Obesidade/tratamento farmacológico , Obesidade/complicações , Sobrepeso/tratamento farmacológico , Sobrepeso/complicações , Doenças Cardiovasculares/prevenção & controle , Pressão Sanguínea/efeitos dos fármacos , Hipoglicemiantes/uso terapêutico
5.
Am. j. cardiovasc. drugs ; Am. j. cardiovasc. drugs;24maio.2024. ilus
Artigo em Inglês | CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1554136

RESUMO

BACKGROUND: GLP-1 receptor agonists (GLP-1 RAs) have emerged as an effective therapeutic class for weight loss. However, the efficacy of these agents in reducing cardiovascular endpoints among patients living with obesity or overweight is unclear. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing GLP-1 RAs versus placebo in patients with obesity or overweight. We searched PubMed, Cochrane, and Embase databases. A random-effects model was used to calculate risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). RESULTS: A total of 13 RCTs were included, with 30,512 patients. Compared with placebo, GLP-1 RAs reduced systolic blood pressure (MD - 4.76 mmHg; 95% CI - 6.03, - 3.50; p < 0.001; I2 = 100%) and diastolic blood pressure (MD - 1.41 mmHg; 95% CI - 2.64, - 0.17; p = 0.03; I2 = 100%). GLP-1 RA significantly reduced the occurrence of myocardial infarction (RR 0.72; 95% CI 0.61, 0.85; p < 0.001; I2 = 0%). There were no significant differences between groups in unstable angina (UA; RR 0.84; 95% CI 0.65, 1.07; p = 0.16; I2 = 0%), stroke (RR 0.91; 95% CI 0.74, 1.12; p = 0.38; I2 = 0%), atrial fibrillation (AF; RR 0.49; 95% CI 0.17, 1.43; p = 0.19; I2 = 22%), and deep vein thrombosis (RR 0.30; 95% CI 0.06, 1.40; p = 0.13; I2 = 0%). CONCLUSIONS: In patients living with obesity or overweight, GLP-1 RA reduced systolic and diastolic blood pressure and the occurrence of myocardial infarction, with a neutral effect on the occurrence of UA, stroke, AF, and deep vein thrombosis.


Assuntos
Agonistas do Receptor do Peptídeo 1 Semelhante ao Glucagon , Obesidade , Ensaios Clínicos Controlados como Assunto , Sobrepeso
6.
Eur J Pediatr ; 183(5): 2037-2047, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38451294

RESUMO

Urinary tract infections (UTI) affect between 3% to 7.5% of the febrile pediatric population each year, being one of the most common bacterial infections in pediatrics. Nevertheless, there is no consensus in the medical literature regarding the duration of per oral (p.o.) antibiotic therapy for UTI among these patients. Therefore, our meta-analysis aims to assess the most effective therapy length in this scenario. PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing short (≤ 5 days) with long-course (≥ 7 days) per os (p.o.) antibiotic therapy for children with UTI. Statistical analysis was performed using R Studio version 4.2.1, heterogeneity was assessed with I2 statistics, and the risk of bias was evaluated using the RoB-2 tool. Risk Ratios (RR) with p < 0.05 were considered statistically significant. Seventeen studies involving 1666 pediatric patients were included. Of these, 890 patients (53.4%) were randomized to receive short-course therapy. Patients undergoing short-course therapy showed higher treatment failure rates (RR 1.61; 95% CI 1.15-2.27; p = 0.006). Furthermore, there were no statistically significant differences between groups regarding reinfection (RR 0.73; 95% CI 0.47-1.13; p = 0156) and relapse rates (RR 1.47; 95% CI 0.8-2.71; p = 0.270).  Conclusion: In summary, our results suggest that long-course p.o. antibiotic therapy is associated with a lower rate of treatment failure when compared to short-course p.o. antibiotic therapy. There was no statistical difference between both courses regarding reinfection and relapse rates within 15 months.    PROSPERO identifier: CRD42023456745. What is Known: • Urinary tract infections (UTIs) are common in children, affecting around 7.5% of those under 18. • The optimal duration of antibiotic treatment for pediatric UTIs has been a subject of debate. What is New: • Short-course therapy (5 or fewer days) was associated with a significantly higher failure rate when compared to long-course therapy. • There was no significant difference in reinfection and relapse rates within 15 months between short and long-course therapy.


Assuntos
Antibacterianos , Esquema de Medicação , Infecções Urinárias , Criança , Humanos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológico
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