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Human Vaccines & Immunotherapeutics Dec 2023Debate regarding vaccinating high-risk infants with penta- and hexavalent vaccines persists, despite their good immunogenicity and acceptable safety profile in healthy...
Debate regarding vaccinating high-risk infants with penta- and hexavalent vaccines persists, despite their good immunogenicity and acceptable safety profile in healthy full-term infants. We report the findings of a systematic literature search that aimed to present data on the immunogenicity, efficacy, effectiveness, safety, impact, compliance and completion of penta- and hexavalent vaccination in high-risk infants, including premature newborns. Data from the 14 studies included in the review showed that the immunogenicity and the safety profile of penta- and hexavalent vaccines in preterm infants was generally similar to those seen in full-term infants, with the exception of an increase in cardiorespiratory adverse events such as apnea, bradycardia and desaturation following vaccination in preterm infants. Despite recommendations of vaccinating preterm infants according to their actual age, and the relatively high completion rate of the primary immunization schedule, vaccination was often delayed, increasing the vulnerability of this high-risk population to vaccine-preventable diseases.
Topics: Infant; Infant, Newborn; Humans; Infant, Premature; Vaccines, Combined; Vaccination; Infant, Newborn, Diseases; Immunization Schedule; Rubiaceae
PubMed: 37076111
DOI: 10.1080/21645515.2023.2191575 -
BMJ Open Sport & Exercise Medicine 2023Dance is a popular physical activity. Increased dance training has been associated with an increased risk of injury. Given the established association between training... (Review)
Review
Dance is a popular physical activity. Increased dance training has been associated with an increased risk of injury. Given the established association between training load (TL) and injury in sport, knowledge of how TL is currently being measured in dance is critical. The objective of this study is to summarise published literature examining TL monitoring in dance settings. Six prominent databases (CINAHL, EMBASE, Medline, ProQuest, Scopus, SportDiscus) were searched and nine dance-specific journals were handsearched up to May 2022. Selected studies met inclusion criteria, where original TL data were collected from at least one dancer in a class, rehearsal and/or performance. Studies were excluded if TL was not captured in a dance class, rehearsal or performance. Two reviewers independently assessed each record for inclusion at title, abstract and full-text screening stages. Study quality was assessed using Joanna Briggs Institute Critical Appraisal Tool checklists for each study design. The 199 included studies reported on female dancers (61%), ballet genre (55%) and the professional level (31%). Dance hours were the most common tool used to measure TL (90%), followed by heart rate (20%), and portable metabolic systems (9%). The most common metric for each tool was mean weekly hours (n=381; median=9.5 hours, range=0.2-48.7 hours), mean heart rate (n=143) and mean oxygen consumption (n=93). Further research on TL is needed in dance, including a consensus on what tools and metrics are best suited for TL monitoring in dance.
PubMed: 37457429
DOI: 10.1136/bmjsem-2022-001484 -
Revista Brasileira de Enfermagem 2023to map the scientific evidence on the use of abdominal compressions during cardiopulmonary resuscitation in patients with cardiac arrest. (Review)
Review
OBJECTIVES
to map the scientific evidence on the use of abdominal compressions during cardiopulmonary resuscitation in patients with cardiac arrest.
METHODS
this is a scoping review based on the question: "What is the evidence regarding the use of abdominal compressions during cardiopulmonary resuscitation in patients with cardiac arrest?". Publications up to August 2022 were collected from eight databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was used.
RESULTS
seventeen publications were included. The identified general population consisted of adults and elderly individuals. The primary outcome revealed significant rates of return of spontaneous circulation. Secondary outcomes indicated a significant improvement in heart rate, blood pressure, oxygen saturation, and other outcomes.
CONCLUSIONS
abdominal compressions have been shown to be beneficial. However, further clinical studies are needed to identify the best execution method and its impacts.
Topics: Adult; Humans; Aged; Cardiopulmonary Resuscitation; Heart Arrest; Pressure; Blood Pressure; Heart Rate
PubMed: 38018609
DOI: 10.1590/0034-7167-2022-0400 -
Conventional Cardiotocography Computerized CTG Analysis and Perinatal Outcomes: a Systematic Review.Maedica Sep 2023Cardiotocography (CTG) constitutes a major and generally used tool for the assessment of fetal well-being. Subjectivity is the main difficulty in the interpretation of...
Cardiotocography (CTG) constitutes a major and generally used tool for the assessment of fetal well-being. Subjectivity is the main difficulty in the interpretation of CTG. Inter- and intra-observer variability are substantival features of the interpretation of CTGs. An auspicious answer for reduction of inter- and intra-observer variability is the computerized analysis of fetal heart rate (FHR). Moreover, computerized analysis contributes to the reduction of adverse maternal and fetal outcomes. The aim of the present review was to compare the visual and computerized analysis of CTG for establishing whether computerized CTG was related to better perinatal outcomes. Three electronic medical related databases (PubMed, Scopus and Cochrane) were searched from May to June 2023 in order to find randomized controlled trials (RCTs) in English. Studies were evaluated for their methodological quality with the CONSORT checklist. The target population comprised pregnant or intrapartum women into cardiotocographic monitoring. The intervention was represented by the visual analysis of CTG, and the comparison intervention by the computerized analysis of CTG. Primary outcomes included adverse perinatal outcomes. A total of 47 studies relevant with the topic were examined. However, only five articles met all inclusion and methodological criteria; four of those demonstrated that computerized analysis had no significant reduction in the rate of metabolic acidosis or obstetric interventions, and one study found a lower incidence of adverse perinatal outcome with conventional CTG (with fetal blood sampling). However, all reviews propose further development of decision-support software and more large-scale RCTs in the future. The computerized analysis of FHR is a promising solution for the reduction of adverse perinatal outcomes and elimination of inter- and intra-observer variability.
PubMed: 38023753
DOI: 10.26574/maedica.2023.18.3.483 -
BMJ Open Respiratory Research Dec 2023We aimed to assess the available evidence for corticosteroids in fibrotic interstitial lung disease (fILD) to inform the randomised embedded multifactorial adaptive... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
We aimed to assess the available evidence for corticosteroids in fibrotic interstitial lung disease (fILD) to inform the randomised embedded multifactorial adaptive platform ILD.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
We searched Embase, Medline, Cochrane CENTRAL and Web of Science databases from inception to April 17 2023.
ELIGIBILITY CRITERIA
We included studies that compared corticosteroids with standard care, placebo or no treatment in adult patients with fILD.
DATA EXTRACTION AND SYNTHESIS
We report on the change in forced vital capacity (FVC) and mortality. We used random-effects meta-analysis to estimate relative risk (RR) for dichotomous outcomes, and mean difference (MD) and standardised MDs for continuous outcomes, with 95% CIs.
RESULTS
Of the 13 229 unique citations identified, we included 10 observational studies comprising 1639 patients. Corticosteroids had an uncertain effect on mortality compared with no treatment (RR 1.03 (95% CI 0.85 to 1.25); very low certainty evidence). The effect of corticosteroids on the rate of decline in FVC (% predicted) was uncertain when compared with no treatment (MD 4.29% (95% CI -8.26% to 16.83%); very low certainty evidence). However, corticosteroids might reduce the rate of decline in FVC in patients with non-idiopathic pulmonary fibrosis (IPF) fILD (MD 10.89% (95% CI 5.25% to 16.53%); low certainty evidence), while an uncertain effect was observed in patients with IPF (MD -3.80% (95% CI -8.94% to 1.34%); very low certainty evidence).
CONCLUSIONS
The current evidence on the efficacy and safety of corticosteroids in fILD is limited and of low certainty. Randomised trials are needed to address this significant research gap.
Topics: Adult; Humans; Adrenal Cortex Hormones; Lung Diseases, Interstitial; Vital Capacity
PubMed: 38160015
DOI: 10.1136/bmjresp-2023-002008 -
JAMA Cardiology Jul 2023The clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular... (Meta-Analysis)
Meta-Analysis
Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis.
IMPORTANCE
The clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown.
OBJECTIVE
To provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain.
DATA SOURCES
PubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021.
STUDY SELECTION
Selected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included.
DATA EXTRACTION AND SYNTHESIS
This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
MAIN OUTCOMES AND MEASURES
Diagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death.
RESULTS
A total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%.
CONCLUSION AND RELEVANCE
In this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.
Topics: Humans; Coronary Artery Disease; Contrast Media; Prognosis; Magnetic Resonance Imaging, Cine; Gadolinium; Magnetic Resonance Imaging; Chest Pain; Arteries
PubMed: 37285143
DOI: 10.1001/jamacardio.2023.1290 -
Frontiers in Neuroscience 2023The number of randomized controlled trials using auricular stimulation (AS) such as transauricular vagus nerve stimulation, or other auricular electrostimulation or...
BACKGROUND
The number of randomized controlled trials using auricular stimulation (AS) such as transauricular vagus nerve stimulation, or other auricular electrostimulation or auricular acupuncture or acupressure, in experimental and clinical settings, has increased markedly over the last three decades. This systematic review focusses on cardiovascular effects of auricular stimulation.
METHODS AND ANALYSIS
The following databases were searched: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, and Scopus Database. RCTs were reviewed that had been published in English and European languages. Data collection and analysis was conducted by two reviewers independently. Quality and risk assessment of included studies was performed and the meta-analysis of the effect of the most frequently assessed biomarkers.
RESULTS
Altogether, 78 trials were included. 38 studies assessed heart rate (HR), 19 studies analyzed heart rate variability (HRV), 31 studies analyzed blood pressure (BP) and 7 studies were identified that measured oxygen saturation (O2), 2 studies on baroreflex sensitivity and 2 studies on skin conductance were evaluated in this review. 26 studies contained continuous data and were eligible for meta-analysis, 50 trials reported non continuous data and were evaluated descriptively. The overall quality of the studies was moderate to low. AS leads to a significant reduction of HR, the changes though were not considered an adverse reaction. Furthermore, when looking at HRV, AS was able to reduce the LF/HF ratio significantly compared to control procedures. No other cardiovascular parameters (blood pressure, oxygen saturation, baroreflex sensitivity) were changed significantly. AS produced only minor side effects in all trials.
CONCLUSION
AS can lead to clinically safe reduction of HR and changes in the LF/HF ratio of the HRV, which is presumably via an increase in vagal activity. More research is needed to clarify whether AS can be used to modulate tachycardia or indications with autonomic imbalance.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=231885 PROSPERO, ID CRD42021231885.
PubMed: 37727325
DOI: 10.3389/fnins.2023.1227858 -
International Journal of Cardiology.... Mar 2024Breathing exercises have been reported to have positive physiological effects on the body. The incidence of hypertension has become a major risk factor for cardiac...
BACKGROUND
Breathing exercises have been reported to have positive physiological effects on the body. The incidence of hypertension has become a major risk factor for cardiac complications leading to higher morbidity and mortality. Our aim was to conduct a systematic review and meta-analysis to study the effect of breathing exercises on blood pressure (BP) and heart rate (HR).
METHODS
A systematic review and meta-analysis analyzing randomized clinical trials (RCTs) about the effect of breathing exercises on blood pressure was conducted (PROSPERO Registration ID: CRD42022316413). PubMed, ScienceDirect, WebofScience, and Cochrane Library databases were screened for RCTs from January 2017 to September 2022. The main search terms included "breathing exercise", "Pranayam", "Bhramari", "alternate nostril breathing", "deep breathing", "slow breathing", "hypertension", and "high blood pressure". The primary outcome was the value of the systolic blood pressure and diastolic blood pressure after the intervention. The effect on heart rate was also analyzed as a secondary outcome.
RESULTS
A total of 15 studies were included in the meta-analysis. Breathing exercises have a modest but significant effect on decreasing systolic blood pressure (-7.06 [-10.20, -3.92], P = <0.01) and diastolic blood pressure (-3.43 [-4.89, -1.97], P = <0.01) mm Hg. Additionally, breathing exercises were also observed to cause a significant decrease in the heart rate (-2.41 [-4.53, -0.30], P = 0.03) beats/minute.
CONCLUSION
In a comprehensive systematic review and meta-analysis of breathing exercises and its effect on BP and HR, there is a moderate but significant positive effect. The studies are not deprived of bias.
PubMed: 38179185
DOI: 10.1016/j.ijcrp.2023.200232 -
Scientific Reports Sep 2023The effect of sodium-glucose co-transporter-2 (SGLT-2) inhibitors on cardiovascular and renal outcomes has not been systematically reviewed across baseline kidney... (Meta-Analysis)
Meta-Analysis
The effect of sodium-glucose co-transporter-2 (SGLT-2) inhibitors on cardiovascular and renal outcomes has not been systematically reviewed across baseline kidney function groups. We conducted a systematic review and meta-analysis of randomized control trials (RCTs) with SGLT-2 inhibitors in patients with and without CKD. We performed a PubMed/Medline search of randomized, placebo-controlled, event-driven outcome trials of SGLT-2 inhibitors versus active or placebo control in patients with and without diabetes from inception to November 2022. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m (PROSPERO registration CRD4202016054). The primary outcome was cardiovascular death. Secondary outcomes included hospitalization for heart failure, major adverse cardiovascular events, CKD progression, all-cause mortality, treatment discontinuation, and acute kidney injury (AKI). The relative risk (RR) was estimated using a random-effects model. Twelve RCTs were included in this meta-analysis (89,191 patients, including 38,949 with eGFR < 60 ml/min/1.73m). Use of an SGLT-2 inhibitor in patients with CKD was associated with a lower incidence of cardiovascular death (RR 0.87; 95% CI 0.79-0.95) and of heart failure (RR 0.67; 95% CI 0.61-0.75), compared with placebo. Heart failure risk reduction with SGLT-2 inhibitors was larger among patients with CKD compared with patients without CKD (RR for the interaction 0.87, 95% CI 0.75-1.02, and p-value for interaction 0.08). SGLT-2 inhibitors were associated with a lower incidence of CKD progression among patients with pre-existing CKD: RR 0.77 (95% CI 0.68-0.88), compared with placebo. Among patients with CKD, a lower risk of AKI (RR 0.82; 95% CI 0.72-0.93) and treatment discontinuation was seen with SGLT-2 inhibitors compared with placebo. SGLT-2 inhibitors offer substantial protection against cardiovascular and renal outcomes in patients with CKD. These results strongly advocate in favor of using them in patients with CKD and keeping them as kidney function declines.
Topics: Humans; Sodium-Glucose Transporter 2 Inhibitors; Heart Failure; Kidney; Acute Kidney Injury; Renal Insufficiency, Chronic
PubMed: 37741858
DOI: 10.1038/s41598-023-42989-z -
Diabetology & Metabolic Syndrome Oct 2023Serum uric acid levels are higher in patients with type 2 diabetes and prediabetes compared to healthy individuals, and hyperuricemia causes a significant rate of... (Review)
Review
BACKGROUND
Serum uric acid levels are higher in patients with type 2 diabetes and prediabetes compared to healthy individuals, and hyperuricemia causes a significant rate of complications and mortality through heart and kidney diseases. Accordingly, the present systematic review and meta-analysis aimed to investigate the effect of empagliflozin on serum uric acid levels.
MATERIALS AND METHODS
Electronic databases, including PubMed, Scopus, Web of Science, Cochrane, and Google Scholar, were used to search papers until May 22, 2023. Data analysis was conducted by STATA Version 14, and P-value < 0.05 were considered statistically significant.
RESULTS
The results obtained from the combination of 12 studies with 7801 samples of diabetic patients indicated that in the empagliflozin group, the serum uric acid levels of the patients decreased ([standardized mean difference (SMD): - 1.97 (95%CI - 3.39, - 0.55)], Systolic blood pressure (SBP) [SMD: - 2.62 (95%CI - 3.87, - 1.37)] and diastolic blood pressure (DBP) [SMD: - 0.49 (95%CI - 0.68, - 0.29)]). On the other side, empagliflozin treatment did not affect the patients' HbA1c levels ([SMD: - 2.85 (95%CI - 6.14, 0.45)], eGFR [SMD: 0.78 (95%CI - 0.63, 2.18)], creatinine [SMD:0.11 (95%CI - 0.10, 0.31)], LDL [SMD: 0.14 (95%CI - 0.43, 0.71)], and HDL [SMD:1.38 (95%CI - 0.22, 2.99)]). Compared with the placebo, empagliflozin was more effective in reducing the uric acid levels ([SMD: - 1.34 (95%CI - 2.05, - 0.63)], SBP [SMD: - 2.11 (95%CI - 3.89, - 0.33)], and HbA1c [SMD: - 1.04 (95%CI - 1.95, - 0.13)]). Moreover, compared with sitagliptin also, empagliflozin was more effective in reducing uric acid levels ([SMD: - 1 (95%CI - 1.78, - 0.22)], and creatinine [SMD: - 1.60 (95%CI - 2.28, - 0.92)]) and increasing eGFR levels [SMD: 0.99 (95%CI: 0.37, 1.62)] of the patients. Compared with dapagliflozin also, empagliflozin caused a reduction in eGFR level [SMD: - 0.45 (95%CI - 0.82, - 0.08)].
CONCLUSION
Empagliflozin treatment was effective in controlling diabetic patients' hyperuricemia and hypertension.
PubMed: 37840144
DOI: 10.1186/s13098-023-01182-y