Nevin Manimala

Eur J Gastroenterol Hepatol. 2024 Jul 2. doi: 10.1097/MEG.0000000000002817. Online ahead of print.

ABSTRACT

Ustekinumab and vedolizumab are key treatment options for Crohn’s disease patients who fail anti-tumor necrosis factor (TNF) therapy. This updated meta-analysis aims to compare the efficacy and safety of these two drugs. We performed a systematic review in PubMed, Embase, and Cochrane databases searching for randomized and nonrandomized studies comparing vedolizumab versus ustekinumab in patients with Crohn’s disease with previous anti-TNF failure or intolerance. The primary outcome was steroid-free clinical remission (SFR) at the pos-induction (12-16 weeks) and maintenance period (48-52 weeks). The odds ratio (OR) was used for binary outcomes with their respective 95% confidence interval (CI). Heterogeneity was assessed using the Cochran Q test and I2 statistics. This meta-analysis included 11 studies and 2724 patients. There was a significant difference favoring ustekinumab in SFR at pos-induction (OR, 1.44; 95% CI, 1.11-1.88; P = 0.006; I2 = 27%) and maintenance periods (OR, 1.86; 95% CI, 1.23-2.82; P = 0.003; I2 = 80%), in clinical remission at pos-induction period (OR, 2.04; 95% CI, 1.58-2.63; P < 0.001; I2 = 3%), and in treatment discontinuation due to adverse events (OR, 0.31; 95% CI, 0.16-0.60; P < 0.001; I2 = 0%). In patients with Crohn’s disease with prior anti-TNF failure, ustekinumab showed higher SFR during both the pos-induction and maintenance period and a lower rate of treatment discontinuation due to adverse events.

PMID:38973525 | DOI:10.1097/MEG.0000000000002817

Eur J Gastroenterol Hepatol. 2024 Jul 2. doi: 10.1097/MEG.0000000000002820. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with cirrhosis commonly undergo endoscopic cyanoacrylate injection for gastric and esophageal variceal bleeding. However, postoperative infections can increase the risk of rebleeding and mortality.

AIM: This study aimed to determine the risk of postoperative infections and its associated factors following cyanoacrylate injection treatment in these patients.

METHODS: A retrospective analysis was conducted on 57 patients treated with ligation (ligation group), 66 patients treated with cyanoacrylate injection (injection group), and 91 patients treated with conservative treatment (control group) at the Nanchong Central Hospital.

RESULTS: The rate of postoperative infection was similar among the cyanoacrylate, ligation, and conservative treatment groups, with no significant statistical difference observed (P = 0.97). Multivariate analysis identified postoperative Child-Pugh score and renal insufficiency as two independent risk factors for postoperative infection. The rebleeding rate in the injection group was significantly lower than in the other groups (P = 0.01). Mortality was significantly higher in the control group compared with the ligation and injection groups (P = 0.01).

CONCLUSION: Cyanoacrylate combined with lauromacrogol injection did not significantly increase the risk of infection compared with ligation and conservative treatments, and it was more effective in reducing the risk of rebleeding. This method is safe, effective, and holds clinical value for broader application.

PMID:38973513 | DOI:10.1097/MEG.0000000000002820

Strabismus. 2024 Jul 8:1-9. doi: 10.1080/09273972.2024.2368703. Online ahead of print.

ABSTRACT

Introduction: Postoperative agitation is a common complication of sevoflurane anesthesia in children and might lead to self-harm and recovery disruption. This study aimed to compare the prophylactic effect of dexmedetomidine and remifentanil on postoperative agitation after anesthesia with sevoflurane. Methods: In this clinical trial, 60 children aged 2 to 7 years with ASA class І, II, candidates for elective strabismus surgery, were randomly assigned to three groups using block randomization. Patients in the first group D received 0.5 µgr/kg dexmedetomidine, the second group R received 0.1 µgr/kg remifentanil, and another group C received normal saline at the end of anesthesia. Children’s agitation degree was measured by the Pediatric Anesthesia Emergence Delirium (PAED) scales and the 4-point agitation scale at the time of extubation, entering the recovery room, 10, 20, and 30 minutes after entrance. Data analysis was performed using descriptive and inferential statistical tests. Results: The postoperative agitation and pain were significantly lower among children who received dexmedetomidine compared with those in remifentanil and the control group (p < .001). It was observed that the administration of dexmedetomidine at the end of anesthesia significantly decreased the incidence of postoperative agitation (p < .001). None of the patients in group D had a PAED score of over 12. Conclusion: Based on PAED and the 4-point scales, none of the cases in group D had experienced postoperative agitation; this made a significant statistical difference compared with groups C and R (p-value <. 001). Although both dexmedetomidine and remifentanil can prevent and attenuate postoperative agitation, dexmedetomidine administration seems significantly more effective.

PMID:38973503 | DOI:10.1080/09273972.2024.2368703

Circulation. 2024 Jul 8. doi: 10.1161/CIRCULATIONAHA.124.069006. Online ahead of print.

ABSTRACT

BACKGROUND: A dual-chamber leadless pacemaker system has been designed for AV synchronous pacing using wireless, beat-to-beat, implant-to-implant (i2i) communication between distinct atrial and ventricular leadless pacemakers. The AV synchrony achieved across various ambulatory scenarios has yet to be systematically evaluated.

METHODS: A prospective, single-arm, unblinded, multicenter, international clinical trial of the leadless pacemaker system was conducted in patients with a conventional dual-chamber pacing indication enrolled from February 2022 to March 2023. Leadless pacemaker systems were implanted, and 12-lead Holter electrocardiographic recordings were collected 3 months after implantation over various postures/activities: sitting, supine, left lateral recumbent, right lateral recumbent, standing, normal walk, and fast walk. An independent Holter core laboratory performed a manual adjudication of the percent of AV synchronous beats using the standard 300-millisecond PR interval limit. Atrium-to-ventricle and ventricle-to-atrium i2i communication success rates were also assessed. Post hoc summary statistics describing the relationships between AV synchrony and i2i success, posture/activity, implantation indication, AV event, and heart rate were calculated.

RESULTS: In the evaluable population (n=384 of 464 enrolled [83%]; 61% male; age, 70 years; weight, 82 kg; 60% ejection fraction; 95% of beats evaluable), the mean AV synchrony of 98% of beats observed across all postures using the standard 300-millisecond limit was greater than both atrium-to-ventricle i2i (94%) and ventricle-to-atrium i2i (94%; P<0.001), exceeding both i2i values in 95% of patients. AV synchrony was achieved in >95% of evaluable beats across all postures/activities, implantation indications, AV paced/sensed event combinations, and heart rate ranges (including >100 bpm).

CONCLUSIONS: This dual-chamber leadless pacemaker system demonstrated AV synchrony in 98% of evaluable beats at 3 months after implantation. AV synchrony was maintained across postures/activities and remained robust for heart rates >100 bpm.

PMID:38973458 | DOI:10.1161/CIRCULATIONAHA.124.069006

Kardiol Pol. 2024 Jul 8. doi: 10.33963/v.phj.101280. Online ahead of print.

NO ABSTRACT

PMID:38973436 | DOI:10.33963/v.phj.101280

Pharmacoepidemiol Drug Saf. 2024 Jul;33(7):e5853. doi: 10.1002/pds.5853.

ABSTRACT

BACKGROUND: Adverse drug events (ADEs) are a frequent cause of injury in patients. Our aim was to assess whether pharmacist interventions compared with no pharmacist intervention results in reduced ADEs and potential adverse drug events (PADEs).

METHODS: We searched MEDLINE, Embase, and two other databases through September 19, 2022 for any RCT assessing the effect of a pharmacist intervention compared with no pharmacist intervention and reporting on ADEs or PADEs. The risk of bias was assessed using the Cochrane tool for RCTs. A random-effects model was used to pool summary results from individual RCTs.

RESULTS: Fifteen RCTs met the inclusion criteria. The pooled results showed a statistically significant reduction in ADE associated with pharmacist intervention compared with no pharmacist intervention (RR = 0.86; [95% CI 0.80-0.94]; p = 0.0005) but not for PADEs (RR = 0.79; [95% CI 0.47-1.32]; p = 0.37). The heterogeneity was insignificant (I² = 0%) for ADEs and substantial (I² = 77%) for PADEs. Patients receiving a pharmacist intervention were 14% less likely for ADE than those who did not receive a pharmacist intervention. The estimated number of patients needed to prevent one ADE across all patient locations was 33.

CONCLUSIONS: To our knowledge, this is the first systematic review and meta-analysis of RCTs seeking to understand the association of pharmacist interventions with ADEs and PADEs. The risk of having an ADE is reduced by a seventh for patients receiving a pharmacist care intervention versus no such intervention. The estimated number of patients needed to be followed across all patient locations to prevent one preventable ADE across all patient locations is 33.

PMID:38973415 | DOI:10.1002/pds.5853

Dtsch Arztebl Int. 2024 May 17;121(10):340-341. doi: 10.3238/arztebl.m2024.0030.

NO ABSTRACT

PMID:38973405 | DOI:10.3238/arztebl.m2024.0030

Dtsch Arztebl Int. 2024 May 17;121(10):338-339. doi: 10.3238/arztebl.m2024.0026.

NO ABSTRACT

PMID:38973404 | DOI:10.3238/arztebl.m2024.0026

Scand Cardiovasc J. 2024 Dec;58(1):2374391. doi: 10.1080/14017431.2024.2374391. Epub 2024 Jul 8.

NO ABSTRACT

PMID:38973392 | DOI:10.1080/14017431.2024.2374391

Food Funct. 2024 Jul 8. doi: 10.1039/d4fo01410c. Online ahead of print.

ABSTRACT

Currently, associations between dietary intakes of individual monounsaturated fatty acids (MUFAs) and hypertension were not well disclosed, and the interaction effects of MUFAs on their associations with hypertension were unknown. Obesity was correlated with both MUFAs and hypertension, while if anthropometric obesity indices performed mediating roles in associations between MUFAs and hypertension remained underdetermined. In our study, 8509 Chinese adults investigated from 2004 to 2011 were included. Dietary information collection and physical examinations were performed at baseline and each timepoint of follow-up. As we found, inverse associations of MUFA17, MUFA18 and MUFA20 with hypertension were statistically significant after adjustments, hazard ratios (HRs) were 0.87, 0.90 and 0.91, respectively. MUFA15 was positively associated with hypertension, with an HR of 1.07 (95% confidence interval: 1.01, 1.12). By performing principal component analysis (PCA) to estimate the joint effects of MUFAs on hypertension, the PCA score of MUFAs was only inversely associated with blood pressure. No joint effect was observed in g-computation analyses. Both linear and nonlinear interactions of MUFAs on their associations with hypertension were estimated using restricted cubic spline analysis. The association between MUFA15 and hypertension was interacted by MUFA17, and the association between MUFA20 and hypertension was interacted by MUFA18. The mediation effects of body mass index and waist circumference were found on associations of hypertension with MUFA15, MUFA17 and MUFA20. Our findings suggested that associations with hypertension were different among individual MUFAs, and mutual interactions existed, implying that the utility of individual MUFAs might be recommended for estimating relationships between MUFAs and diseases. Moreover, fat accumulation might potentially underlie associations between MUFAs and hypertension.

PMID:38973334 | DOI:10.1039/d4fo01410c