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Medical Sciences (Basel, Switzerland) Apr 2021: Antidepressants are one of the most prescribed medications, particularly for patients with mental disorders. Nevertheless, there are still limited data regarding the... (Meta-Analysis)
Meta-Analysis
: Antidepressants are one of the most prescribed medications, particularly for patients with mental disorders. Nevertheless, there are still limited data regarding the risk of ventricular arrhythmia (VA) and sudden cardiac death (SCD) associated with these medications. Thus, we performed systemic review and meta-analysis to characterize the risks of VA and SCD among patients who used common antidepressants. A literature search for studies that reported risk of ventricular arrhythmias and sudden cardiac death in antidepressant use from MEDLINE, EMBASE, and Cochrane Database from inception through September 2020. A random-effects model network meta-analysis model was used to analyze the relation between antidepressants and VA/SCD. Surface Under Cumulative Ranking Curve (SUCRA) was used to rank the treatment for each outcome. The mean study sample size was 355,158 subjects. Tricyclic antidepressant (TCA) patients were the least likely to develop ventricular arrhythmia events/sudden cardiac deaths at OR 0.24, 0.028-1.2, OR 0.32 (95% CI 0.038-1.6) for serotonin and norepinephrine reuptake inhibitors (SNRI), and OR 0.36 (95% CI 0.043, 1.8) for selective serotonin reuptake inhibitors (SSRI), respectively. According to SUCRA analysis, TCA was on a higher rank compared to SNRI and SSRI considering the risk of VA/SCD. Our network meta-analysis demonstrated the low risk of VA/SCD among patients using antidepressants for SNRI, SSRI and especially, TCA. Despite the relatively lowest VA/SCD in TCA, drug efficacy and other adverse effects should be taken into account in patients with mental disorders.
Topics: Antidepressive Agents; Antidepressive Agents, Tricyclic; Death, Sudden, Cardiac; Humans; Network Meta-Analysis; Norepinephrine; Selective Serotonin Reuptake Inhibitors; Serotonin and Noradrenaline Reuptake Inhibitors
PubMed: 33922524
DOI: 10.3390/medsci9020026 -
Annals of Medicine 2023Cardiac sympathetic hyperinnervation after myocardial infarction (MI) is associated with arrhythmogenesis and sudden cardiac death. The characteristics of cardiac... (Review)
Review
BACKGROUND
Cardiac sympathetic hyperinnervation after myocardial infarction (MI) is associated with arrhythmogenesis and sudden cardiac death. The characteristics of cardiac sympathetic hyperinnervation remain underexposed.
OBJECTIVE
To provide a systematic review on cardiac sympathetic hyperinnervation after MI, taking into account: (1) definition, experimental model and quantification method and (2) location, amount and timing, in order to obtain an overview of current knowledge and to expose gaps in literature.
METHODS
References on cardiac sympathetic hyperinnervation were screened for inclusion. The included studies received a full-text review and quality appraisal. Relevant data on hyperinnervation were collected and qualitatively analysed.
RESULTS
Our literature search identified 60 eligible studies performed between 2000 and 2022. Cardiac hyperinnervation is generally defined as an increased sympathetic nerve density or increased number of nerves compared to another control group (100%). Studies were performed in a multitude of experimental models, but most commonly in male rats with permanent left anterior descending (LAD) artery ligation (male: 63%, rat: 68%, permanent ligation: 93%, LAD: 97%). Hyperinnervation seems to occur mainly in the borderzone. Quantification after MI was performed in regions of interest in µm/mm (41%) or in percentage of nerve fibres (46%) and the reported amount showed a great variation ranging from 439 to 126,718 µm/mm. Hyperinnervation seems to start from three days onwards to >3 months without an evident peak, although studies on structural evaluation over time and in the chronic phase were scarce.
CONCLUSIONS
Cardiac sympathetic hyperinnervation after MI occurs mainly in the borderzone from three days onwards and remains present at later timepoints, for at least 3 months. It is most commonly studied in male rats with permanent LAD ligation. The amount of hyperinnervation differs greatly between studies, possibly due to differential quantification methods. Further studies are required that evaluate cardiac sympathetic hyperinnervation over time and in the chronic phase, in transmural sections, in the female sex, and in MI with reperfusion.
Topics: Male; Female; Rats; Humans; Animals; Heart; Myocardial Infarction; Arrhythmias, Cardiac; Sympathetic Nervous System; Death, Sudden, Cardiac
PubMed: 38065671
DOI: 10.1080/07853890.2023.2283195 -
PLoS Medicine Feb 2024Evidence suggests common pathways between pregnancy losses and subsequent long-term maternal morbidity, rendering pregnancy complications an early chronic disease... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Evidence suggests common pathways between pregnancy losses and subsequent long-term maternal morbidity, rendering pregnancy complications an early chronic disease marker. There is a plethora of studies exploring associations between miscarriage and stillbirth with long-term adverse maternal health; however, these data are inconclusive.
METHODS AND FINDINGS
We systematically searched MEDLINE, EMBASE, AMED, BNI, CINAHL, and the Cochrane Library with relevant keywords and MeSH terms from inception to June 2023 (no language restrictions). We included studies exploring associations between stillbirth or miscarriage and incidence of cardiovascular, malignancy, mental health, other morbidities, and all-cause mortality in women without previous pregnancy loss. Studies reporting short-term morbidity (within a year of loss), case reports, letters, and animal studies were excluded. Study selection and data extraction were performed by 2 independent reviewers. Risk of bias was assessed using the Newcastle Ottawa Scale (NOS) and publication bias with funnel plots. Subgroup analysis explored the effect of recurrent losses on adverse outcomes. Statistical analysis was performed using an inverse variance random effects model and results are reported as risk ratios (RRs) with 95% confidence intervals (CIs) and prediction intervals (PIs) by combining the most adjusted RR, odds ratios (ORs) and hazard ratios (HRs) under the rare outcome assumption. We included 56 observational studies, including 45 in meta-analysis. There were 1,119,815 women who experienced pregnancy loss of whom 951,258 had a miscarriage and 168,557 stillbirth, compared with 11,965,574 women without previous loss. Women with a history of stillbirth had a greater risk of ischaemic heart disease (IHD) RR 1.56, 95% CI [1.30, 1.88]; p < 0.001, 95% PI [0.49 to 5.15]), cerebrovascular (RR 1.71, 95% CI [1.44, 2.03], p < 0.001, 95% PI [1.92, 2.42]), and any circulatory/cardiovascular disease (RR 1.86, 95% CI [1.01, 3.45], p = 0.05, 95% PI [0.74, 4.10]) compared with women without pregnancy loss. There was no evidence of increased risk of cardiovascular disease (IHD: RR 1.11, 95% CI [0.98, 1.27], 95% PI [0.46, 2.76] or cerebrovascular: RR 1.01, 95% CI [0.85, 1.21]) in women experiencing a miscarriage. Only women with a previous stillbirth were more likely to develop type 2 diabetes mellitus (T2DM) (RR: 1.16, 95% CI [1.07 to 2.26]; p < 0.001, 95% PI [1.05, 1.35]). Women with a stillbirth history had an increased risk of developing renal morbidities (RR 1.97, 95% CI [1.51, 2.57], p < 0.001, 95% [1.06, 4.72]) compared with controls. Women with a history of stillbirth had lower risk of breast cancer (RR: 0.80, 95% CI [0.67, 0.96], p-0.02, 95% PI [0.72, 0.93]). There was no evidence of altered risk of other malignancies in women experiencing pregnancy loss compared to controls. There was no evidence of long-term mental illness risk in women with previous pregnancy losses (stillbirth: RR 1.90, 95% CI [0.93, 3.88], 95% PI [0.34, 9.51], miscarriage: RR 1.78, 95% CI [0.88, 3.63], 95% PI [1.13, 4.16]). The main limitations include the potential for confounding due to use of aggregated data with variable degrees of adjustment.
CONCLUSIONS
Our results suggest that women with a history of stillbirth have a greater risk of future cardiovascular disease, T2DM, and renal morbidities. Women experiencing miscarriages, single or multiple, do not seem to have an altered risk.
Topics: Pregnancy; Female; Humans; Pregnancy Outcome; Stillbirth; Abortion, Spontaneous; Diabetes Mellitus, Type 2; Cardiovascular Diseases
PubMed: 38335157
DOI: 10.1371/journal.pmed.1004342 -
Scientific Reports Sep 2023Outcomes of conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation (HFOV) in patients with congenital diaphragmatic hernia (CDH) were... (Meta-Analysis)
Meta-Analysis
Outcomes of conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation (HFOV) in patients with congenital diaphragmatic hernia (CDH) were compared through a systematic review and meta-analysis. Outcome measures included mortality and incidence of chronic lung disease (CLD). Odds ratio (OR) and 95% confidence interval (95%CI) were evaluated. Subgroup analyses were performed according to the strategy for applying HFOV in CDH patients. Group A: CMV was initially applied in all CDH patients, and HFOV was applied in unstable patients. Group B: chronologically analyzed. (CMV and HFOV era) Group C: CMV or HFOV was used as the initial MV. Of the 2199 abstracts screened, 15 full-text articles were analyzed. Regarding mortality, 16.7% (365/2180) and 32.8% (456/1389) patients died in CMV and HFOV, respectively (OR, 2.53; 95%CI 2.12-3.01). Subgroup analyses showed significantly worse, better, and equivalent mortality for HFOV than that for CMV in group A, B, and C, respectively. CLD occurred in 32.4% (399/1230) and 49.3% (369/749) patients in CMV and HFOV, respectively (OR, 2.37; 95%CI 1.93-2.90). The evidence from the literature is poor. Mortality and the incidence of CLD appear worse after HFOV in children with CDH. Cautious interpretation is needed due to the heterogeneity of each study.
Topics: Child; Humans; Respiration, Artificial; Hernias, Diaphragmatic, Congenital; High-Frequency Ventilation; Death; Cytomegalovirus Infections
PubMed: 37752154
DOI: 10.1038/s41598-023-42344-2 -
British Journal of Clinical Pharmacology Oct 2021Concerns exist regarding the cardiovascular safety of domperidone. However, many of the previous studies addressing this issue had important limitations. We aimed to... (Meta-Analysis)
Meta-Analysis Review
AIMS
Concerns exist regarding the cardiovascular safety of domperidone. However, many of the previous studies addressing this issue had important limitations. We aimed to examine domperidone and the risks of sudden cardiac death and ventricular arrhythmia through a systematic review and meta-analysis of observational studies, including an in-depth methodological assessment.
METHODS
We systematically searched MEDLINE, PubMed, EMBASE, Scopus and CINAHL Plus to identify observational studies examining the association of domperidone and sudden cardiac death and/or ventricular arrhythmia. We assessed study quality in duplicate using the ROBINS-I tool supplemented by an assessment of specific biases and the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. Data were pooled across studies using DerSimonian and Laird random-effects models.
RESULTS
Six case-control studies, 1 case-crossover study and 1 retrospective cohort study were included (n = 480 395). Based on ROBINS-I, 3 studies had moderate risk of bias, 4 had serious risk, and 1 had critical risk. The overall GRADE rating is moderate. When data were pooled across nonoverlapping studies, domperidone was associated with an increased risk of composite endpoint of sudden cardiac death or ventricular arrhythmia compared to nonuse (adjusted odds ratio: 1.69; 95% confidence interval: 1.46, 1.95; I : 0%; τ : 0). This association persisted when restricted to higher-quality studies (odds ratio: 1.60; 95% confidence interval: 1.30, 1.97; I : 0%; τ : 0).
CONCLUSION
Domperidone is associated with an increased risk of sudden cardiac death and ventricular arrhythmia compared to nonuse. Further investigation comparing domperidone to an active comparator and in younger populations are warranted.
Topics: Antiemetics; Arrhythmias, Cardiac; Cross-Over Studies; Death, Sudden, Cardiac; Domperidone; Humans; Retrospective Studies
PubMed: 33439512
DOI: 10.1111/bcp.14737 -
Journal of Athletic Training May 2022To determine the effect of electrocardiogram (ECG) screening on the prevention of sudden cardiac arrest and death in young athletes and military members. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the effect of electrocardiogram (ECG) screening on the prevention of sudden cardiac arrest and death in young athletes and military members.
DATA SOURCES
MEDLINE, Embase, CENTRAL, Web of Science, BIOSIS, Scopus, SPORTDiscus, PEDro, and ClinicalTrials.gov were searched from inception to dates between February 21 and July 29, 2019.
STUDY SELECTION
Randomized and nonrandomized controlled trials in which preparticipation examination including ECG was the primary intervention used to screen athletes or military members aged ≤40 years. Acceptable control groups were those receiving no screening, usual care, or preparticipation examination without ECG. Three published studies and 1 conference abstract were identified for inclusion.
DATA EXTRACTION
In all 4 studies, risk of bias was assessed using the Cochrane risk-of-bias tool and was found to be generally high. Two studies had data extracted for random effects meta-analysis, and the remaining study and conference abstract were included in the narrative review. The overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.
DATA SYNTHESIS
We included 4 nonrandomized studies (11 689 172 participants), of which all had a high risk of bias. Pooled data from 2 studies (n = 3 869 274; very low-quality evidence) showed an inconclusive 42% relative decrease in risk of sudden cardiac death (relative risk = 0.58; 95% CI = 0.23, 1.45), equating to an absolute risk reduction of 0.0016%. The findings were consistent with a potential 77% relative decreased risk to a 45% relative increased risk in participants screened using ECG. Heterogeneity was found to be high, as measured using I2 statistic (71%). Data from the remaining study and abstract were similarly inconclusive.
CONCLUSIONS
Existing evidence for the effect of ECG screening is inconclusive and of very low quality. In our meta-analysis, we observed that screening ECG may result in a considerable benefit or harm to participants. Higher-quality studies are needed to reduce this uncertainty.
Topics: Humans; Military Personnel; Athletes; Electrocardiography; Mass Screening; Death, Sudden, Cardiac
PubMed: 34038955
DOI: 10.4085/1062-6050-0746.20 -
Neurology India 2022New controversies have raised on brain death (BD) diagnosis when lesions are localized in the posterior fossa. (Review)
Review
BACKGROUND
New controversies have raised on brain death (BD) diagnosis when lesions are localized in the posterior fossa.
OBJECTIVE
The aim of this study was to discuss the particularities of BD diagnosis in patients with posterior fossa lesions.
MATERIALS AND METHODS
The author made a systematic review of literature on this topic.
RESULTS AND CONCLUSIONS
A supratentorial brain lesion usually produces a rostrocaudal transtentorial brain herniation, resulting in forebrain and brainstem loss of function. In secondary brain lesions (i.e., cerebral hypoxia), the brainstem is also affected like the forebrain. Nevertheless, some cases complaining posterior fossa lesions (i.e., basilar artery thrombotic infarcts, or hemorrhages of the brainstem and/or cerebellum) may retain intracranial blood flow and EEG activity. In this article, I discuss that if a posterior fossa lesion does not produce an enormous increment of intracranial pressure, a complete intracranial circulatory arrest does not occur, explaining the preservation of EEG activity, evoked potentials, and autonomic function. I also addressed Jahi McMath, who was declared braindead, but ancillary tests, performed 9 months after initial brain insult, showed conservation of intracranial structures, EEG activity, and autonomic reactivity to "Mother Talks" stimulus, rejecting the diagnosis of BD. Jahi McMath's MRI study demonstrated a huge lesion in the pons. Some authors have argued that in patients with primary brainstem lesions it might be possible to find in some cases partial recovery of consciousness, even fulfilling clinical BD criteria. This was the case in Jahi McMath.
Topics: Brain; Brain Death; Brain Diseases; Brain Stem; Humans; Intracranial Pressure
PubMed: 35532637
DOI: 10.4103/0028-3886.344634 -
Preventing Chronic Disease Aug 2022Pre-existing comorbid conditions in COVID-19 patients are risk factors for developing severe disease and death. We aimed to determine the association of chronic liver... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Pre-existing comorbid conditions in COVID-19 patients are risk factors for developing severe disease and death. We aimed to determine the association of chronic liver disease (CLD), a comorbid condition, with severity of disease and death among COVID-19 patients.
METHODS
We searched for studies reporting COVID-19 outcomes among CLD and non-CLD patients in databases including Medline, EMBASE, ScienceDirect, Google Scholar, and Cochrane Library from inception of the pandemic until February 2022. Risk of bias assessment was conducted by using the Newcastle-Ottawa Scale for assessing the quality of nonrandomized studies in meta-analyses. We conducted a meta-analysis with a random-effects model and reported pooled odds ratios (ORs) with 95% CIs.
RESULTS
We included 40 studies with 908,032 participants. Most studies were conducted in China and the US. COVID-19 patients with CLD had significantly higher odds of having a severe form of COVID-19 (pooled OR = 2.44; 95% CI, 1.89-3.16) and death (pooled OR = 2.35; 95% CI, 1.85-3.00) when compared with COVID-19 patients without CLD.
CONCLUSION
The presence of CLD is significantly related to adverse clinical outcomes among COVID-19 patients in terms of severity and mortality. Clinicians should develop a comprehensive intervention plan to manage these high-risk patients and reduce COVID-19-related deaths.
Topics: COVID-19; Comorbidity; Humans; Liver Diseases; Pandemics; Risk Factors
PubMed: 36007255
DOI: 10.5888/pcd19.210228 -
Taiwanese Journal of Obstetrics &... Jan 2022Flood is one of the natural disasters with high prevalence in the world. The aim of this research was to investigate the effect of flood on pregnancy outcome and... (Review)
Review
Flood is one of the natural disasters with high prevalence in the world. The aim of this research was to investigate the effect of flood on pregnancy outcome and pregnancy complication such as preterm birth, LBW, SGA, stillbirth, spontaneous abortion, preeclampsia and eclampsia. This is a systematic review based on the PRISMA model that examines pregnancy disorder, pregnancy complication, and reproductive outcomes in floods. For fulfilling of the objectives of the research, related keywords were identified using Mesh and Emtree databases. Then the search was done in the electronic database of Medline, Web of Science, Embase, scopus until 2021.2.10. The search strategy in the Medline database. Database searches resulted in 823 non-duplicate records. After reading the abstracts, 808 articles were excluded. 15 abstracts were eligible for the study, which their full texts were provided. Finally based on inclusion and exclusion criteria 7 articles were included in this study. After flood, the rate of LBW birth and gestational hypertension increases. However, there is no significant difference in preterm birth rates. Pregnancy complications can be reduced or prevented by starting prenatal care early and also by controlling risk factors such as reducing smoking and alcohol consumption.
Topics: Female; Floods; Humans; Infant, Low Birth Weight; Infant, Newborn; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Stillbirth
PubMed: 35181015
DOI: 10.1016/j.tjog.2021.11.005 -
Surgery Open Science Oct 2022To determine common etiologies, presentations, management strategies and outcomes in patients with tumor embolism causing acute arterial occlusion. (Review)
Review
OBJECTIVE
To determine common etiologies, presentations, management strategies and outcomes in patients with tumor embolism causing acute arterial occlusion.
STUDY DESIGN
This is a systematic review of published case reports on tumor embolism.
SEARCH STRATEGY
All published cases of tumor embolism in the MEDLINE and EMBASE databases were reviewed. The search terminologies were (Tumor Embolism), (Ischemia), (Occlusion) and (Infarction).
INCLUSION AND EXCLUSION CRITERIA
All published reports of tumor embolism were included. Studies regarding venous thromboembolism and cancer-associated thromboembolism without tumor embolization were excluded. The cases included numbered 42.
OUTCOME MEASURES
These included the frequencies of different primary tumor types, clinical presentations, anatomical sites of embolization, types of intervention and outcomes including number of deaths and successful discharges.
RESULTS
Lung cancer and Atrial Myxoma each accounted for 14 out of 42 cases (33%). There were 11 cases (26.9%) of stroke and 9 cases (21.4%) of myocardial infarction and limb ischemia. Femoral thrombo-embolectomy was performed in all 9 cases of limb ischemia and Primary coronary intervention was performed in 7 out of 9 (77.8%) cases of myocardial infarction. There were 14 inpatient deaths (33.3%) and 19 patients were successfully discharged (45.2%).
CONCLUSION
Lung cancer and atrial myxoma were the most common sources for tumor embolism. Acute stroke was the most common presentation. This is treated with antiplatelets or anticoagulation as well as chemotherapy and resection of primary tumor. Early revascularisation can prevent severe complications such as death, paralysis, heart failure and limb loss in selected cases of tumor embolism.
KEY MESSAGE
Histopathological examination of embolic tissue can demonstrate tumor tissue and alert the clinician to a cancer elsewhere. This is most likely to be lung cancer or atrial myxoma. Early revascularisation in selected cases of acute tumor embolism can prevent severe complications and these patients should not be automatically palliated due to their underlying neoplasm.
PubMed: 36389271
DOI: 10.1016/j.sopen.2022.10.006