Rheumatic Diseases Following Metabolic and Bariatric Surgery: A Systematic Review and Meta-Analysis.

Metabolic and bariatric surgery (MBS) has been associated with weight reduction and obesity complications improvement. However, there is no clear evidence of the extent and consistency of the effects of this procedure on rheumatic diseases. This study aims to conduct a meta-analysis to address the impact of MBS on rheumatic diseases. We searched PubMed, Cochrane, and Embase for studies reporting the prevalence of rheumatic diseases, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the medication use after MBS. We conducted a random-effects meta-analysis using odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). P-values < 0.05 were considered statistically significant. We included 28 studies comprising 43,421 patients, with 13,347 patients with rheumatic diseases. The prevalence of osteoarthritis (OA), rheumatoid arthritis, and psoriatic arthritis was significantly reduced after MBS (OR 0.20; 95% CI 0.12 to 0.33; P = 0.01). The WOMAC index for patients with OA had a statistically significant overall reduction after MBS at 6 months (MD - 20.60 points; 95% CI - 28.73 to - 12.47; P < 0.01) and at 12 months (MD - 15.88 points; 95% CI - 19.09 to - 12.66; P < 0.01). Medication use significantly decreased after MBS, both at the follow-up beyond 2 years (OR 0.49; 95% CI 0.35 to 0.69; P < 0.01) and up to 2 years (OR 0.32; 95% CI 0.15 to 0.69; P < 0.01). In this meta-analysis, we found a significant decrease in the prevalence of rheumatic diseases, improvements in the WOMAC index, and reduced medication use among patients undergoing MBS.

Comparing pulsed field ablation with very high-power and high-power short-duration radiofrequency ablation for atrial fibrillation: a systematic review and meta-analysis.

BACKGROUND: Catheter ablation is a key treatment for atrial fibrillation (AF), with high-power, very high-power short-duration and pulsed field ablation (PFA) being efficient options. However, direct comparisons between these techniques are lacking. OBJECTIVE: We performed a systematic review and meta-analysis, which included predominantly observational studies (four retrospective and one prospective study), to compare PFA and High-power short-duration (HPSD) and very high-power short-duration (vHPSD) radiofrequency (RF) ablation in patients with AF. METHODS: We searched PubMed, Embase and Cochrane Central. Outcomes of interest included: Arrhythmia-free survival (AF, atrial flutter, and atrial tachycardia recurrences 30 s during follow-up after a 1-month blanking period), procedure time, fluoroscopy time, fluoroscopy dose, complications overall. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I2 statistics. RESULTS: Our meta-analysis included 1,255 patients from 5 studies, with a mean age ranging from 63 to 68 years. Among them, 554 (45.2%) underwent pulsed field ablation (PFA) and 701 (55.8%) received high/very high potential short-duration ablation. PFA improved arrhythmia-free survival (RR 1.05; 95% CI 1.002-1.120; P = 0.004; I2 = 0%) and reduced procedure time (MD -29.95 min; 95% CI -30.90 to -29.00; P < 0.01; I2 = 0%). However, PFA increased fluoroscopy time (MD 6.33 min; 95% CI 1.65 to 11.01; P < 0.01; I2 = 98%) and showed no significant difference in overall complications (RR 0.88; 95% CI 0.38-2.02; P = 0.756; I2 = 47%), cardiac tamponade (RR 1.62; 95% CI 0.27-9.85; P = 0.599; I2 = 40%), or stroke/transient ischemic attack (TIA) incidence (RR 0.64; 95% CI 0.15-2.80; P = 0.555; I2 = 0%). PFA was associated with a reduced need for redo procedures (RR 0.66; 95% CI 0.45-0.97; P = 0.036; I2 = 0%) and did not significantly affect the fluoroscopy dose (MD 896.86 mGy·cm2; 95% CI -1269.44 to 3063.15; P = 0.42; I2 = 39%). CONCLUSION: In this meta-analysis, PFA was associated with improved arrhythmia-free survival and reduced procedure time, although it resulted in increased fluoroscopy time. PFA and high/very high power short-duration ablation yielded similar outcomes regarding overall complications, cardiac tamponade, and stroke/TIA incidence. Both techniques demonstrated comparable efficacy in treating atrial fibrillation.

Methotrexate for osteoarthritis: a systematic review meta-analysis of randomized controlled trials.

BACKGROUND: Osteoarthritis (OA) is a common joint disorder causing pain and stiffness, with limited effective treatment options. Methotrexate, known for its anti-inflammatory properties in rheumatoid arthritis, is being explored as a treatment for OA. This study evaluates Methotrexate's efficacy compared to placebo in reducing OA symptoms, such as stiffness in the knee and hand, and its impact on pain, physical function. METHODS: We systematically searched PubMed, Google Scholar, Embase, Web of Science, and Cochrane databases for randomized controlled trials (RCTs), analyzing the efficacy of Methotrexate compared to placebo in patients with OA. We pooled risk ratios (RR) for binary outcomes. For continuous outcomes, we used standard mean difference (SMD) and mean difference (MD) with 95% confidence intervals (CI). Outcomes included were related to knee and hand pain, knee stiffness, and similar outcomes. We used R version 4.4.1 for statistical analyses. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach evaluated the quality of evidence. RESULTS: This analysis included 5 RCTs comprising 465 patients, of whom 229 were randomized to Methotrexate. The age ranged from 52.4 to 67.5 years among studies. Compared with placebo, Methotrexate significantly reduced knee and hand stiffness at the end of follow-up (SMD - 0.36; 95% CI - 0.57 to - 0.15; p< 0.01), knee and hand stiffness at 6 months of follow-up (SMD - 0.48; 95% CI - 0.70 to - 0.27; p< 0.01). CONCLUSION: Methotrexate significantly reduced knee stiffness in both knee and hand OA. However, current literature might be underpowered, more robust RCTs are necessary to validate these findings.

The cardiotoxic effects of CAR-T cell therapy: An updated systematic review and meta-analysis.

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.

Monoclonal antibodies in patients with osteoporosis and renal insufficiency: An updated systematic review and meta-analysis.

Objectives: There are challenges for the treatment of osteoporosis in patients with kidney failure and monoclonal antibodies (MAb) might be a suitable therapy. However, the efficacy and safety of MAb among patients with osteoporosis and renal insufficiency remains unclear. Methods: We systematically searched PubMed, Embase, and Cochrane Central for studies evaluating the efficacy and safety of the use of MAb in patients with osteoporosis and renal insufficiency. We pooled risk ratios (RR) and 95% confidence intervals (CI) for binary outcomes. Mean difference (MD) was used for continuous outcomes. Results: We included 5 studies with 33,550 patients. MAb therapy decreased the risk of vertebral fractures (RR 0.32; 95% CI 0.26-0.40; P < 0.01) when compared to placebo and no statistical difference was found when comparing to bisphosphonate (RR 0.71; 95% CI 0.49-1.03; P = 0.07). MAb therapy also decreased the risk of nonvertebral fractures (RR 0.79; 95% CI 0.69-0.91; P = 0.0009). Lumbar spine bone mineral density (BMD) was higher in the MAb therapy when compared to both placebo (MD 10.90; 95% CI 8.00-13.80; P < 0.01) and bisphosphonate (MD 7.66; 95% CI 6.19-9.14; P < 0.01). There was no statistically significant difference in the change of estimated glomerular filtration rate and in the incidence of hypocalcemia and serious adverse events between groups. Conclusions: There were reductions in both vertebral and nonvertebral fracture risks, alongside improvements in BMD among patients with renal insufficiency treated with MAb.

Tight Versus Liberal Blood Glucose Control in Patients With Diabetes in the ICU: A Meta-Analysis of Randomized Controlled Trials.

Introduction: Glycemia is an important factor among critically ill patients in the intensive care unit (ICU). There is conflicting evidence on the preferred strategy of blood glucose control among patients with diabetes in the ICU. We aimed to conduct a meta-analysis comparing tight with liberal blood glucose in critically ill patients with diabetes in the ICU. Methods: We systematically searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing tight versus liberal blood glucose control in critically ill patients with diabetes from inception to December 2023. We pooled odds-ratios (OR) and 95% confidence intervals (CI) with a random-effects model for binary endpoints. We used the Review Manager 5.17 and R version 4.3.2 for statistical analyses. Risk of bias assessment was performed with the Cochrane tool for randomized trials (RoB2). Results: Eight RCTs with 4474 patients were included. There was no statistically significant difference in all-cause mortality (OR 1.11; 95% CI 0.95-1.28; P = .18; I² = 0%) between a tight and liberal blood glucose control. RoB2 identified all studies at low risk of bias and funnel plot suggested no evidence of publication bias. Conclusion: In patients with diabetes in the ICU, there was no statistically significant difference in all-cause mortality between a tight and liberal blood glucose control. PROSPERO registration: CRD42023485032.

Catheter ablation versus medical therapy for atrial fibrillation in patients with heart failure with preserved ejection fraction: A systematic review and meta-analysis.

BACKGROUND: The benefit of catheter ablation for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) remains uncertain. OBJECTIVE: We performed a systematic review and meta-analysis to compare catheter ablation and medical therapy (antiarrhythmics for rhythm or rate control) in patients with AF and HFpEF. METHODS: We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials. Outcomes were the composite end points of death or heart failure (HF) hospitalization, all-cause death, cardiovascular death, all-cause rehospitalization, and HF hospitalization. Statistical analysis was performed using R statistical software, version 4.3.2 (R Foundation for Statistical Computing). Heterogeneity was assessed with I2 statistics. RESULTS: We included 20,257 patients from 8 studies. Of those, 3 were derived from RCTs, either through post hoc analysis or subgroup analysis, and 5 were observational studies. The median follow-up ranged from 24.6 to 61.2 months. Compared with medical therapy, catheter ablation was associated with a statistically significant lower risk of death or HF hospitalization (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.47-0.83; P = .001; I2 = 66%), all-cause death (HR 0.68; 95% CI 0.46-0.99; P = .047; I2 = 61%), cardiovascular death (HR 0.42; 95% CI 0.21-0.84; P = .014; I2 = 22%), and HF hospitalization (HR 0.43; 95% CI 0.23-0.82; P = .011; I2 = 87%). CONCLUSION: In this meta-analysis, catheter ablation was associated with a lower risk of all-cause death, cardiovascular death, HF hospitalization, and all-cause rehospitalization in comparison to medical therapy in patients with AF and HFpEF.