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Blood Cancer Journal Mar 2022Extramedullary involvement (or extramedullary disease, EMD) represents an aggressive form of multiple myeloma (MM), characterized by the ability of a clone and/or... (Review)
Review
Extramedullary involvement (or extramedullary disease, EMD) represents an aggressive form of multiple myeloma (MM), characterized by the ability of a clone and/or subclone to thrive and grow independent of the bone marrow microenvironment. Several different definitions of EMD have been used in the published literature. We advocate that true EMD is restricted to soft-tissue plasmacytomas that arise due to hematogenous spread and have no contact with bony structures. Typical sites of EMD vary according to the phase of MM. At diagnosis, EMD is typically found in skin and soft tissues; at relapse, typical sites involved include liver, kidneys, lymph nodes, central nervous system (CNS), breast, pleura, and pericardium. The reported incidence of EMD varies considerably, and differences in diagnostic approach between studies are likely to contribute to this variability. In patients with newly diagnosed MM, the reported incidence ranges from 0.5% to 4.8%, while in relapsed/refractory MM the reported incidence is 3.4 to 14%. Available data demonstrate that the prognosis is poor, and considerably worse than for MM without soft-tissue plasmacytomas. Among patients with plasmacytomas, those with EMD have poorer outcomes than those with paraskeletal involvement. CNS involvement is rare, but prognosis is even more dismal than for EMD in other locations, particularly if there is leptomeningeal involvement. Available data on treatment outcomes for EMD are derived almost entirely from retrospective studies. Some agents and combinations have shown a degree of efficacy but, as would be expected, this is less than in MM patients with no extramedullary involvement. The paucity of prospective studies makes it difficult to justify strong recommendations for any treatment approach. Prospective data from patients with clearly defined EMD are important for the optimal evaluation of treatment outcomes.
Topics: Humans; Multiple Myeloma; Neoplasm Recurrence, Local; Plasmacytoma; Prospective Studies; Retrospective Studies; Tumor Microenvironment
PubMed: 35314675
DOI: 10.1038/s41408-022-00643-3 -
Journal of the American Heart... Apr 2021Acquired tuberculosis continues to be a challenge worldwide. Although tuberculosis has been considered a global public health emergency, it remains poorly controlled in...
Acquired tuberculosis continues to be a challenge worldwide. Although tuberculosis has been considered a global public health emergency, it remains poorly controlled in many countries. Despite being primarily a pulmonary disease, tuberculosis could involve the heart. This systematic review is part of the "Neglected Tropical Diseases and Other Infectious Diseases Involving the Heart" (the NET-Heart Project) initiative from the Interamerican Society of Cardiology. This project aims to review the cardiovascular involvement of these heterogeneous diseases, advancing original algorithms to help healthcare providers diagnose and manage cardiovascular complications. In tuberculosis, pericardium involvement is relatively common, especially in AIDS, and tuberculosis is the most common cause of constrictive pericarditis in endemic countries. Myocarditis and aortitis by tuberculosis are rare. Clinical manifestations of cardiovascular involvement by tuberculosis differ from those typically found for bacteria or viruses. Prevailing systemic symptoms and the pericarditis diagnostic index should be taken into account. An echocardiogram is the first step for diagnosing cardiovascular involvement; however, several image modalities can be used, depending on the suspected site of infection. Adenosine deaminase levels, gamma interferon, or polymerase chain reaction testing could be used to confirm tuberculosis infection; each has a high diagnostic performance. Antituberculosis chemotherapy and corticosteroids are treatment mainstays that significantly reduce mortality, constriction, and hospitalizations, especially in patients with HIV. In conclusion, tuberculosis cardiac involvement is frequent and could lead to heart failure, constrictive pericarditis, or death. Early detection of complications should be a cornerstone of overall management.
Topics: Disease Management; Global Health; Humans; Morbidity; Myocarditis; Tuberculosis, Cardiovascular
PubMed: 33733808
DOI: 10.1161/JAHA.120.019435 -
The Cochrane Database of Systematic... Aug 2014Pericarditis is the inflammation of the pericardium, the membranous sac surrounding the heart. Recurrent pericarditis is the most common complication of acute... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pericarditis is the inflammation of the pericardium, the membranous sac surrounding the heart. Recurrent pericarditis is the most common complication of acute pericarditis, causing severe and disabling chest pains. Recurrent pericarditis affects one in three patients with acute pericarditis within the first 18 months. Colchicine has been suggested to be beneficial in preventing recurrent pericarditis.
OBJECTIVES
To review all randomised controlled trials (RCTs) that assess the effects of colchicine alone or combined, compared to any other intervention to prevent further recurrences of pericarditis, in people with acute or recurrent pericarditis.
SEARCH METHODS
We searched the following bibliographic databases on 4 August 2014: Cochrane Central Register of Controlled Trials (CENTRAL, Issue 7 of 12, 2014 on The Cochrane Library), MEDLINE (OVID, 1946 to July week 4, 2014), EMBASE (OVID, 1947 to 2014 week 31), and the Conference Proceedings Citation Index - Science on Web of Science (Thomson Reuters) 1990 to 1 Aug 2014. We did not apply any language or time restrictions.
SELECTION CRITERIA
RCTs of people with acute or recurrent pericarditis who are receiving colchicine compared to any other treatment, in order to prevent recurrences.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The first primary outcome was the time to recurrence, measured by calculating the hazard ratios (HRs). The second primary outcome was the adverse effects of colchicine. Secondary outcomes were the rate of recurrences at 6, 12 and 18 months, and symptom relief.
MAIN RESULTS
We included four RCTs, involving 564 participants in this review. We compared the effects of colchicine in addition to a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, aspirin or indomethacin to the effects of the NSAID alone. Two comparable trials studied the effects of colchicine in 204 participants with recurrent pericarditis and two trials studied 360 people with acute pericarditis. All trials had a moderate quality for the primary outcomes. We identified two on-going trials; one of these trials examines acute pericarditis and the other assesses recurrent pericarditis.There was moderate quality evidence that colchicine reduces episodes of pericarditis in people with recurrent pericarditis over 18 months follow-up (HR 0.37; 95% confidence interval (CI) 0.24 to 0.58). It is expected that at 18 months, the number needed to treat (NNT) is 4. In people with acute pericarditis, there was moderate quality evidence that colchicine reduces recurrence (HR 0.40; 95% CI 0.27 to 0.61) at 18 months follow-up. Colchicine led to a greater chance of symptom relief at 72 hours (risk ratio (RR) 1.4; 95% CI 1.26 to 1.56; low quality evidence). Adverse effects were mainly gastrointestinal and included abdominal pain and diarrhoea. The pooled RR for adverse events was 1.26 (95% CI 0.75 to 2.12). While the number of people experiencing adverse effects was higher in the colchicine than the control groups (9% versus 7%), the quality of evidence was low owing to imprecision, and there was no statistically significant difference between the treatment groups (P = 0.42). There was moderate quality evidence that treatment with colchicine led to more people stopping treatment due to adverse events (RR 1.87; 95% CI 1.02 to 3.41).
AUTHORS' CONCLUSIONS
Colchicine, as adjunctive therapy to NSAIDs, is effective in reducing the number of pericarditis recurrences in patients with recurrent pericarditis or acute pericarditis. However, evidence is based on a limited number of small trials. Patients with multiple resistant recurrences were not represented in any published or on-going trials, and it is these patients that are in the most need for treatment.
Topics: Acute Disease; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Colchicine; Humans; Ibuprofen; Indomethacin; Pericarditis; Randomized Controlled Trials as Topic; Recurrence
PubMed: 25164988
DOI: 10.1002/14651858.CD010652.pub2 -
Cureus Oct 2022Inflammation of the pericardium is referred to as pericarditis, which can cause sharp chest pain and has a high chance of recurrence even after treatment. This review... (Review)
Review
Inflammation of the pericardium is referred to as pericarditis, which can cause sharp chest pain and has a high chance of recurrence even after treatment. This review will explore anakinra, which is an interleukin-1 receptor antagonist, as a potential new treatment for pericarditis. The systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by searching PubMed and GoogleScholar from the years 2012 to 2022. After applying inclusion and exclusion criteria, thorough screening, and quality appraisal, a total of eleven studies were included in the review; eight case reports and three clinical trials. All studies showed that 100 mg/day of anakinra caused a remarkable improvement in patient outcomes. In addition, the pericarditis resolved quicker and had a lower chance of recurrence in comparison to conventional therapy.
PubMed: 36212270
DOI: 10.7759/cureus.29862 -
Diagnostics (Basel, Switzerland) Jan 2023(1) Background: Long COVID syndrome is a significant cause of morbidity in COVID-19 patients who remain symptomatic with varied clinical presentations beyond three...
(1) Background: Long COVID syndrome is a significant cause of morbidity in COVID-19 patients who remain symptomatic with varied clinical presentations beyond three weeks. Furthermore, the relevance of considering cardiovascular outcomes in post-COVID-19 syndrome is important in the current COVID-19 pandemic; (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this systematic review and meta-analysis. Systematic searches were conducted from multiple databases without language restrictions until October 8, 2022, to find studies evaluating cardiovascular outcomes such as arrhythmias, myocardium and pericardium diseases, coronary vessel disease, and thromboembolic disorders in post-COVID cases. The pooled odds ratio (OR), and standard mean difference (SMD) with their corresponding 95% confidence intervals (CI) were computed to find the association; (3) Results: Altogether, seven studies with a total of 8,126,462 (cases: 1,321,305; controls: 6,805,157) participants were included in the meta-analysis. Pooled odds ratios of cardiovascular outcomes were significantly higher in post-COVID cases (OR > 1, < 0.05) than in controls. However, the mortality (OR: 4.76, = 0.13), and heart rate variability (SMD: -0.06, = 0.91) between cases and controls were not statistically significant; (4) Conclusions: Significant cardiovascular sequelae in long COVID syndrome highlight the importance of careful cardiac monitoring of COVID-19 patients in the post-COVID phase to address cardiovascular complications as soon as possible; larger-scale prospective studies are required for accurate estimation.
PubMed: 36766599
DOI: 10.3390/diagnostics13030491 -
The Cochrane Database of Systematic... Sep 2017Tuberculous pericarditis can impair the heart's function and cause death; long term, it can cause the membrane to fibrose and constrict causing heart failure. In... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tuberculous pericarditis can impair the heart's function and cause death; long term, it can cause the membrane to fibrose and constrict causing heart failure. In addition to antituberculous chemotherapy, treatments include corticosteroids, drainage, and surgery.
OBJECTIVES
To assess the effects of treatments for tuberculous pericarditis.
SEARCH METHODS
We searched the Cochrane Infectious Diseases Group Specialized Register (27 March 2017); the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library (2017, Issue 2); MEDLINE (1966 to 27 March 2017); Embase (1974 to 27 March 2017); and LILACS (1982 to 27 March 2017). In addition we searched the metaRegister of Controlled Trials (mRCT) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal using 'tuberculosis' and 'pericard*' as search terms on 27 March 2017. We searched ClinicalTrials.gov and contacted researchers in the field of tuberculous pericarditis. This is a new version of the original 2002 review.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) and quasi-RCTs.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened search outputs, evaluated study eligibility, assessed risk of bias, and extracted data; and we resolved any discrepancies by discussion and consensus. One trial assessed the effects of both corticosteroid and Mycobacterium indicus pranii treatment in a two-by-two factorial design; we excluded data from the group that received both interventions. We conducted fixed-effect meta-analysis and assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS
Seven trials met the inclusion criteria; all were from sub-Saharan Africa and included 1959 participants, with 1051/1959 (54%) HIV-positive. All trials evaluated corticosteroids and one each evaluated colchicine, M. indicus pranii immunotherapy, and open surgical drainage. Four trials (1841 participants) were at low risk of bias, and three trials (118 participants) were at high risk of bias.In people who are not infected with HIV, corticosteroids may reduce deaths from all causes (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.59 to 1.09; 660 participants, 4 trials, low certainty evidence) and the need for repeat pericardiocentesis (RR 0.85, 95% CI 0.70 to 1.04; 492 participants, 2 trials, low certainty evidence). Corticosteroids probably reduce deaths from pericarditis (RR 0.39, 95% CI 0.19 to 0.80; 660 participants, 4 trials, moderate certainty evidence). However, we do not know whether or not corticosteroids have an effect on constriction or cancer among HIV-negative people (very low certainty evidence).In people living with HIV, only 19.9% (203/1959) were on antiretroviral drugs. Corticosteroids may reduce constriction (RR 0.55, 0.26 to 1.16; 575 participants, 3 trials, low certainty evidence). It is uncertain whether corticosteroids have an effect on all-cause death or cancer (very low certainty evidence); and may have little or no effect on repeat pericardiocentesis (RR 1.02, 0.89 to 1.18; 517 participants, 2 trials, low certainty evidence).For colchicine among people living with HIV, we found one small trial (33 participants) which had insufficient data to make any conclusions about any effects on death or constrictive pericarditis.Irrespective of HIV status, due to very low certainty evidence from one trial, it is uncertain whether adding M. indicus pranii immunotherapy to antituberculous drugs has an effect on any outcome.Open surgical drainage for effusion may reduce repeat pericardiocentesis In HIV-negative people (RR 0.23, 95% CI 0.07 to 0.76; 122 participants, 1 trial, low certainty evidence) but may make little or no difference to other outcomes. We did not find an eligible trial that assessed the effects of open surgical drainage in people living with HIV.The review authors found no eligible trials that examined the length of antituberculous treatment needed nor the effects of other adjunctive treatments for tuberculous pericarditis.
AUTHORS' CONCLUSIONS
For HIV-negative patients, corticosteroids may reduce death. For HIV-positive patients not on antiretroviral drugs, corticosteroids may reduce constriction. For HIV-positive patients with good antiretroviral drug viral suppression, clinicians may consider the results from HIV-negative patients more relevant.Further research may help evaluate percutaneous drainage of the pericardium under local anaesthesia, the timing of pericardiectomy in tuberculous constrictive pericarditis, and new antibiotic regimens.
Topics: Adrenal Cortex Hormones; Antitubercular Agents; Cause of Death; Colchicine; Drainage; HIV Seronegativity; HIV Seropositivity; Humans; Immunotherapy; Pericardiectomy; Pericarditis, Tuberculous; Pericardium; Randomized Controlled Trials as Topic
PubMed: 28902412
DOI: 10.1002/14651858.CD000526.pub2 -
European Journal of Vascular and... Feb 2021There is discordance between reviews comparing eversion endarterectomy (EvE) with conventional carotid endarterectomy (CEA) mostly because under this term various... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
There is discordance between reviews comparing eversion endarterectomy (EvE) with conventional carotid endarterectomy (CEA) mostly because under this term various "closure" techniques are included, from direct closure to a wide spectrum of patches with different materials.
DATA SOURCES
MEDLINE (via PubMed) and SCOPUS.
REVIEW METHODS
This was a systematic review of the Medline (via PubMed) and SCOPUS databases for randomised controlled trials (RCTs) comparing different CEA closure techniques. Network meta-analysis (NMA) was performed with a frequentist approach. The primary and the secondary outcome measures were the 30 day combined stroke and death rate and the late restenosis rate, respectively.
RESULTS
Twenty-three RCTs were finally included in the NMA with a total of 4440 patients randomised, representing seven different techniques (primary carotid closure, n = 753; EvE, n = 431; vein patch closure, n = 973; polytetrafluoroethylene [PTFE] patch, n = 948; Dacron patch, n = 828; bovine pericardium patch, n = 249; and polyurethane patch, n = 258). NMA showed that EvE had a decreased 30 day combined stroke and death rate vs. all other methods of arterial closure, with the exception of PTFE and bovine pericardium patching. Additionally, EvE was associated with the lowest restenosis rate vs. all other methods of arterial closure after CEA. EvE was significantly superior to Dacron patches with regard to late restenosis, with the prediction intervals (PIs) lying completely on the beneficial side (risk ratio 0.06; PI 0.01-0.58) and increasing confidence of this comparison. Rare catastrophic complications of vein patch blow out or synthetic patch infection were reported in 0.2% of the total (n = 9/4 400) and no comparisons were made.
CONCLUSION
EvE and patching with bovine pericardium or PTFE is associated with a lower incidence in both short term and late undesired outcomes following CEA and seems to represent the best choice compared with other carotid closure techniques. These results may support the vascular surgeon's choice of technique/patch material.
Topics: Biocompatible Materials; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Carotid Arteries; Endarterectomy, Carotid; Humans; Outcome Assessment, Health Care; Postoperative Complications; Wound Closure Techniques
PubMed: 33257115
DOI: 10.1016/j.ejvs.2020.10.009 -
Medical Acupuncture Feb 2021A complementary treatment for managing chemotherapy-induced nausea and vomiting (CINV) with promising results is electrostimulation of Pericardium 6 (PC 6; ). This... (Review)
Review
A complementary treatment for managing chemotherapy-induced nausea and vomiting (CINV) with promising results is electrostimulation of Pericardium 6 (PC 6; ). This review was conducted to evaluate the effects of electrostimulation therapy at PC 6 to control CINV in patients with cancer. The review was registered on PROSPERO (CRD42018087753). This systematic review and meta-analysis of clinical trials was accomplished according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies written in English, Portuguese, or Spanish that met the eligibility criteria organized according to the PICO [Patient, Problem or Population; Intervention; Comparison, Control, or comparator; Outcome(s)] anagram were included. Descriptors used to search the databases were identified and selected according to the Medical Subject Headings of the National Library of Medicine. The primary outcomes evaluated were the frequency and severity of nausea, vomiting, and general emesis after the experimental protocol. The secondary outcomes evaluated were the numbers of antiemetic pills taken and the patients' quality of life. Fourteen articles were included. There was a reduction in the mean number of episodes of acute nausea (mean difference [MD] = -2.08; 95% confidence interval [95%CI] = -2.76, -1.39) and acute vomiting (MD = -0.91; 95% CI = -1.39, -0.42) or delayed (MD = -0.85; 95%CI = -1.47, -0.23) in patients given the treatment. The other analyses of nausea, vomiting and emesis showed no differences. Electrostimulation at PC6 has an effect on controlling general emesis, and acute nausea and vomiting in different phases of recovery from chemotherapy in patients with cancer.
PubMed: 33613810
DOI: 10.1089/acu.2020.1431 -
Journal of the American Heart... Aug 2017Epicardial adipose tissue (EAT) is hypothesized to alter atherosclerotic plaque composition, with potential development of high-risk plaque (HRP). EAT can be measured by... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Epicardial adipose tissue (EAT) is hypothesized to alter atherosclerotic plaque composition, with potential development of high-risk plaque (HRP). EAT can be measured by volumetric assessment (EAT-v) or linear thickness (EAT-t). We performed a systematic review and random-effects meta-analysis to assess the association of EAT with HRP and whether this association is dependent on the measurement method used.
METHODS AND RESULTS
Electronic databases were systematically searched up to October 2016. Studies reporting HRP by computed tomography or intracoronary imaging and studies measuring EAT-v or EAT-t were included. Odds ratios were extracted from multivariable models reporting the association of EAT with HRP and described as pooled estimates with 95% confidence intervals (CIs). Analysis was stratified by EAT measurement method. Nine studies (n=3772 patients) were included with 7 measuring EAT-v and 2 measuring EAT-t. Increasing EAT was significantly associated with the presence of HRP (odds ratio: 1.26 [95% CI, 1.11-1.43]; <0.001). Patients with HRP had higher EAT-v than those without (weighted mean difference: 28.3 mL [95% CI, 18.8-37.8 mL]; <0.001). EAT-v was associated with HRP (odds ratio: 1.19 [95% CI, 1.06-1.33]; <0.001); however, EAT-t was not (odds ratio: 3.09 [95% CI, 0.56-17]; =0.2). Estimates remained significant when adjusted for small-study effect bias (odds ratio: 1.13 [95% CI, 1.03-1.28]; =0.04).
CONCLUSIONS
Increasing EAT is associated with the presence of HRP, and patients with HRP have higher quantified EAT-v. The association of EAT-v with HRP is significant compared with EAT-t; however, a larger scale study is still required, and further evaluation is needed to assess whether EAT may be a potential therapeutic target for novel pharmaceutical agents.
CLINICAL TRIAL REGISTRATION
URL: https://www.crd.york.ac.uk/. Unique identifier: CRD42017055473.
Topics: Adipose Tissue; Adiposity; Adult; Aged; Aged, 80 and over; Coronary Artery Disease; Coronary Vessels; Female; Humans; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Pericardium; Plaque, Atherosclerotic; Risk Assessment; Risk Factors; Rupture, Spontaneous; Young Adult
PubMed: 28838916
DOI: 10.1161/JAHA.117.006379 -
International Journal of Preventive... 2018Nausea and vomiting of pregnancy (NVP) is a common problem for pregnant women. Researchers have recently paid special attention to complementary medicine methods for the... (Review)
Review
Nausea and vomiting of pregnancy (NVP) is a common problem for pregnant women. Researchers have recently paid special attention to complementary medicine methods for the treatment of NVP. Regarding the high prevalence of NVP as well as maternal and fetal adverse effects of chemical drugs, the present study, focusing on clinical trials carried out in Iran, was conducted to assess safety and efficacy of different nonpharmacological methods in relieving NVP. This systematic review focused on randomized controlled trials (RCTs) and assessed complementary medicine on NVP for which databases including MedLib, Magiran, Iran Medex, SID, PubMed, Scopus, and Google Scholar search engines from 2000 to 2015 were searched. Those articles that gained score 3 or higher, according to Jadad criteria, were recruited for the study. In this study, 31 clinical trials assessing NVP were conducted on Iranian pregnant women. After removing ten articles, 21 articles with scores 3 and higher, according to Jedad criteria, were assessed. Out of 21 papers, 10 papers were about ginger, one was about cardamom, one was about lemon, two were about peppermint aromatherapy, six were about pericardium 6 (P6) acupressure, and one article about KID21 acupressure. Most studies have demonstrated a positive effect on reducing NVP; however, no adverse effect was reported. According to the results of this review, the majority of methods employed were effective in reducing the incidence of NVP, among which ginger and P6 acupressure can be recommended with more reliability.
PubMed: 30319738
DOI: 10.4103/ijpvm.IJPVM_430_16