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Alhadeethi A, Adel Awwad S, Abed M, Amin AM, Aboelkhier MM, Yassin MNA, Morsi MH, Kashbour MO. Nintedanib in Combination With Chemotherapy in the Treatment of Non-small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e53812. [PMID: 38465177 PMCID: PMC10924634 DOI: 10.7759/cureus.53812] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Lung cancer remains a major global health challenge, contributing to substantial morbidity and mortality rates. Nintedanib, a tyrosine kinase inhibitor, has demonstrated potential as a treatment for lung cancer. We aim to evaluate nintedanib's efficacy in treating patients with non-small cell lung cancer (NSCLC), depending on the available evidence. Our search for relevant articles was conducted on PubMed, Cochrane Library, Scopus, and Web of Science for randomized controlled trials (RCTs) that involved adult patients with NSCLC up to August 15, 2023. These trials compared the combination of nintedanib and chemotherapy to either placebo plus chemotherapy or chemotherapy alone. Our main outcomes include progression-free survival (PFS) and overall survival (OS). We utilized the Review Manager Software V.5.4 (The Cochrane Collaboration) to analyze all relevant data. Three identified trials, which included 2270 patients, fulfilled the inclusion criteria. Our analysis showed significantly improved PFS (hazard ratio (HR) = 0.79; 95% confidence interval (CI) 0.71-0.88, P < 0.0001) in patients receiving nintedanib compared to placebo. However, OS was not statistically significant (HR = 0.96; 95% CI 0.88-1.05, P = 0.35). In conclusion, a combination of nintedanib and chemotherapy in treating patients with NSCLC was associated with improved PFS than chemotherapy alone but not with improved OS. Further clinical trials assessing nintedanib in the setting of NSCLC are necessary before any further recommendations can be made.
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Affiliation(s)
- Abdulhameed Alhadeethi
- Department of General Medicine, Medical Research Group of Egypt, Negida Academy LCC, Arlington, USA
- Department of General Medicine, Al-Salam Teaching Hospital, Mosul, IRQ
| | - Sara Adel Awwad
- College of Medicine, Jordan University of Science and Technology, Irbid, JOR
| | - Mohamed Abed
- Department of Internal Medicine, Faculty of Medicine, University of Tripoli, Tripoli, LBY
| | - Ahmed Mostafa Amin
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Menna M Aboelkhier
- Department of Internal Medicine, Faculty of Science, Cairo University, Cairo, EGY
| | | | - Maha H Morsi
- Department of Oncology, Medical Research Group of Egypt, Negida Academy LLC, Arlington, USA
- Department of Chemical Pathology, Misr University for Science and Technology, Giza, EGY
| | - Muataz Omar Kashbour
- Department of Diagnostic Radiology, National Cancer Institute, Misrata, LBY
- Department of Radiology, Medical Research Group of Libya, Negida Research Academy, Arlington, USA
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Elkasaby MH, Khalefa BB, Yassin MNA, El-Hameed MMA, Elkoumi O, Al Hennawi H. Two-incision versus three-incision implantation technique of subcutaneous implantable cardioverter defibrillator: Systematic review and meta-analysis of 2076 patients. Pacing Clin Electrophysiol 2024; 47:281-291. [PMID: 38071455 DOI: 10.1111/pace.14902] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 02/15/2024]
Abstract
INTRODUCTION The implantable cardioverter-defibrillator (ICD) was designed to detect and treat ventricular arrhythmias, which account for nearly half of all cardiovascular fatalities. Transvenous ICD (TV-ICD) complications were reduced by introducing subcutaneous ICD (S-ICD). S-ICD can be implanted using a three (3IT)- or two (2IT)-incision technique. This systematic review and meta-analysis was conducted to compare the 3IT to the 2IT. METHODS We searched medical electronic databases of Cochrane Central, Embase, PubMed, Scopus, and Web of Science (WOS) from the study's inception until March 8, 2023. We compared 2IT and 3IT techniques of S-ICDs in terms of procedural, safety, and efficacy outcomes. We used Review Manager software for the statistical analysis. We calculated the risk ratio (RR) with its 95% confidence interval (CI) for dichotomous variables; and the mean difference with its 95% CI for continuous variables. We measured the heterogeneity using the chi-squared and I-squared tests. If the data were heterogeneous, the random-effect (RE) model was applied; otherwise, the fixed-effect model (FE) was used. RESULTS We included three retrospective observational studies of 2076 patients, 1209 in the 2IT group and 867 in the 3IT. There was no statistically significant difference in erosion after S-ICD when 2IT compared with 3IT (RR = 0.27, 95% CI: [0.07, 1.02]; P = .05) (I2 = 0%, P = .90). There was no difference in risk of infection, lead dislocation, or inappropriate shock with either incision technique (RR = 0.78, 95% CI: [0.48, 1.29]; P = .34) (I2 = 0%, P = .71) and (RR = 0.37, 95% CI: [0.02, 8.14]; P = .53) (I2 = 66%, P = .05) respectively. Our meta-analysis showed that the efficacy of both techniques is comparable; Appropriate shock (RR = 0.94, 95% CI: [0.78, 1.12]; P = .48) (I2 = 0%, P = .81) and first shock efficacy (RR = 0.89, 95% CI: [0.44, 1.82]; P = .76) (I2 = 0%, P = .87). CONCLUSION 2IT and 3IT of S-ICD have comparable efficacy and complication rates; however, the 3IT exposes patients to an additional incision without any additional benefits. These findings may provide clinicians with a simpler method for subcutaneous ICD implantation and likely result in improved cosmetic outcomes. Before the 2IT technique can be considered the standard of care, randomized controlled trials (RCTs) must be conducted to assess its long-term safety and efficacy.
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Affiliation(s)
- Mohamed Hamouda Elkasaby
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Medical Research Group of Egypt (MRGE), Arlington, Massachusetts, USA
| | - Basma Badrawy Khalefa
- Medical Research Group of Egypt (MRGE), Arlington, Massachusetts, USA
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mazen Negmeldin Aly Yassin
- Medical Research Group of Egypt (MRGE), Arlington, Massachusetts, USA
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Malak Mohamed Abd El-Hameed
- Medical Research Group of Egypt (MRGE), Arlington, Massachusetts, USA
- Faculty of Medicine, Zagazig University, Al-Sharqia, Egypt
| | - Omar Elkoumi
- Medical Research Group of Egypt (MRGE), Arlington, Massachusetts, USA
- Faculty of Medicine, Suez University, Suez, Egypt
| | - Hussam Al Hennawi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, Pennsylvania, USA
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Elkasaby MH, Khalefa BB, Yassin MNA, Alabdallat YJ, Atia A, Altobaishat O, Omar I, Hussein A. Transcatheter aortic valve implantation versus surgical aortic valve replacement for pure aortic regurgitation: a systematic review and meta-analysis of 33,484 patients. BMC Cardiovasc Disord 2024; 24:65. [PMID: 38262990 PMCID: PMC10804466 DOI: 10.1186/s12872-023-03667-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/09/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION The published studies comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in pure aortic regurgitation (AR) are conflicting. We conducted this systematic review and meta-analysis to compare TAVI with SAVR in pure AR. METHODS We searched PubMed, Embase, Web of Science (WOS), Scopus, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) from inception until 23 June 2023. Review Manager was used for statistical analysis. The risk ratio (RR) with a 95% confidence interval (CI) was used to compare dichotomous outcomes. Continuous outcomes were compared using the mean difference (MD) and 95% CI. The inconsistency test (I2) assessed the heterogeneity. We used the Newcastle-Ottawa scale to assess the quality of included studies. We evaluated the strength of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scale. RESULTS We included six studies with 5633 patients in the TAVI group and 27,851 in SAVR. In-hospital mortality was comparable between TAVI and SAVR (RR = 0.89, 95% CI [0.56, 1.42], P = 0.63) (I2 = 86%, P < 0.001). TAVI was favored over SAVR regarding in-hospital stroke (RR = 0.50; 95% CI [0.39, 0.66], P < 0.001) (I2 = 11%, P = 0.34), in-hospital acute kidney injury (RR = 0.56; 95% CI: [0.41, 0.76], P < 0.001) (I2 = 91%, P < 0.001), major bleeding (RR = 0.23; 95% CI: [0.17, 0.32], P < 0.001) (I2 = 78%, P < 0.001), and shorter hospital say (MD = - 4.76 days; 95% CI: [- 5.27, - 4.25], P < 0.001) (I2 = 88%, P < 0.001). In contrast, TAVI was associated with a higher rate of pacemaker implantation (RR = 1.68; 95% CI: [1.50, 1.88], P < 0.001) (I2 = 0% P = 0.83). CONCLUSION TAVI reduces in-hospital stroke and is associated with better safety outcomes than SAVR in patients with pure AR.
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Affiliation(s)
- Mohamed Hamouda Elkasaby
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
- Medical Research Group of Egypt (MRGE), Cairo, Egypt.
| | - Basma Badrawy Khalefa
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Mazen Negmeldin Aly Yassin
- Faculty of Medicine, Helwan University, Cairo, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Yasmeen Jamal Alabdallat
- Faculty of Medicine, Hashemite University, Zarqa, Jordan
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Ahmed Atia
- Faculty of Medicine, Cairo University, Cairo, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Obieda Altobaishat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Islam Omar
- Faculty of Pharmacy, South Valley University, Qena, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Amany Hussein
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
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Sharapi M, Afifi E, Al Mawla AM, Yassin MNA, Awwad SA, El-Samahy M. Ultrasound-based Accuro system versus traditional palpation technique for neuraxial anaesthesia: A systematic review and meta-analysis of randomised controlled trials. J Perioper Pract 2023:17504589231215927. [PMID: 38149589 DOI: 10.1177/17504589231215927] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
INTRODUCTION This review evaluates the efficacy and safety of Accuro, a handheld ultrasound device, compared to the palpation technique for neuraxial anaesthesia. Accuro provides real-time imaging guidance, potentially improving accuracy and efficiency. METHODS A comprehensive search across six electronic databases identified randomised clinical trials comparing Accuro with palpation for neuraxial anaesthesia. Risk ratios or mean differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Bias risk was evaluated using the Cochrane Risk of Bias tool. RESULTS Five studies (n=369) met the inclusion criteria. Accuro showed a favourable risk ratio for first insertion success (1.44 [95% CI [1.01, 2.05], p=0.05]). It significantly reduced needle skin passes (MD -0.63; 95% CI [-1.05, -0.21]; p<0.01), but not needle redirection (MD -1.31; 95% CI [-2.71, 0.11]; p=0.07). Procedure time was shorter in palpation (MD 127.82; 95% CI [8.68, -246.97]; p=0.04). Four studies had a low risk of bias; one had some concerns. CONCLUSION Accuro can potentially improve success rates and reduce skin passes in neuraxial anaesthesia. Further trials with larger samples are needed, especially in patients with anticipated difficulties.
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Affiliation(s)
| | - Eslam Afifi
- Faculty of Medicine, Benha University, Benha, Egypt
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