Is Anticoagulant Necessary in Patients with Coronary Artery Ectasia Presenting with Acute Coronary Syndrome? A Systematic Review of Case Reports

Coronary artery ectasia is found in 3 to 8% of patient's undergoing angiography and may sometimes induce acute myocardial infarction. Some articles reported a recurrence of acute coronary syndrome (ACS) in the presence of coronary artery ectasia (CAE). Our study aims to summarize the latest evidence on whether the use of anticoagulant in addition to SAPT/DAPT (single antiplatelet/dual antiplatelet) treating ACS with CAE patients is necessary. Since the trials concerning our objectives were scarce, we pooled case reports/series. We performed a comprehensive search on case reports/series on coronary artery ectasia that presented with acute coronary syndrome published until March 2019. We collected 13 cases from 11 reports. Out of 13 patients, 5 (38.5%) took DAPT only without anticoagulant and 8 (61.5%) took anticoagulant ± DAPT. Three out of five (60%) who took DAPT only, experienced recurrences at 1st and 2nd months' follow-up. The other two (40%) was uneventful at a mean of two months' follow-up. Eight patients who took anticoagulant were uneventful for a mean of 8.4 months. Those who took anticoagulant were at lower risk of experiencing ACS recurrence ( p  = 0.035). Two of the patients who experienced recurrence became 6 and 12 months free after optimal anticoagulation. The author of this study proposed that anticoagulant must be considered should SAPT/DAPT failed to provide adequate protection to the recurrence of ACS, especially in CAE patients who did not have other obvious stenotic lesions. However, the evidence is weak since this study only pooled case reports/series.

Intravitreal conbercept improves outcome in patients undergoing vitrectomy for proliferative diabetic retinopathy: A systematic review and meta-analysis

OBJECTIVES

To evaluate the latest evidence concerning the efficacy of conbercept on vitrectomy for proliferative diabetic retinopathy (PDR) and its efficacy compared to control and other antivascular endothelial growth factor.

METHODS

We performed a systematic literature search on topics that assess the role of conbercept in patients undergoing vitrectomy for PDR from inception to November 2019, using PubMed, EuropePMC, Cochrane Central Database, ProQuest, ScienceDirect, and Clinicaltrials.gov. Two researchers independently searched literature, extracted data, and evaluated the risk of bias. RevMan 5.3 and StataMP 16 software were used to perform data analysis.

RESULTS

There were 699 cases (eyes) from eight studies. Baseline best-corrected visual acuity (BCVA) was better in the control group compared to conbercept group (mean difference [MD] = 0.13, I2   = 0%). A greater BCVA improvement was observed in the conbercept group after 1-month (MD = -0.27, I2   = 1%), 3-month (MD = -0.28, I2   = 0%), and 6-month (MD = -0.20, I2   = 78%) follow-up. The need for endodiathermy (odds ratio [OR] = 0.20, I2   = 0%) and silicone oil tamponade use (OR = 0.59, I2   = 72%) and intraoperative bleeding (OR = 0.11, I2   = 33%) was lower in conbercept group. Postoperative early (OR = 0.22, I2   = 0%) and late (OR = 0.47, I2   = 0%) vitreous hemorrhage was lower in conbercept group. There was no significant difference in BCVA improvement and intraoperative outcome between conbercept and ranibizumab.

CONCLUSIONS

Intravitreal conbercept was associated with a more significant BCVA improvement, better intraoperative outcome, and less postoperative vitreous hemorrhage compared to no conbercept.

Hypofractionated versus single-fraction stereotactic radiosurgery for the treatment of brain metastases: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to synthesize the latest evidence on the hypofractionated stereotactic radiosurgery (HF-SRS) compared to single-fraction stereotactic radiosurgery (SF-SRS) for the treatment of brain metastases.

METHODS

We systematically searched PubMed, Scopus, EuropePMC, ProQuest, and Cochrane Central Databases. Original research articles investigating patients with brain metastasis receiving HF-SRS or SF-SRS reporting the local control/failure and/or radionecrosis during follow-up were included.

RESULTS

There were 1100 patients from 7 studies. 616 lesions were allocated to HF-SRS group and 777 lesions were allocated to SF-SRS group. Pooled rate of local control was 88% (95% CI 84%, 91%) in HF-SRS group and 81% (95% CI 74%, 88%) in the SF-SRS groups. Local control was higher in patients receiving HF-SRS compared to SF-SRS (OR 1.53 [95% CI 1.08, 2.18], p = 0.018; I2: 0%). Pooled rate of radionecrosis was 7% (95% CI 3%, 12%) in HF-SRS group and 15% (95% CI 8%, 23%) in the SF-SRS groups. Similar rate of radionecrosis was observed in both HF-SRS and SF-SRS (OR 0.82 [95% CI 0.31, 2.21], p = 0.698; I2: 61.3%). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) qualification showed a low level of certainty for the higher local control in patients receiving HF-SRS compared to SF-SRS and a very low level of certainty for similar risk of radionecrosis between the two groups.

CONCLUSION

This meta-analysis showed that HF-SRS was associated with higher local control and similar rate of radionecrosis compared to SF-SRS in patients with brain metastases.

PROSPERO ID

CRD42020210469.

Comparison between surgical and catheter based ablation in atrial fibrillation, should surgical based ablation be implemented as first line? - A meta-analysis of studies

INTRODUCTION

Ablation remains a modality of choice in select patients with Atrial fibrillation (AF). Which is done via a surgical or catheter-based approach.

OBJECTIVE

This meta-analysis aimed to compare the efficacy of Surgical and Catheter ablation in the management of AF.

METHODS

Electronic search on PubMed (MEDLINE), EBSCO, EuropePMC, Clinicaltrials.gov, and Google Scholar was done. Studies comparing the use of surgical or catheter ablation in patients with AF were included. The Primary outcome of interest was Arrhythmia free patients at 12 months post-ablation.

RESULTS

Eight studies (744 patients) reported a statistically significant difference in Arrhythmia recurrence rate between surgical and catheter-based ablation. The pooled hazard ratio was chosen to compare the risk of AF recurrence between these groups with pooled Hazard ratio comparing surgical to catheter approach of 0.40 [0.35,0.45], p < 0.001 favoring surgical approach; low heterogeneity I2 22%, p = 0.25. Meta-analyses were also performed on procedural time, length of stay and major adverse events.

CONCLUSION

The increased rate of adverse effects and length of hospitalization impedes the implementation of surgical ablation as primary ablation method of AF in general. However, the result of our meta-analysis shows the promising result of surgical ablation compared to catheter-based ablation.

Serum Galectin-3 level and recurrence of atrial fibrillation post-ablation - Systematic review and meta-analysis

BACKGROUND

Serum galectin-3, a circulating biomarker of fibrosis, has been associated with atrial remodelling. Recent studies investigating serum galectin-3 and AF recurrence post-ablation have shown mixed results. We aimed to analyze the latest evidence on the association between serum galectin-3 and AF recurrence after catheter ablation.

METHODS

We performed a comprehensive search on topics that assesses serum galectin-3 and AF recurrence post-ablation up until August 2019.

RESULTS

There were 597 patients from seven studies. The mean difference of serum galectin-3 was similar in both AF recurrence and non AF recurrence group (mean difference 0.78 ng/mL [-0.56, 2.13]; p = 0.25; I2: 69%. Upon removal of a study in sensitivity analysis, the serum galectin-3 became higher in AF recurrence group (mean difference 1.41 ng/mL [0.47, 2.34], p = 0.003; I2: 17%). Serum galectin-3 was associated with a higher risk for AF recurrence (HR 1.25 [1.01, 1.55]; p = 0.04; I2: 76%). Upon removal of a study in sensitivity analysis, HR became 1.45 [1.07, 1.96], p = 0.02; I2: 47%. Meta-analysis of adjusted HR demonstrated that high serum galectin-3 independently predicts AF recurrence (HR 1.15 [1.02, 1.29], p < 0.02; I2: 57%, p = 0.10) CONCLUSION: Serum galectin-3 is associated with an increased risk of AF recurrence post-ablation. Further studies are required, especially emphasis on the cut-off point should be given, before integrating it in routine risk stratification for AF ablation.

Association between PR Interval, First-degree atrioventricular block and major arrhythmic events in patients with Brugada syndrome - Systematic review and meta-analysis

BACKGROUND

Risk stratification in patients with asymptomatic Brugada Syndrome is challenging, and despite recent advances, there is no clear evidence. The first-degree atrioventricular block was hypothesized to be a predictor of arrhythmic events. Measurement of the PR interval and diagnosing atrioventricular block from surface ECG is easy, noninvasive, and cost-effective. We aimed to assess the latest evidence on PR interval or first-degree atrioventricular block and major arrhythmic events related to Brugada Syndrome.

METHODS

We performed a comprehensive search in PubMed for "atrioventricular block" OR "PR interval" and "Brugada syndrome." We included studies that have a component of PR interval and/or first-degree atrioventricular block and major arrhythmic events related to Brugada Syndrome including syncope/VT/VF/appropriate ICD shocks/ICD implantation.

RESULTS

We included 1526 subjects from 7 studies. Pooled mean difference of PR interval in 4 studies showed a significant difference [MD 10.77 ms (2.97-18.57) P = 0.007, moderate-high heterogeneity I2 = 53% P = 0.08]. On sensitivity analysis by removing a study, it became MD 6.50 ms [1.97-11.03], P = 0.005, heterogeneity I2 = 0% P = 0.52. Indicating that PR interval was prolonged by small margin. Pooled analysis of the association between a first-degree atrioventricular block and major arrhythmic events was significant [OR 3.33 (2.02-5.50) P < 0.001, low heterogeneity I2 = 0% P = 0.57].

CONCLUSION

First-degree AV block is associated with more frequent major arrhythmic events in Brugada syndrome patients. PR interval seemed to be prolonged but is yet to be determined whether the PR interval association is still significant if it did not cross the first-degree AVB threshold.

Efficacy and safety of catheter ablation for atrial fibrillation in congenital heart disease - A systematic review and meta-analysis

BACKGROUND

Prevalence of atrial fibrillation (AF) in patients with congenital heart disease (CHD) is on the rise. Anti-arrhythmic drugs are usually the first line of treatment in CHD, however, it is often ineffective and poorly tolerated. We aimed to perform a systematic review to assess the efficacy and safety of catheter ablation for AF in CHD.

METHODS

We performed a comprehensive search on catheter ablation for atrial fibrillation in congenital heart disease up until July 2019 through several electronic databases.

RESULTS

Ablation of AF in patients with CHD had a modest 12 months AF freedom ranging from 32.8% to 63%, which can be increased by subsequent/repeat ablation. The complexity of CHD appears to have a significant effect on a study but not in others. Catheter ablation in ASD and persistent left superior vena cava had a high success rate. Overall, catheter ablation is safe whichever the type of CHD is.

CONCLUSION

Catheter ablation for AF in CHD had modest efficacy that can be increased by subsequent/repeat ablation and it also has an excellent safety profile. Ablation in complex CHD could also have similar efficacy, however, it is preferably done by experts in a high volume tertiary center.

Efficacy and safety of renal denervation in addition to pulmonary vein isolation for atrial fibrillation and hypertension-Systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

This systematic review and meta-analysis aimed to assess the latest evidence on the use of renal denervation (RDN) + pulmonary vein isolation (PVI) compared to PVI alone for treating atrial fibrillation (AF) with hypertension.

METHODS

A systematic literature search from several electronic databases was performed up until January 2020. The primary outcome was AF recurrence defined as AF/atrial flutter (AFL)/atrial tachycardia (AT) ≥30 seconds at 12-month follow-up and the secondary outcome was procedure-related complications.

RESULTS

There were 568 subjects from five studies. AF recurrence was 90/280 (32.1%) in the RDN + PVI group and 142/274 (51.8%) in the PVI group. RDN + PVI was associated with a lower incidence of AF recurrence (RR 0.62 [0.51, 076], P < .001; I 2: 0%). Pooled analysis of HR showed that RDN + PVI was associated with reduced AF recurrence (HR 0.51 [0.38, 0.70], P < .001; I 2: 0%). Complications were 7/241 (2.9%) in the RDN + PVI group and 8/237 (3.4%) in the PVI group. The rate of complications between the groups was similar (RR 0.87 [0.33, 2.29], P = .77; I 2: 0%). In the subgroup analysis of paroxysmal AF, RDN + PVI was shown to reduce AF recurrence (RR 0.64 [0.49, 0.82], P < .001; I 2: 0% and HR 0.56 [0.38, 0.82], P = .003; I 2: 0%) compared to PVI alone. RDN + PVI has a moderate certainty of evidence in the reducing AF recurrence with an absolute reduction of 197 fewer per 1000 (from 254 fewer to 124 fewer).

CONCLUSION

RDN in addition to PVI, is associated with reduced 12-month AF recurrence and similar procedure-related complications compared to PVI alone.

Decompression Alone Compared to Decompression With Fusion in Patients With Lumbar Spondylolisthesis: Systematic Review, Meta-Analysis, and Meta-Regression

BACKGROUND

We aimed to synthesize the latest evidence on the efficacy and safety of decompression alone compared to decompression with fusion in patients with lumbar spondylolisthesis. We also aimed to evaluate factors affecting the efficacy and complications.

METHODS

A systematic literature search was conducted using PubMed, Scopus, Europe PMC, Cochrane Central Database, and ClinicalTrials.gov. The main outcome was improvement in Oswestry Disability Index (ODI). The secondary outcome was back pain and leg pain improvement, complications, reoperation rate, duration of surgery, length of hospital stay, and blood loss.

RESULTS

There were 3993 patients from 13 studies. Decompression with fusion was associated with greater reduction in ODI (mean difference 4.04 [95% CI 0.95, 7.13], P = 0.01) compared to decompression alone. Greater reduction in back (standardized mean difference [SMD] 0.27 [95% CI 0.00, 0.53], P = 0.05) and leg pain (SMD 0.13 [95% CI 0.06, 0.21], P < 0.001) was observed in the decompression with fusion group. Complications were similar in the 2 groups (OR 0.60 [95% CI 0.34, 1.04], P = 0.07). The reoperation rate was similar in both groups (P = 0.54). Decompression alone resulted in shorter duration of surgery (mean difference -85.18 minutes [95% CI -122.79, -47.57], P < 0.001), less blood loss (mean difference -262.65 mL [95% CI -313.45, -211.85], P < 0.001), and shorter hospital stay (mean difference -2.64 days [95% CI -3.58, -1.70], P < 0.001). Empirical Bayes random-effects meta-regression showed that the rate of complication was influenced by age (coefficient 0.172, P = 0.004).

CONCLUSION

Decompression with fusion had greater efficacy than decompression alone but was associated with more blood loss, lengthier surgery, and hospitalization. In terms of complications, decompression alone may be beneficial in younger patients. (PROSPERO CRD42020211904) LEVEL OF EVIDENCE: 2A.

Corrigendum: Low Serum 25-hydroxyvitamin D (Vitamin D) Level Is Associated With Susceptibility to COVID-19, Severity, and Mortality: A Systematic Review and Meta-Analysis

[This corrects the article DOI: 10.3389/fnut.2021.660420.].

The efficacy and safety of oral paracetamol versus oral ibuprofen for patent ductus arteriosus closure in preterm neonates - A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to synthesize the latest evidence on the efficacy and safety of oral acetaminophen compared to oral ibuprofen for patent ductus arteriosus (PDA) in preterm infants.

METHODS

We performed a systematic literature search on topics that assesses the use of oral paracetamol compared to oral ibuprofen in preterm neonates diagnosed with PDA from PubMed, EuropePMC, Cochrane Central Database, ScienceDirect, ProQuest, ClinicalTrials.gov, and hand-sampling from potential articles.

RESULTS

There were 1547 subjects from 10 selected studies. Primary closure rate was similar in both groups. Subgroup analysis on studies enrolling neonates with ≤30 weeks gestational age showed that ibuprofen was superior (OR 0.52 [0.31, 0.90], I2: 0%). On the other hand, paracetamol was superior neonates with ≤34 weeks gestational age (OR 1.73 [1.01, 2.94], I2: 30%). Reopening rate, surgical closure rate, mortality, intraventricular hemorrhage, and necrotizing enterocolitis were similar in both groups. Rate of renal dysfunction (OR 0.27 [0.10, 0.77], I2: 0%) and gastrointestinal bleeding (OR 0.31 [0.11, 0.88], I2: 0%) were lower in paracetamol group. Subgroup analysis of randomized controlled studies (RCTs) showed similar results. Meta-regression analysis showed that the primary closure rate was not influenced by gestational age, birth weight, and gender. GRADE demonstrates a low level of certainty for primary closure and mortality. Renal dysfunction and gastrointestinal bleeding havea moderate level of certainty.

CONCLUSION

There was no significant difference between the efficacy of oral paracetamol and oral ibuprofen. However, the rate of renal dysfunction and gastrointestinal bleeding were higher in oral ibuprofen.

Subperiosteal versus subdural drainage after burr hole evacuation of chronic subdural hematoma: systematic review and meta-analysis

BACKGROUND

The evidence for subperiosteal drainage (SPD) versus subdural drainage (SDD) in chronic subdural hematoma (CSDH) remains controversial, and most surgeons prefer to use SDD over SPD. We aim to assess the latest evidence on the use of SPD compared to SDD in patients with CSDH undergoing burr hole evacuation.

METHODS

We performed a systematic literature search on topics that assesses the use of SPD compared to SDD in patients with CSDH up until November 2019 from PubMed, EuropePMC, Cochrane Central Database, ScienceDirect, ProQuest, and ClinicalTrials.gov. The primary outcome was recurrent CSDH, and the secondary outcomes were mortality, surgical morbidities, and modified Rankin Score (mRS).

RESULTS

There were a total of 3241 subjects from 10 studies. SPD was shown to reduce recurrent CSDH (OR 0.66 [0.52, 0.84], p < 0.001; I2: 17%, p = 0.30) compared to SDD. Recurrent CSDH was lower in SPD group in subgroup analysis at 3-months (OR 0.63 [0.49, 0.81]; I2: 68%, p = 0.04) and 6-months (OR 0.66 [0.51, 0.85], p = 0.001; I2: 77%, p = 0.01) follow-up. However, there was no difference in CSDH recurrence upon subgroup analysis of RCTs. Similar mortality was demonstrated between SPD and SDD group (p = 0.13). The occurrence of parenchymal injury/new neurological deficit was significantly lower in SPD group (OR 0.26 [0.14, 0.51], p < 0.001; I2: 49%, p = 0.08). The rate of seizure, (p = 0.57), postoperative bleeding (p = 0.29), and infection (p = 0.25) were shown to be similar in both SPD and SDD group. Overall, the rate of surgical morbidity was significantly lower in SPD group (OR 0.61 [0.44, 0.85], p = 0.003; I2: 16%, p = 0.25). mRS at the end of follow-up was similar in SPD and SDD group (p = 0.12).

CONCLUSION

SPD was associated with less CSDH recurrence, but similar rate of mortality, seizures, postoperative bleeding, and infections compared to SDD. The rate of parenchymal injury/new neurological deficit was lower in the SPD group.

Topical nitroglycerin is associated with a reduced mastectomy skin flap necrosis-systematic review and meta-analysis

INTRODUCTION

The flap necrosis rate remains high despite the advancement of technology in daily practices. Several randomized trials of topical Nitroglycerin (NTG) have shown promise in reducing flap necrosis. We aim to evaluate the efficacy and safety of topical NTG in preventing flap failure based on existing databases.

METHOD

We searched through PubMed, EuropePMC, EBSCOhost, Cochrane CENTRAL database, Clinicaltrials.gov, and hand sampling for "flap survival", "topical nitroglycerin", and "flap perfusion".

RESULTS

With a total of 6947 patients from 3 RCT and 2 retrospective cohorts, NTG was shown to prevent flap failure in mastectomy flaps by NTG with an OR 0.23 [0.10, 0.53]; p < 0.001), I2 73%. Upon sensitivity analysis to reduce heterogeneity, the OR was 0.17 [0.07, 0.40]; p < 0.001, I2 52%. Upon subgroup analysis of RCT, the OR was 0.17 [0.10, 0.30]; p < 0.001, I2 50%. Newer studies subgroup had OR 0.48 [0.33, 0.70]; p<0.001; I2 46. Upon subgroup analysis of single application only, the OR for flap necrosis was 0.36 [0.18, 0.73]; p = 0.005, I2 67% and subgroup analysis repeated application had an OR of 0.05 [0.01, 0.21]; p < 0.001, I2 14%.

CONCLUSION

Nitroglycerin seemed to be an ideal agent to increase the chance of flap survival in mastectomy flaps. It has an excellent safety profile, hence, is suitable for empiric use. More randomized controlled trials comparing different regiments and other preparations are needed to conclude whether repeated application at a low dose is most effective, and whether the success is reproducible on other types of flaps.

Clinical significance of bendopnea in heart failure-Systematic review and meta-analysis

BACKGROUND

Bendopnea is a symptom mediated by increased ventricular filling pressure during bending forward. Presence of bendopnea in patients can be easily evaluated without additional maneuver in several countries whose norms, habits, culture, and occupation relates to a higher frequency of bending forward. This information may prove valuable in routine clinical practice. We aimed to analyze the latest evidence on bendopnea in order to further define the clinical significance of this symptom.

METHODS

We performed a comprehensive search on bendopnea in heart failure from inception up until January 2019 through PubMed, EuropePMC, EBSCOhost, Cochrane Central Database, and ClinicalTrials.gov.

RESULTS

There were 283 patients (31.76%) who have bendopnea, and a total of 891 patients from six studies were included. Bendopnea was associated with the presence of dyspnea [odds ratio (OR) 69.70 (17.35-280.07); <0.001], orthopnea [OR 3.02 (2.02-4.52); <0.001], paroxysmal nocturnal dyspnea [OR 2.76 (1.76-4.32); <0.001], and abdominal fullness [OR 7.50 (4.15-13.58); <0.001]. Association with elevated jugular venous pressure was shown in two studies. New York Heart Association (NYHA) functional class IV was more prevalent in patients with bendopnea [OR 7.58 (4.35-13.22); <0.001]. Bendopnea was also associated with increased mortality [OR 2.21 (1.34-3.66); 0.002].

CONCLUSION

Bendopnea is associated with the presence of several signs and symptoms. This study also showed that bendopnea is one of the signs and symptoms of advanced heart failure associated with increased mortality. However, owing to the limited number of studies, further investigation is needed before drawing a definite conclusion.

Drug-Coated Balloon Versus Drug-Eluting Stent in Patients With Femoropopliteal Artery Disease: A Systematic Review and Meta-Analysis

OBJECTIVE

In this systematic review and meta-analysis, we aimed to compare drug-coated balloon (DCB) to drug-eluting stent (DES) in patients with femoropopliteal lesions in terms of restenosis, target lesion revascularization (TLR), and mortality.

METHODS

A comprehensive literature search was performed through PubMed, Scopus, and Embase databases. The intervention group was patients receiving percutaneous balloon angioplasty using the DCB. The control group was patients receiving percutaneous intervention using the DES. The primary outcome was restenosis, and the secondary outcomes were TLR and mortality.

RESULTS

There were 4 studies comprising 812 patients (906 lesions) included in this systematic review and meta-analysis. The rate of restenosis was .19 [.13, .26] in DCB and .24 [.20, .28] in DES. There was a trend toward lower rate of restenosis (OR .73 [.52, 1.03], P = .074; I2: 46.3%) for DCB use compared to DES use. The rate of TLR was .11 [.08, .14] in DCB and .17 [.14, .21] in DES. TLR was lower (OR .61 [.41, .92], P = .017; I2: 1.2%) in the DCB group compared to the DES group. There were no significant differences in mortality (OR 1.38 [.78, 2.44], P = .268; I2: 0%) among the two groups. Meta-regression analysis showed that the rate of restenosis in DCB in this pooled analysis was affected by sex (reference: male, coefficient -.004, P = .009), smoking (coefficient: .003, P = .010), and total occlusion (coefficient: .008, P = .004).

CONCLUSION

DCB use in patients with femoropopliteal lesion was associated with similar rate of restenosis, lower TLR, and similar mortality rate compared to DES use.

Prognostic value of fasting hyperglycemia in patients with COVID-19 - Diagnostic test accuracy meta-analysis

AIMS

This meta-analysis aimed to assess the prognostic value of fasting hyperglycemia in patients with COVID-19.

METHODS

A systematic literature search on PubMed, Embase, and Scopus were performed up until February 18, 2021. Fasting hyperglycemia was defined as fasting plasma glucose level above the reference value. The outcome of interest was poor outcome, which was a composite of mortality and severe COVID-19. The effect estimate was in odds ratio (OR).

RESULTS

There were 9045 patients from 12 studies included in this systematic review and meta-analysis. The prevalence of fasting hyperglycemia was 29%. The incidence of poor outcome was 15%. Fasting hyperglycemia was associated with poor outcome in COVID-19 (OR 4.72 [3.32, 6.72], p < 0.001; I2: 69.8%, p < 0.001). Subgroup analysis in patients without prior history of diabetes showed that fasting hyperglycemia was associated with poor outcome in COVID-19 (OR 3.387 [2.433, 4.714], p < 0.001; I2: 0, p = 0.90). Fasting hyperglycemia has a sensitivity of 0.57 [0.45, 0.68], specificity of 0.78 [0.70, 0.84], PLR of 2.6 [2.0, 3.3], NLR of 0.55 [0.44, 0.69], DOR of 5 [3, 7], and AUC of 0.74 [0.70, 0.78] for predicting poor outcome. In this pooled analysis, fasting hyperglycemia has a 32% post-test probability for poor outcome, and absence of fasting hyperglycemia confers to a 9% post-test probability. Meta-regression and subgroup analysis showed that the sensitivity and specificity varies by chronic kidney disease but not by age, male (gender), hypertension, and chronic kidney disease.

CONCLUSION

Fasting hyperglycemia was associated with mortality in COVID-19 patients, with or without diabetes.

PROSPERO

CRD42021237997.

The Role of MicroRNA in Contrast-Induced Nephropathy: A Scoping Review and Meta-Analysis

OBJECTIVE

Early diagnosis of contrast-induced nephropathy (CIN) remains crucial for successful treatment; unfortunately, the widely used serum creatinine is elevated only in the late stage of CIN. The circulating microRNAs (miRNAs) are stable biomarker that might be useful. The aim of this scoping review and meta-analysis is to assess the role of miRNAs in CIN.

METHODS

We performed a systematic literature search on topics that assess the role of miRNAs in CIN from several electronic databases.

RESULTS

There were 6 preclinical studies and 2 of them validated their findings in human. Only miR-30a, miR-30c, miR-30e, and miR-188 have been validated in human models. Meta-analysis showed that increase in miR-30a expression was associated with higher incidence of CIN (OR 4.48 [1.52, 13.26],  p = 0.007; I 2: 94%, p < 0.001). An increase in miR-30e expression was associated with higher incidence of CIN (OR 2.34 [1.70, 3.20], p < 0.001; I 2: 0%, p = 0.76). There is an indication that miR-188 is associated with contrast-induced apoptosis and might potentially be a drug target in the future.

CONCLUSION

This study highlighted the importance of certain miRNAs in CIN pathophysiology. Future researches should explore on the prognostic and therapeutic implication of miRNA in CIN.

A Systematic Review of Jailed Balloon Technique for Coronary Bifurcation Lesion: Conventional-Jailed Balloon Technique vs Modified-Jailed Balloon Technique

BACKGROUND

In this systematic review, we aim to evaluate the latest evidence on the efficacy and safety of conventional jailed balloon technique and modified jailed balloon technique for bifurcation lesion, and also whether the former or latter is more effective for preventing side branch occlusion during main branch stenting in bifurcation lesions.

METHODS

We performed comprehensive search on studies assessing the efficacy and safety of conventional jailed balloon and modified jailed balloon technique for bifurcation lesion from several electronic databases.

RESULTS

There were 908 patients from six studies comprising of 615 in conventional jailed balloon technique group and 293 in modified jailed balloon technique group. Side branch loss was lower in modified jailed balloon technique group, however, the proportion of lesions with TIMI flow <3 in the final percutaneous coronary intervention result was somewhat higher in the modified jailed balloon technique group. The efficacy issue regarding side branch dissection was reported as high as 3.4%, especially at proximal stent edge in conventional jailed balloon technique group, but not quantitatively described in the modified jailed balloon technique group. Zero percent major adverse cardiovascular events at 9-12 months follow up was demonstrated in modified jailed balloon technique group, and 1-5% in the conventional jailed balloon group at a longer observation period up to 2.7 years.

CONCLUSION

Our study showed that modified jailed balloon technique is potentially better compared to conventional jailed balloon in terms of side branch loss, dissection, and major adverse cardiovascular events. Further controlled studies are warranted for definite conclusion.

Repurposing FIB-4 index as a predictor of mortality in patients with hematological malignancies and COVID-19

BACKGROUND

In this study, we aimed to investigate whether FIB-4 index is useful in predicting mortality in patients with concurrent hematological malignancies and COVID-19. We also aimed to determine the optimal cut-off point for the prediction.

METHODS

This is a single-center retrospective cohort study conducted in Dharmais National Cancer Hospital, Indonesia. Consecutive sampling of adults with hematological malignancies and COVID-19 was performed between May 2020 and January 2021. COVID-19 screening test using the reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal samples were performed prior to hospitalization for chemotherapy. FIB-4 index is derived from [age (years) × AST (IU/L)]/[platelet count (109/L) × √ALT (U/L)]. The primary outcome of this study is mortality, defined as clinically validated death/non-survivor during a 3-months (90 days) follow-up.

RESULTS

There were a total of 70 patients with hematological malignancies and COVID-19 in this study. Median FIB-4 Index was higher in non-survivors (13.1 vs 1.02, p<0.001). FIB-4 index above 3.85 has a sensitivity of 79%, specificity of 84%, PLR of 5.27, and NLR of 0.32. The AUC was 0.849 95% CI 0.735-0.962, p<0.001. This cut-off point was associated with OR of 16.70 95% CI 4.07-66.67, p<0.001. In this study, a FIB-4 >3.85 confers to 80% posterior probability of mortality and FIB-4 <3.85 to 19% probability. FIB-4 >3.85 was associated with shorter time-to-mortality (HR 9.10 95% CI 2.99-27.65, p<0.001). Multivariate analysis indicated that FIB-4 >3.85 (HR 4.09 95% CI 1.32-12.70, p = 0.015) and CRP> 71.57 mg/L (HR 3.36 95% CI 1.08-10.50, p = 0.037) were independently associated with shorter time-to-mortality.

CONCLUSION

This study indicates that a FIB-4 index >3.85 was independent predictor of mortality in patients with hematological malignancies and COVID-19 infection.

Infective endocarditis due to Burkholderia cepacia in a neonate: a case report

BACKGROUND

Burkholderia is a pathogen that is rarely seen in clinical cases. However, this organism is being found more commonly in hospitals.

CASE PRESENTATION

A female Indonesian newborn was referred to our neonatal intensive care unit because of respiratory distress. The newborn had been delivered the previous night via cesarean section. A physical examination revealed intercostal retractions and weak cry. The newborn's gestational history was preterm, small for gestational age, and preterm premature ruptured membrane for 14 hours. Continuous positive airway pressure was administered. A multiple-antibiotic regimen consisting of ampicillin-sulbactam, gentamicin, meropenem, and ceftriaxone was initiated. Insertion of a central catheter was performed. The patient's laboratory results were low blood albumin and globulin, anemia, and leukopenia. A blood culture revealed Burkholderia cepacia that was resistant to multiple antimicrobial agents. A chest x-ray showed infiltrate on both lung fields. Echocardiography showed two vegetations on the tricuspid valve.

CONCLUSIONS

B. cepacia is a rare cause of infective endocarditis. With its capability to colonize water and grow on microbicides, the presence of B. cepacia in a patient's blood warrants further investigation in institutions providing care. This might not be the first publication on this topic.

Direct Acting Oral Anticoagulant vs. Warfarin in the Prevention of Thromboembolism in Patients With Non-valvular Atrial Fibrillation With Valvular Heart Disease-A Systematic Review and Meta-Analysis

Purpose: There is uncertainty as to which anticoagulant should be used in non-valvular atrial fibrillation (AF) with valvular heart disease. This systematic review and meta-analysis aimed to assess the efficacy and safety of direct-acting oral anticoagulants (DOACs) compared with warfarin in patients with non-valvular AF with valvular heart disease. Methods: We performed a comprehensive literature search using PubMed, Scopus, Embase, and Clinicaltrials.gov from the inception of databases up until August 2, 2021, and the search was updated and finalized on October 17, 2021. The intervention group was DOACs and the control group was warfarin. The primary outcome was systemic embolism and stroke (SSE), and the secondary outcome was major bleeding and intracranial hemorrhage. The pooled effect estimate was reported as the hazard ratio (HR) and odds ratio (OR). Results: There were 21,185 patients from seven studies included in this systematic review and meta-analysis. Stroke and systemic embolism were lower in patients receiving DOACs [HR 0.76 (95% CI 0.67, 0.87), p < 0.001; I2: 5%] compared with warfarin. The subgroup analysis on RCTs showed the significant reduction of SSE in the DOACs group [HR 0.73 (95% CI 0.60, 0.89), p = 0.002; I2: 16%]. There was no significant difference in terms of major bleeding [HR 0.89 (95% CI 0.75, 1.05), p = 0.18; I2: 69%]. Intracranial hemorrhage [HR 0.42 (95% CI 0.22, 0.80), p = 0.008; I2: 73%] were lower in the DOAC group. Conclusion: This meta-analysis indicates that DOACs were associated with a lower risk of SSE and intracranial hemorrhage compared with patients receiving warfarin. There was no significant difference between the two groups in terms of major bleeding.