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PloS One 2019To summarize the best available evidence on the effectiveness of physical counterpressure manoeuvers (PCM) for vasovagal syncope management compared to a control... (Meta-Analysis)
Meta-Analysis
AIMS
To summarize the best available evidence on the effectiveness of physical counterpressure manoeuvers (PCM) for vasovagal syncope management compared to a control intervention. Control interventions included either a PCM, no intervention, or other interventions feasible in a lay setting.
METHODS
A systematic literature search (March 21st 2018) was performed in the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase. PCM were subdivided into 1) PCM decreasing orthostatic load (PCMOL), 2) PCM shortening the hydrostatic column between heart and brain (PCMHC), 3) PCM using mechanical compression of the veins (PCMMC). The primary outcome was syncope, secondary outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR). When possible, a random effects meta-analysis was performed. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for dichotomous outcomes, and mean differences (MD) or standardized mean differences (SMD) were calculated for continuous outcomes. Heterogeneity was assessed by means of the I2 statistic. The total body of evidence was evaluated by means of the GRADE methodology.
RESULTS
Eleven trials involving 688 people with vasovagal syncope were included. Risk of bias was high in all included studies. The total body of evidence (GRADE) was considered to be low or very low. PCM were found to improve syncope as compared to control (OR: 0.52, 95% CI [0.33;0.81], p = 0.004). Similarly, before-and-after studies without a control group showed a significant reduction in syncope following PCM (OR: 0.01, 95%CI [0.00;0.01], p<0.001). No studies investigated PCMOL. PCMHC increased SBP, DBP, MAP, SV, and CO, and decreased HR. PCMMC increased SBP, DBP, and MAP.
CONCLUSION
PCM may reduce syncope and increase SBP, DBP, and MAP. The effects on other outcomes are less clear. Additional high-quality studies are needed.
Topics: Bias; Blood Pressure; Female; Humans; Male; Motor Activity; Non-Randomized Controlled Trials as Topic; Randomized Controlled Trials as Topic; Syncope, Vasovagal; Treatment Outcome
PubMed: 30818337
DOI: 10.1371/journal.pone.0212012 -
Vox Sanguinis Apr 2010This systematic review was aimed at finding evidence for the safety of blood donation by individuals with treated hypertension or type 2 diabetes. It was undertaken as... (Review)
Review
BACKGROUND AND OBJECTIVES
This systematic review was aimed at finding evidence for the safety of blood donation by individuals with treated hypertension or type 2 diabetes. It was undertaken as part of a wider project to re-evaluate exclusion criteria for UK blood donors with a view to increasing eligibility.
MATERIALS AND METHODS
Searches were undertaken in the Cochrane Library to 2008, MEDLINE (1950 onwards), EMBASE (1974 onwards), CINAHL (1982 onwards), BNID (1994 onwards), the NHSBT SRI Handsearching Database and the Web of Science (all years) to February 2008. Planned analysis was largely descriptive.
RESULTS
We identified only 16 relevant papers. None of the identified studies directly addressed the review questions and methodological appraisal highlighted a number of deficiencies. However all included papers provided contributory data and the findings were consistent. No study found any evidence of increased risk to homologous (allogeneic) or autologous blood donors with treated hypertension or with raised baseline systolic blood pressure up to 200 mmHg. We found very few data relating to blood donation by diabetic subjects.
CONCLUSIONS
No identified study indicated that raised baseline blood pressure level, treated hypertension or diabetes was predictive of increased adverse reactions in blood donors but the level of overall evidence was limited. This is the first attempt to systematically review a donor area as part of an approach to change longstanding practice recommendations, and may have implications for other recommendations for changes in donor acceptance criteria.
Topics: Antihypertensive Agents; Blood Component Removal; Blood Donors; Blood Pressure; Blood Transfusion; Blood Transfusion, Autologous; Diabetes Mellitus, Type 2; Epidemiologic Research Design; Female; Humans; Hypertension; Hypoglycemic Agents; Insulin; Male; Phlebotomy; Syncope, Vasovagal; United Kingdom
PubMed: 19878496
DOI: 10.1111/j.1423-0410.2009.01275.x -
Frontiers in Pediatrics 2021This study was designed to assess the efficacy of increased salt and water intake in the treatment of pediatric vasovagal syncope (VVS) based on a meta-analysis of...
This study was designed to assess the efficacy of increased salt and water intake in the treatment of pediatric vasovagal syncope (VVS) based on a meta-analysis of global data. Following the established inclusion criteria, seven databases, Cochrane Library, EMBASE, PubMed, Web of Science, VIP, Wanfang, and China National Knowledge Infrastructure (CNKI), were searched using specific terms. The Cochrane Bias risk assessment tool was used as a quality assessment tool of the included studies, and publication bias was assessed by funnel plots. Review Manager 5.4 software was used to analyze the efficacy of the included studies, taking the negative changing rate of the head-up tilt test (HUTT) and recurrence rate of syncope or presyncope as therapeutic efficacy evaluations. In total, 5 randomized controlled trials (RCTs) were finally obtained, using the negative changing rate of the HUTT as an efficacy evaluation, while in 4 of the studies, the recurrence rate of syncope or presyncope was also evaluated. A total of 233 children with VVS were included in the salt and water intervention group. The cases in the control group were treated with non-medicinal conventional therapy. The results revealed that the negative changing rate of the HUTT in the intervention group (144/233, 61.8%) was higher than that in the control group (48/179, 26.8%), and the difference was significant ( < 0.00001). The recurrence rate of syncope or presyncope in the intervention group (85/195, 43.6%) was lower than that in the control group (86/144, 59.7%), and the difference was significant ( = 0.002). The current findings suggest that increased salt and water intake may increase the negative changing rates of the HUTT and reduce syncope or presyncope recurrence rates in pediatric patients with VVS.
PubMed: 34055695
DOI: 10.3389/fped.2021.663016 -
Endocrinology and Metabolism (Seoul,... Feb 2023There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of...
BACKGRUOUND
There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of FNAB.
METHODS
Studies related with the harms of FNAB were searched on MEDLINE, Embase, Cochrane library, and KoreaMed from 2012 to 2022. Also, studies reviewed in the previous systematic reviews were evaluated. Included clinical complications were postprocedural pain, bleeding events, neurological symptoms, tracheal puncture, infections, post-FNAB thyrotoxicosis, and needle tract implantation of thyroid cancers.
RESULTS
Twenty-three cohort studies were included in this review. Nine studies which were related with FNAB-related pain showed that most of the subjects had no or mild discomfort. The 0% to 6.4% of the patients had hematoma or hemorrhage after FNAB, according to 15 studies. Vasovagal reaction, vocal cord palsy, and tracheal puncture have rarely described in the included studies. Needle tract implantation of thyroid malignancies was described in three studies reporting 0.02% to 0.19% of the incidence rate.
CONCLUSION
FNAB is considered to be a safe diagnostic procedure with rare complications, which are mainly minor events. Thorough assessement of the patients' medical condition when deciding to perform FNABs would be advisable to lower potential complications.
Topics: Humans; Thyroid Nodule; Biopsy, Fine-Needle; Thyroid Neoplasms; Cohort Studies; Pain
PubMed: 36891657
DOI: 10.3803/EnM.2023.1669 -
The Journal of the Royal College of... Mar 2023We present a case of syncopal episode in emergency department (ED) and subsequent admission to the geriatric assessment unit. The patient presented with self-limiting...
We present a case of syncopal episode in emergency department (ED) and subsequent admission to the geriatric assessment unit. The patient presented with self-limiting central abdominal pain. Given a history of previous aortic aneurysm repair, a contrast CT angiogram was performed. With no evidence of leaking aneurysm, the patient was discharged from the ED. The syncopal episode happened while waiting for a taxi. A review of the earlier CT scan showed the presence of air in the venous circulatory system. In hindsight, it was thought the syncopal episode occurred due to air embolism introduced during or shortly after venous cannulation. We discuss the aetiology of venous air embolism and highlight the lack of evidence regarding tolerable amounts of air in the circulatory system. Physiological changes associated with age may suggest that elderly patients are uniquely maladapted to overcome sudden insults to their cardiovascular status.
Topics: Aged; Humans; Embolism, Air; Emergency Service, Hospital; Syncope; Syncope, Vasovagal; Tomography, X-Ray Computed
PubMed: 36642954
DOI: 10.1177/14782715221147969 -
Pacing and Clinical Electrophysiology :... Oct 2019Vasovagal reflex is the most common cause of syncope. Pacemaker with rate drop response (RDR) or closed-loop stimulation (CLS) anti-syncope algorithms have been studied...
Vasovagal reflex is the most common cause of syncope. Pacemaker with rate drop response (RDR) or closed-loop stimulation (CLS) anti-syncope algorithms have been studied in recurrent vasovagal syncope (VVS), with conflicting results. We aim to investigate the role of pacemaker therapy and anti-syncope pacing mode in cardioinhibitory recurrent VVS. MEDLINE, Cochrane Library and registered clinical trials were searched for single or double-blind randomized controlled trials on pacing as a treatment for recurrent VVS. Five studies were eligible, overall enrolling 228 patients. After pooling data from all trials, pacemaker therapy showed a 63% reduction in syncope recurrence compared to control [Risk Ratio (RR): 0.37; 95% CI: 0.14-0.98; I = 67%)]. Subgroup analyses suggested that the effect was greater in single-blind studies (RR: 0.07; 95% CI: 0.01-0.52, I = 0%). When comparing pacing algorithms, the results from RDR versus no pacing trials (n = 2) did not show a significant reduction in syncope recurrence (RR: 0.73; 95% CI: 0.25-2.16, I 60 = 75%). In contrast, the data from the CLS versus standard pacing trials (n = 3) evidenced a statistically meaningful reduction in syncopal burden (RR: 0.18; 95% CI: 0.07-0.47, I = 0%). It is unclear whether pacemaker therapy reduces syncopal burden in cardioinhibitory recurrent VVS. However, our results suggest effectiveness of CLS pacing mode.
Topics: Algorithms; Cardiac Pacing, Artificial; Humans; Randomized Controlled Trials as Topic; Recurrence; Syncope, Vasovagal
PubMed: 31433493
DOI: 10.1111/pace.13790 -
Frontiers in Physiology 2019The paper presents a meta-analysis of studies comparing hemodynamic parameters: heart rate (HR), systolic blood pressure (sBP), diastolic blood pressure (dBP), and...
The paper presents a meta-analysis of studies comparing hemodynamic parameters: heart rate (HR), systolic blood pressure (sBP), diastolic blood pressure (dBP), and stroke volume (SV) measured during head-up tilt table test (HUTT) in patients with positive and negative HUT test outcome. Pubmed and Clinical Key databases were searched for English-only articles presenting results of biosignals measurements during tilt test in patients suffering from syncope. From 3,289 articles 13 articles published between 1997 and 2015 investigating 892 patients (467 with positive HUTT outcome and 401 with negative one) were selected. There were not statistically significant differences observed between the parameters measured in supine position in patients with positive and negative test outcome [HR ( = 0.86), sBP ( = 0.32), dBP ( = 0.21), SV ( = 0.71)]. In tilt position the parameters HR and SV were significantly different when compared between the two groups of patients [HR ( = 0.02), sBP ( = 0.10), dBP ( = 0.59), SV ( = 0.0004)]. Changes in HR and SV parameters in response to tilt test turned out to be statistically significant. In supine position the differences between patients with positive and negative test outcome were not significant, hence tilt test can be considered as necessary in the diagnosis of vasovagal syndrome.
PubMed: 30899228
DOI: 10.3389/fphys.2019.00184 -
Open Heart Jun 2024Neurocardiogenic syncope is a common condition with significant associated psychological and physical morbidity. The effectiveness of therapeutic options for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neurocardiogenic syncope is a common condition with significant associated psychological and physical morbidity. The effectiveness of therapeutic options for neurocardiogenic syncope beyond placebo remains uncertain.
METHODS
The primary endpoint was the risk ratio (RR) of spontaneously recurring syncope following any therapeutic intervention. We also examined the effect of blinding on treatment efficacy. We identified all randomised trials which evaluated the effect of any pharmacological, device-based or supportive intervention on patients with a history of syncope. A systematic search was conducted on Medline, Embase, PubMed databases and Cochrane Central Register for Controlled Trials from 1950 to 25 April 2023. Event rates, their RRs and 95% CIs were calculated, and a random-effects meta-analysis was conducted for each intervention. Data analysis was performed in R using RStudio.
RESULTS
We identified 47 eligible trials randomising 3518 patients. Blinded trials assessing syncope recurrence were neutral for beta blockers, fludrocortisone and conventional dual-chamber pacing but were favourable for selective serotonin reuptake inhibitors (SSRIs) (RR 0.40, 95% CI 0.26 to 0.63, p<0.001), midodrine (RR 0.70, 95% CI 0.53 to 0.94, p=0.016) and closed-loop stimulation (CLS) pacing (RR 0.15, 95% CI 0.07 to 0.35, p<0.001). Unblinded trials reported significant benefits for all therapy categories other than beta blockers and consistently showed larger benefits than blinded trials.
CONCLUSIONS
Under blinded conditions, SSRIs, midodrine and CLS pacing significantly reduced syncope recurrence. Future trials for syncope should be blinded to avoid overestimating treatment effects.
PROSPERO REGISTRATION NUMBER
CRD42022330148.
Topics: Humans; Syncope, Vasovagal; Randomized Controlled Trials as Topic; Treatment Outcome; Recurrence
PubMed: 38890128
DOI: 10.1136/openhrt-2024-002669