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Alharbi A, Shah M, Gupta M, Rejent K, Mahmoud M, Alsughayer A, Alryheal A, Sayeh W, Siddiqi R, Jabr A, Kwak ES, Khuder S, Assaly R, Grubb B. The efficacy of non-pharmacological and non-pacing therapies in preventing vasovagal syncope: Tilt training, physical counter pressure maneuvers, and yoga - A systematic review and meta-analysis. Auton Neurosci 2024; 251:103144. [PMID: 38181551 DOI: 10.1016/j.autneu.2023.103144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Vasovagal syncope (VVS) is a prevalent condition characterized by a sudden drop in blood pressure and heart rate, leading to a brief loss of consciousness and postural control. Recurrent episodes of VVS significantly impact the quality of life and are a common reason for emergency department visits. Non-pharmacological interventions, such as tilt training, physical counter pressure maneuvers, and yoga, have been proposed as potential treatments for VVS. However, their efficacy in preventing VVS remains uncertain. METHODS A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched up to March 2023 for randomized controlled trials comparing non-pharmacological interventions with control in preventing VVS recurrence. The primary outcome was the recurrence rate of VVS episodes. RESULTS A total of 1130 participants from 18 studies were included in the meta-analysis. The overall mean effect size for non-pharmacological interventions versus control was 0.245 (95 % CI: 0.128-0.471, p-value <0.001). Subgroup analysis showed that yoga had the largest effect size (odds ratio 0.068, 95 % CI: 0.018-0.250), while tilt training had the lowest effect size (odds ratio 0.402, 95 % CI: 0.171-0.946) compared to control. Physical counter pressure maneuvers demonstrated an odds ratio of 0.294 (95 % CI: 0.165-0.524) compared to control. CONCLUSION Non-pharmacological interventions show promise in preventing recurrent VVS episodes. Yoga, physical counter pressure maneuvers, and tilt training can be considered as viable treatment options. Further research, including randomized studies comparing pharmacological and non-pharmacological approaches, is needed to evaluate the safety and efficacy of these interventions for VVS treatment.
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Affiliation(s)
| | - Momin Shah
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Monik Gupta
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Kassidy Rejent
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Mona Mahmoud
- Division of Cardiology, Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Anas Alsughayer
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ahmad Alryheal
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Wasef Sayeh
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Rabbia Siddiqi
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Abed Jabr
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Eun Seo Kwak
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Sadik Khuder
- Department of Medicine and Public Health, University of Toledo Medical Center, OH, USA
| | - Ragheb Assaly
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA; Pulmonary and Critical Care Medicine, University of Toledo, Toledo, OH, USA
| | - Blair Grubb
- Division of Cardiology, Department of Medicine, University of Toledo, Toledo, OH, USA
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Alharbi A, Mhanna M, Alyosif M, Pena C, Jabr A, Alsughayer A, Alfatlawi H, Safi M, Aldhafeeri A, Patel N, Khuder S, Eltahawy E. Safety and Efficacy of Direct Oral Anticoagulant in Addition to Antiplatelet Therapy After Acute Coronary Syndrome: A Systemic Review and Meta-analysis of 53,869 Patients. Clin Ther 2024; 46:e1-e6. [PMID: 37880055 DOI: 10.1016/j.clinthera.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/17/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Significant progress has been made in the management of patients with acute coronary syndrome (ACS) during the past few decades. However, the role of direct oral anticoagulants (DOACs) in post-ACS prophylactic therapy remains unknown. This study aims to assess the efficacy and safety of DOACs plus antiplatelet treatment (APT) after ACS. METHODS A systematic literature search was conducted to identify randomized clinical trials comparing DOACs plus APT with APT alone after ACS. The primary efficacy end points were cardiovascular mortality, myocardial infarction, all-cause mortality, and stroke and systemic embolization (SSE). The primary safety end point was major bleeding. The random-effects model was used to calculate relative risk (RR) and corresponding 95% CIs. RESULTS Nine trials with a total of 53,869 patients were identified, with 33,011 (61.2%) in the DOACs plus APT group and 20,858 (38.8%) in the APT alone group. The use of DOACs did not decrease the risk of cardiovascular death (RR = 0.87; 95% CI, 0.75-1.01; P = 0.08; I2 = 0%) or myocardial infarction (RR = 0.90; 95% CI, 0.80-1.02; P = 0.10; I2 = 6%). However, the risk of SSE was significantly lower in patients who received DOACs plus APT compared with APT alone (RR = 0.67; 95% CI, 0.50-0.90; P = 0.008). Moreover, all-cause mortality was significantly lower in the DOACs plus APT group (RR = 0.83; 95% CI, 0.71-98; P = 0.03; I2 = 0%). However, the risk of major bleeding was significantly higher in patients treated with DOACs plus APT compared with APT alone (RR = 2.53; 95% CI, 1.96-3.26; P < 0.01; I2 = 0%), as was the risk of nonmajor bleeding (RR = 2.27; 95% CI, 1.51-3.41; P < 0.01). IMPLICATIONS DOACs plus APT for the prevention of left ventricular thrombus in patients with ACS were associated with a lower risk of SSE and all-cause mortality but increased the risk of major and nonmajor bleeding. The benefits and risks of this approach should be weighed based on a patient's individual clinical characteristics.
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Affiliation(s)
- Abdulmajeed Alharbi
- Department of Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio.
| | - Mohammed Mhanna
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, Iowa
| | - Mohammed Alyosif
- Department of Cardiology, University of Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Clarissa Pena
- Department of Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Abed Jabr
- Department of Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Anas Alsughayer
- Department of Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Halah Alfatlawi
- Department of Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Mohammad Safi
- Department of Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Abdulaziz Aldhafeeri
- Department of Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Neha Patel
- Department of Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Sadik Khuder
- Department of Medicine, Statistics, and Public Health, College of Medicine and Life Sciences, The University of Toledo, Toledo, Ohio
| | - Ehab Eltahawy
- Department of Cardiology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
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Sattar Y, Ahmad B, Suleiman AR, Aamir M, Jabr A, Zaher N, Zghouzi M, Zafrullah F, Ullah W, Alraies MC. COMPARISON OF LEFT ATRIAL APPENDAGE SIZE USING COMPUTED TOMOGRAPHY VS. TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR WATCHMAN DEVICE IMPLANTATION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02807-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dasouki M, Jabr A, AlDakheel G, Elbadaoui F, Alazami AM, Al-Saud B, Arnaout R, Aldhekri H, Alotaibi I, Al-Mousa H, Hawwari A. TREC and KREC profiling as a representative of thymus and bone marrow output in patients with various inborn errors of immunity. Clin Exp Immunol 2020; 202:60-71. [PMID: 32691468 DOI: 10.1111/cei.13484] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/13/2022] Open
Abstract
Primary immune deficiency (PID) disorders are clinically and molecularly heterogeneous diseases. T cell receptor excision circles (TRECs) and κ (kappa)-deleting excision circles (KRECs) are markers of T and B cell development, respectively. They are useful tools to assess T and B cell function and immune reconstitution and have been used for newborn screening for severe combined immunodeficiency disease (SCID) and agammaglobulinemia, respectively. Their profiles in several genetically confirmed PIDs are still lacking. The objective of this study was to determine TREC and KREC genomic profiling among various molecularly confirmed PIDs. We used real-time-quantitative polymerase chain reaction (RT-qPCR)-based triplex analysis of TRECs, KRECs and β-actin (ACTB) in whole blood genomic DNA isolated from 108 patients with molecularly confirmed PIDs. All agammaglobulinemia patients had low KREC counts. All SCIDs and Omenn syndrome patients secondary to mutations in RAG1, RAG2, DCLRE1C and NHEJ1 had low TREC and KREC counts. JAK3-deficient patients had normal KREC and the TREC count was influenced by the type of mutation. Early-onset ADA patients had low TREC and KREC counts. Four patients with zeta-chain-associated protein kinase 70 (ZAP70) had low TREC. All purine nucleoside phosphorylase (PNP) patients had low TREC. Combined immunodeficiency (CID) patients secondary to AK2, PTPRC, CD247, DCLREC1 and STAT1 had normal TREC and KREC counts. Most patients with ataxia-telangiectasia (AT) patients had low TREC and KREC, while most DOCK8-deficient patients had low TRECs only. Two of five patients with Wiskott-Aldrich syndrome (WAS) had low TREC counts as well as one patient each with bare lymphocyte syndrome (BLS) and chronic granulomatous disease. All patients with Griscelli disease, Chediak-Higashi syndrome, hyper-immunoglobulin (Ig)M syndrome and IFNGR2 had normal TREC and KREC counts. These data suggest that, in addition to classical SCID and agammaglobulinemia, TREC/KREC assay may identify ZAP70 patients and secondary target PIDs, including dedicator of cytokinesis 8 (DOCK8) deficiency, AT and some individuals with WAS and BLS.
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Affiliation(s)
- M Dasouki
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - A Jabr
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - G AlDakheel
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - F Elbadaoui
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - A M Alazami
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - B Al-Saud
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - R Arnaout
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - H Aldhekri
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - I Alotaibi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - H Al-Mousa
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - A Hawwari
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City Hospital, Ministry of National Guard Health Affairs, Al-Ahsa, Saudi Arabia
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