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Europace : European Pacing,... Mar 2018The additional benefit of a defibrillator in cardiac resynchronization therapy (CRT) patients is a matter of debate. Cause-of-death analysis in a CRT population has been... (Meta-Analysis)
Meta-Analysis
AIMS
The additional benefit of a defibrillator in cardiac resynchronization therapy (CRT) patients is a matter of debate. Cause-of-death analysis in a CRT population has been recently proposed as a useful approach to gain insight into this problem. We performed a systematic review and meta-analysis looking at cause of death in studies involving CRT subjects with (CRT-D) or without (CRT-P) a defibrillator.
METHODS AND RESULTS
Literature search performed from inception to 31 March 2016 for relevant studies. Proportional and conventional meta-analyses were performed to obtain and compare causes of death in CRT-D vs. CRT-P patients, including sudden cardiac death (SCD), all-cause mortality, heart failure, cardiovascular, and non-cardiovascular mortalities. The systematic review included a total of 44 studies and 18 874 patients (13 248 receiving CRT-D and 5626 receiving CRT-P), representing 48 504 patient-years of follow-up. CRT-D recipients were younger, more often male, had lower NYHA class, less atrial fibrillation, more ischaemic heart disease and were more often on beta-blockers than those receiving CRT-P. There were an additional 42 deaths per 1000 patient-years in the CRT-P group compared with CRT-D (97 ± 9, 95% CI 79-115 vs. 55 ± 5, 95% CI 44-65, respectively), of which 35.7% were due to SCD (20 ± 2, 95% CI 15-24 vs. 5 ± 1, 95% CI 3-6) and the remaining 64.3% due to non-SCD. Of all deaths reported in CRT-D and CRT-P patients, 9.1% and 20.6% were due to SCD, respectively. The extent of SCD in CRT-P patients significantly increased in studies with higher percentage of males, ischaemic cardiomyopathy and NYHA class 3.
CONCLUSION
Overall, compared with CRT-D patients, unadjusted mortality rate was almost two-fold higher in CRT-P recipients, with SCD representing one third of the excess mortality. Rate of SCD was significantly higher in certain subgroups (males, ischaemic cardiomyopathy, NYHA class 3), where a CRT-D may be of more pronounced benefit. This deserves further focused investigation.
Topics: Aged; Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Cause of Death; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Female; Heart Failure; Humans; Incidence; Male; Middle Aged; Protective Factors; Risk Factors; Time Factors; Treatment Outcome
PubMed: 28666319
DOI: 10.1093/europace/eux094 -
JACC. Cardiovascular Imaging Mar 2023Sarcoidosis is a complex multisystem inflammatory disorder, with approximately 5% of patients having overt cardiac involvement. Patients with cardiac sarcoidosis are at... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sarcoidosis is a complex multisystem inflammatory disorder, with approximately 5% of patients having overt cardiac involvement. Patients with cardiac sarcoidosis are at an increased risk of both ventricular arrhythmias and sudden cardiac death. Previous studies have shown that the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is associated with an increased risk of mortality and ventricular arrhythmias and may be useful in predicting prognosis.
OBJECTIVES
This systematic review and meta-analysis assessed the value of LGE on CMR imaging in predicting prognosis for patients with known or suspected cardiac sarcoidosis.
METHODS
The authors searched the Embase and MEDLINE databases from inception to March 2022 for studies reporting individuals with known or suspected cardiac sarcoidosis referred for CMR with LGE. Outcomes were defined as all-cause mortality, ventricular arrhythmia, or a composite outcome of either death or ventricular arrhythmias. The primary analysis evaluated these outcomes according to the presence of LGE. A secondary analysis evaluated outcomes specifically according to the presence of biventricular LGE.
RESULTS
Thirteen studies were included (1,318 participants) in the analysis, with an average participant age of 52.0 years and LGE prevalence of 13% to 70% over a follow-up of 3.1 years. Patients with LGE on CMR vs those without had higher odds of ventricular arrhythmias (odds ratio [OR]: 20.3; 95% CI: 8.1-51.0), all-cause mortality (OR: 3.45; 95% CI: 1.6-7.3), and the composite of both (OR: 9.2; 95% CI: 5.1-16.7). Right ventricular LGE is invariably accompanied by left ventricular LGE. Biventricular LGE is also associated with markedly increased odds of ventricular arrhythmias (OR: 43.6; 95% CI: 16.2-117.2).
CONCLUSIONS
Patients with known or suspected cardiac sarcoidosis with LGE on CMR have significantly increased odds of both ventricular arrhythmias and all-cause mortality. The presence of biventricular LGE may confer additional prognostic information regarding arrhythmogenic risk.
Topics: Humans; Middle Aged; Contrast Media; Gadolinium; Cardiomyopathies; Prognosis; Myocardium; Predictive Value of Tests; Magnetic Resonance Imaging; Sarcoidosis; Arrhythmias, Cardiac; Myocarditis; Magnetic Resonance Spectroscopy; Magnetic Resonance Imaging, Cine
PubMed: 36752432
DOI: 10.1016/j.jcmg.2022.10.018 -
The Cochrane Database of Systematic... Nov 2016Most people with epilepsy have a good prognosis and their seizures can be well controlled with the use of a single antiepileptic drug, but up to 30% develop refractory... (Review)
Review
BACKGROUND
Most people with epilepsy have a good prognosis and their seizures can be well controlled with the use of a single antiepileptic drug, but up to 30% develop refractory epilepsy, especially those with partial seizures. In this review we summarize the current evidence regarding oxcarbazepine when used as an add-on treatment for drug-resistant partial epilepsy.
OBJECTIVES
To evaluate the effects of oxcarbazepine when used as an add-on treatment for drug-resistant partial epilepsy.
SEARCH METHODS
We searched the Cochrane Epilepsy Group's Specialized Register (28 March 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to March 2006). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies. We also contacted Novartis (manufacturers of oxcarbazepine) and experts in the field.
SELECTION CRITERIA
Randomized, placebo-controlled, double-blinded, add-on trials of oxcarbazepine in patients with drug-resistant partial epilepsy.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and extracted the relevant data. The following outcomes were assessed : (a) 50% or greater reduction in seizure frequency; (b) treatment withdrawal (any reason); (c) side effects. Primary analyses were intention-to-treat. Summary odds ratios were estimated for each outcome.
MAIN RESULTS
Two trials were included representing 961 randomized patients.Overall Odds Ratio (OR) (95% Confidence Interval (CIs)) for 50% or greater reduction in seizure frequency compared to placebo 2.96 (2.20, 4.00).Treatment withdrawal OR (95% CIs) compared to placebo 2.17 (1.59, 2.97).Side effects: OR (99% CIs) compared to placebo, ataxia 2.93 (1.72, 4.99); dizziness 3.05 (1.99, 4.67); fatigue 1.80 (1.02, 3.19); nausea 2.88 (1.77, 4.69); somnolence 2.55 (1.84, 3.55); diplopia 4.32 (2.65, 7.04), were significantly associated with oxcarbazepine.
AUTHORS' CONCLUSIONS
Oxcarbazepine has efficacy as an add-on treatment in patients with drug-resistant partial epilepsy, both in adults and children. However, trials reviewed were of relatively short duration, and provide no evidence about the long-term effects of oxcarbazepine. Results cannot be extrapolated to monotherapy or to patients with other epilepsy types.
Topics: Adult; Anticonvulsants; Carbamazepine; Child; Drug Resistance; Drug Therapy, Combination; Epilepsies, Partial; Humans; Outcome Assessment, Health Care; Oxcarbazepine; Randomized Controlled Trials as Topic
PubMed: 27845825
DOI: 10.1002/14651858.CD002028.pub2 -
International Journal of Cardiology Sep 2018Maintenance of sinus rhythm has been associated with lower mortality, but whether atrial fibrillation (AF) ablation per se benefits hard outcomes such as mortality and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Maintenance of sinus rhythm has been associated with lower mortality, but whether atrial fibrillation (AF) ablation per se benefits hard outcomes such as mortality and stroke is still debated.
OBJECTIVE
To determine whether AF ablation is associated with a reduction in all-cause mortality and stroke compared with medical therapy alone.
METHODS
Literature search looking for both randomized and observational studies comparing AF catheter ablation vs. medical management. Data pooled using random-effects. Risk ratios (RR) with 95% confidence intervals (CI) used as a measure of treatment effect. The primary and secondary outcomes were all-cause mortality and occurrence of cerebrovascular events during follow-up, respectively.
RESULTS
Thirty studies were eligible for inclusion, comprising 78,966 patients (25,129 receiving AF ablation and 53,837 on medical treatment) and 233,990patient-years of follow-up. The pooled data of studies revealed that ablation was associated with lower risk of all-cause mortality: 5.7% vs. 17.9%; RR=0.44, 95% CI 0.32-0.62, p<0.001. In a sensitivity analysis by study design, a survival benefit of AF ablation was seen in randomized studies, with no heterogeneity (mortality risk 4.2% vs. 8.9%; RR=0.55, 95% CI 0.39-0.79, p=0.001, I=0%), and also in observational studies, but with marked heterogeneity (6.1% vs. 18.3%; RR=0.39, 95% CI 0.26-0.59, p<0.001, I=95%). The mortality benefit in randomized studies was mainly driven by trials performed in patients with left ventricular (LV) dysfunction and heart failure. The pooled risk of a cerebrovascular event was lower in patients receiving AF ablation (2.3% vs. 5.5%; RR=0.57, 95% CI 0.46-0.70, p<0.001, I=62%), but no difference was seen in randomized trials (2.2% vs. 2.1%; RR=0.94, 95% CI 0.46-1.94, p=0.87, I=0%).
CONCLUSIONS
Ablation of atrial fibrillation associates with a survival benefit compared with medical treatment alone, although evidence is restricted to the setting of heart failure and LV systolic dysfunction.
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Mortality; Observational Studies as Topic; Randomized Controlled Trials as Topic; Stroke; Treatment Outcome
PubMed: 29887429
DOI: 10.1016/j.ijcard.2018.03.068 -
Disability and Rehabilitation May 2024Sedentary behaviour is associated with pain, fatigue, and a more severe impact of the disease in fibromyalgia, independently of physical activity levels. Despite this... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Sedentary behaviour is associated with pain, fatigue, and a more severe impact of the disease in fibromyalgia, independently of physical activity levels. Despite this knowledge, little attention has been attributed to estimate sedentary behaviour in this population. The aims of this meta-analysis were to: (a) establish the pooled mean time spent sedentary, (b) investigate moderators of sedentary levels, and (c) explore differences with age- and gender-matched general population controls in people with fibromyalgia (PwF).
METHODS
Two independent authors searched major databases until 1 December 2022. A random effects meta-analysis was performed. The methodological quality of included studies was assessed with the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies.
RESULTS
Across 7 cross-sectional studies of fair methodological quality, there were 1500 patients with fibromyalgia (age range = 43-53 years). PwF spent 545.6 min/day (95% CI = 523.7-567.5, < 0.001, = 3) engaging in sedentary behaviour. Self-reported questionnaires overestimate sedentary levels with 314.3 min/day (95% CI = 302.0-326.6, = 0.001, = 2). PwF spent 36.14 min/day (95% CI = 16.3-55.9, < 0.001) more in sedentary behaviour than general population controls.
CONCLUSIONS
PwF are more sedentary than the general population. The limited available data should however be considered with caution due to substantial heterogeneity.
Topics: Fibromyalgia; Humans; Sedentary Behavior; Cross-Sectional Studies; Middle Aged; Female; Exercise
PubMed: 37211677
DOI: 10.1080/09638288.2023.2214379 -
Archivos Argentinos de Pediatria Apr 2016Physiological parameters used to measure exercise intensity are oxygen uptake and heart rate. However, perceived exertion (PE) is a scale that has also been frequently... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Physiological parameters used to measure exercise intensity are oxygen uptake and heart rate. However, perceived exertion (PE) is a scale that has also been frequently applied. The objective of this study is to establish the criterion-related validity of PE scales in children during an incremental exercise test.
METHODS
Seven electronic databases were used. Studies aimed at assessing criterion-related validity of PE scales in healthy children during an incremental exercise test were included. Correlation coefficients were transformed into z-values and assessed in a meta-analysis by means of a fixed effects model if I2 was below 50% or a random effects model, if it was above 50%.
RESULTS
wenty-five articles that studied 1418 children (boys: 49.2%) met the inclusion criteria. Children's average age was 10.5 years old. Exercise modalities included bike, running and stepping exercises. The weighted correlation coefficient was 0.835 (95% confidence interval: 0.762-0.887) and 0.874 (95% confidence interval: 0.794-0.924) for heart rate and oxygen uptake as reference criteria. The production paradigm and scales that had not been adapted to children showed the lowest measurement performance (p < 0.05).
CONCLUSION
Measuring PE could be valid in healthy children during an incremental exercise test. Child-specific rating scales showed a better performance than those that had not been adapted to this population. Further studies with better methodological quality should be conducted in order to confirm these results.
Topics: Child; Exercise; Exercise Test; Female; Heart Rate; Humans; Male; Oxygen Consumption; Physical Exertion
PubMed: 27079389
DOI: 10.5546/aap.2016.eng.120 -
Open Forum Infectious Diseases Jul 2019The optimal treatment for potential AmpC-producing Enterobacteriaceae, including Serratia, Providencia, Citrobacter, Enterobacter, and Morganella species, remains...
The optimal treatment for potential AmpC-producing Enterobacteriaceae, including Serratia, Providencia, Citrobacter, Enterobacter, and Morganella species, remains unknown. An updated systematic review and meta-analysis of studies comparing beta-lactam/beta-lactamase inhibitors with carbapenems in the treatment of bloodstream infections with these pathogens found no significant difference in 30-day mortality (OR, 1.13; 95% CI, 0.58 - 2.20).
PubMed: 31363762
DOI: 10.1093/ofid/ofz248 -
Revista Portuguesa de Cardiologia :... Jun 2015International guidelines exclude athletes with implantable cardioverter-defibrillators (ICDs) from participating in sports, except those of low intensity (category IA,... (Review)
Review
International guidelines exclude athletes with implantable cardioverter-defibrillators (ICDs) from participating in sports, except those of low intensity (category IA, such as golf, billiards or bowling). However, these guidelines are based on expert consensus, and thus the safety and risks of participating in sports in this population are still largely unknown in the medical community. We performed a systematic review of the literature in PubMed using the following search string: "((sudden cardiac death) AND (sport OR physical exercise)) AND defibrillator". After the application of pre-defined inclusion and exclusion criteria, 36 results were selected, which are explored in this paper. Preliminary results on ICD use in this population appear to demonstrate the safety and efficacy of the device in this context. Further studies, with longer follow-up and with larger samples, may provide stronger evidence to support these findings. In the meantime, disqualifying almost all ICD patients from participating in sports, without taking into consideration their individual needs and characteristics, may be prejudicial to a considerable number of patients by preventing them from exercising their profession or engaging in recreational sport, for which their risk of sudden cardiac death may be low.
Topics: Death, Sudden, Cardiac; Defibrillators, Implantable; Humans; Sports
PubMed: 26050225
DOI: 10.1016/j.repc.2014.11.007 -
International Braz J Urol : Official... 2016Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The... (Review)
Review
Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.
Topics: Administration, Oral; Adrenergic beta-3 Receptor Agonists; Botulinum Toxins; Female; Humans; Male; Muscarinic Antagonists; Time Factors; Transcutaneous Electric Nerve Stimulation; Treatment Outcome; Urinary Bladder, Overactive
PubMed: 27176185
DOI: 10.1590/S1677-5538.IBJU.2015.0367 -
Psychiatry Research Apr 2024Depression and subthreshold depressive symptoms reduce quality of life and function and treatment does not work effectively in one-third of patients. Exercise can reduce... (Meta-Analysis)
Meta-Analysis
Depression and subthreshold depressive symptoms reduce quality of life and function and treatment does not work effectively in one-third of patients. Exercise can reduce depressive symptoms, but more information is required regarding strength training (ST). The objective of the present meta-analysis was to summarize and estimate the efficacy of ST in people with a diagnosis of depression or subthreshold depressive symptoms and no other severe disease. We also aimed to explore the variables that could influence the antidepressant effects. PubMed, Embase, Web of Science, PsyINFO, CINAHL, and SPORTDiscus were searched from inception to August 2022. The overall effect antidepressant of training was moderate (SMD = -0.51, 95 % CI -0.72 to -0.30, p < 0.001). The meta-regression demonstrated preliminary evidence that the variables: duration of the intervention in weeks, weekly frequency of the intervention, number of sets, and number of repetitions can influence the antidepressant effects. However, these variables had a small role in the variation of the effect.
Topics: Humans; Resistance Training; Depression; Quality of Life; Antidepressive Agents; Exercise
PubMed: 38428290
DOI: 10.1016/j.psychres.2024.115805