scholarly journals The haematological side effects of clozapine: literature review and meta-analysis

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S274-S274
Author(s):  
Tariq Munshi ◽  
Farooq Naeem ◽  
Mohammed Ayub ◽  
Saeed Farooq ◽  
Davit Khachatryan ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Meta Analysis ◽  
Blood Dyscrasia ◽  
Treatment Resistant ◽  
National Guidelines ◽  
True Incidence ◽  
Number Of Patients ◽  
The Impact

AimsThis review and meta-analysis aim to estimate the cumulative incidence of clozapine induced agranulocytosis and leukopenia the impact of the associated factors such as dose of clozapine, duration of follow-up, gender and race on the cumulative incidence.BackgroundClozapine is the only medication licensed for treatment-resistant schizophrenia. There has been a renewed interest in the role of Clozapine in the treatment of Schizophrenia based on strong evidence that favours its efficacy and safety. Despite the evidence that Clozapine has superior efficacy and has been recommended for treatment-resistant cases by the national guidelines, the drug is underutilised.MethodWe included all studies in which clozapine was used for a psychotic illness. We included studies which provided data on two primary indices; Leucopenia or agranulocytosis and neutropenia; defined according to the cut off used by CPMS for total WBC and neutrophil count. Additionally we included studies reporting another blood dyscrasia or death due to agranulocytosis. Studies were identified by searching AMED, BIOSIS, CINAHL, EMBASE, MEDLINE, PsycINFO, PubMed, and registries of Clinical Trials and their monthly updates, hand searches, gray literature, and conference proceedings from the first available date until 2nd February, 2015. The search was updated on 15th March, 2017. The Protocol was initiated and then registered with PROSPERO International prospective register of systematic reviews University of York, Centre for Reviews and Dissemination.ResultThe cumulative incidence of the agranulocytosis in all studies was 00.32 % (CI 00.1-0.63). The cumulative incidence in all studies for different types of blood dyscrasia were following: leucopenia 00.96 % (CI 0.39-1.70), neutropenia 2.93 % (CI 1.49-4.72), other blood dyscrasias 4.64% (CI 2.34-7.52) and any blood dyscrasia was 2.23 (CI 1.46-3.12).ConclusionThe limitations of this review are mainly due to the nature of evidence from the included studies. We adopted a broad inclusion criteria to include all the available evidence. Number of patients started on Clozapine may be withdrawn from the Clozapine on the earliest signs of blood dyscrasias since the introduction of Clozapine monitoring services. This means that the true incidence of agranulocytosis and neutropenia may be higher and this may be a major bias in finding the true incidence of Clozapine induced neutropenia.

scholarly journals P1435 The impact of intermediate wall shear strain on changes of plaque morphology in CAD: A systematic review and meta-analysis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I Bytyci ◽  
A B Artan Bajraktari ◽  
S Elezi ◽  
M Y Michael
Keyword(s):  
Shear Strain ◽  
Atherosclerotic Plaque ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Plaque Morphology ◽  
Central Registry ◽  
Wall Shear ◽  
The Impact

Abstract Background and Aim The experimental studies found that high wall shear strain (WSS) resulted in the development of more vulnerable plaque compared to low WSS. The aim of this meta-analysis is to assess the role of intermediate WSS on atherosclerotic plaque. Methods We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry from 1989 to May 2019 in order to select clinical trials and observational studies, which assessed the relationship between WSS measured by intravascular ultrasound (IVUS) and plaque morphology in CAD. Results A total of 32,083 segments were recruited in 7 studies with mean follow up 8.4 months. The pooled analysis showed that baseline low WSS is associated with similar plaque morphology to that with intermediate WSS: lumen area WMD 0.96 [-0.12 to 2.04, p = 0.08], plaque area WMD -0.43 [-0.09 to 0.13, p = 0.13], necrotic core area WMD -0.18 [-0.45 to 0.08, p = 0.18], dense calcium score WMD -0.12 [-0.26 to 0.02, p = 0.09] as well as fibrous WMD -0.35 [-0.89 to 0.19, p = 0.21] and fibro-fatty area WMD -0.05 [-0.12 to 0.02, p = 0.12]. At follow-up, the only difference found was an increase of fibrous WMD 0.08 [0.01 to 0.16, p = 0.04] and fibro-fatty area, WMD 0.07 [0.01 to 0.12, p = 0.02] in low WSS compared intermediate WSS. Conclusions Intermediate WSS group is associated with plaque features changes similar to those occurring with low WSS. This finding emphasis the role of IVUS in outcome of atherosclerotic plaque in CAD.

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value < 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P < 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P < 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P < 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

Why Do Firms Participate in Voluntary Environmental Programs? A Meta-Analysis of the Role of Institutions, Resources, and Program Stringency

2021 ◽  
pp. 108602662199006
Author(s):  
Peter Tashman ◽  
Svetlana Flankova ◽  
Marc van Essen ◽  
Valentina Marano
Keyword(s):  
Quality Management ◽  
Prior Experience ◽  
Meta Analysis ◽  
Institutional Pressures ◽  
Environmental Programs ◽  
Voluntary Environmental Programs ◽  
Management Standards ◽  
Trade Offs ◽  
The Impact

We meta-analyze research on why firms join voluntary environmental programs (VEPs) to assess the impact of program stringency, or the extent to which they have rigorous, enforceable standards on these decisions. Stringency creates trade-offs for firms by affecting programs’ effectiveness, legitimacy, and adoption costs. Most research considers singular programs and lacks cross program variation needed to analyze program stringency’s impact. Our meta-analysis addresses this by sampling 127 studies and 23 VEPs. We begin by identifying common institutional and resource-based drivers of participation in the literature, and then analyze how program stringency moderates their impacts. Our results suggest that strictly governed VEPs encourage participation among highly visible and profitable firms, and discourage it when informal institutional pressures are higher, and firms have prior experience with other VEPs or quality management standards. We demonstrate that VEP stringency has nuanced effects on firm participation based on the institutional and resource-based factors facing them.

scholarly journals The Impact of Dental Implant Length on Failure Rates: A Systematic Review and Meta-Analysis

Materials ◽  
2021 ◽  
Vol 14 (14) ◽  
pp. 3972
Author(s):  
Maha Abdel-Halim ◽  
Dalia Issa ◽  
Bruno Ramos Chrcanovic
Keyword(s):  
Treatment Plan ◽  
Meta Analysis ◽  
Implant Failure ◽  
Failure Rates ◽  
Manual Search ◽  
Short Implants ◽  
The Many ◽  
The Impact ◽  
Implant Length

The present review aimed to evaluate the impact of implant length on failure rates between short (<10 mm) and long (≥10 mm) dental implants. An electronic search was undertaken in three databases, as well as a manual search of journals. Implant failure was the outcome evaluated. Meta-analysis was performed in addition to a meta-regression in order to verify how the risk ratio (RR) was associated with the follow-up time. The review included 353 publications. Altogether, there were 25,490 short and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher failure risk than long implants (RR 2.437, p < 0.001). There was a decrease in the probability of implant failure with longer implants when implants of different length groups were compared. A sensitivity analysis, which plotted together only studies with follow-up times of 7 years or less, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up. In conclusion, short implants showed a 2.5 times higher risk of failure than long implants. Implant failure is multifactorial, and the implant length is only one of the many factors contributing to the loss of an implant. A good treatment plan and the patient’s general health should be taken into account when planning for an implant treatment.

scholarly journals Therapeutic Value of Single Nucleotide Polymorphisms on the Efficacy of New Therapies in Patients with Multiple Sclerosis

2021 ◽  
Vol 11 (5) ◽  
pp. 335
Author(s):  
María José Zarzuelo Romero ◽  
Cristina Pérez Ramírez ◽  
María Isabel Carrasco Campos ◽  
Almudena Sánchez Martín ◽  
Miguel Ángel Calleja Hernández ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Mechanism Of Action ◽  
Dimethyl Fumarate ◽  
Response To Treatment ◽  
Nucleotide Polymorphisms ◽  
New Therapies ◽  
Therapeutic Value ◽  
The Impact

The introduction of new therapies for the treatment of multiple sclerosis (MS) is a very recent phenomenon and little is known of their mechanism of action. Moreover, the response is subject to interindividual variability and may be affected by genetic factors, such as polymorphisms in the genes implicated in the pathologic environment, pharmacodynamics, and metabolism of the disease or in the mechanism of action of the medications, influencing the effectiveness of these therapies. This review evaluates the impact of pharmacogenetics on the response to treatment with new therapies in patients diagnosed with MS. The results suggest that polymorphisms detected in the GSTP1, ITGA4, NQO1, AKT1, and GP6 genes, for treatment with natalizumab, ZMIZ1, for fingolimod and dimethyl fumarate, ADA, for cladribine, and NOX3, for dimethyl fumarate, may be used in the future as predictive markers of treatment response to new therapies in MS patients. However, there are few existing studies and their samples are small, making it difficult to generalize the role of these genes in treatment with new therapies. Studies with larger sample sizes and longer follow-up are therefore needed to confirm the results of these studies.

Abstract 13315: Long-term Risk of Cardiovascular Events Following Hospitalization for Sepsis: A Systematic Review and Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Leah B Kosyakovsky ◽  
Federico Angriman ◽  
Emma Katz ◽  
Neill Adhikari ◽  
Lucas C Godoy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cumulative Incidence ◽  
Meta Analysis ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Significant Difference ◽  
Sepsis Survivors ◽  
Risk Ratios

Introduction: Sepsis results in dysregulated inflammation, coagulation, and metabolism, which may contribute to increased cardiovascular disease (CVD) risk. We conducted a systematic review and meta-analysis to determine the association between sepsis and subsequent long-term CVD events. Methods: MEDLINE, Embase, and the Cochrane Controlled Trials Register and Database of Systematic Reviews were searched from inception to May 2020 to identify observational studies of adult sepsis survivors (defined by diagnostic codes or consensus definitions) measuring long-term CV outcomes. The primary outcome was a composite of myocardial infarction, CV death, and stroke. Random-effects models estimated the pooled cumulative incidence and adjusted hazard ratios of CV events relative to hospital or population controls. Odds ratios were included as risk ratios assuming <10% incidence in non-septic controls, and risk ratios were taken as hazard ratios (HR) assuming no censoring. Outcomes were analyzed at maximum follow-up (primary analysis) and stratified by time (<1 year, 1-2 years, and >2 years) since sepsis. Results: Of 11,235 abstracts screened, 25 studies (22 cohort studies, 2 case-crossover studies, and 1 case-control) involving 1,949,793 sepsis survivors were included. The pooled cumulative incidence of CVD events was 9% (95% CI; 5-14%). Sepsis was associated with an increased risk (HR 1.59, 95% CI 1.37-1.86) of CVD events at maximum follow-up ( Figure ); between-study heterogeneity was substantial (I 2 =97.3%). There was no significant difference when comparing studies using population and hospital controls. Significantly elevated risk was observed up to 5 years following sepsis. Conclusions: Sepsis survivors experience an approximately 50% increased risk of CVD events, which may persist for years following the index episode. These results highlight a potential unmet need for early cardiac risk stratification and optimization in sepsis survivors.

scholarly journals 1178 High coronary wall shear strain developed more vulnerable plaque compared to low shear strain: a systematic review and meta-analysis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A B Bajraktari ◽  
I B Bytyci ◽  
S E Elezi ◽  
M Y H Henein
Keyword(s):  
Shear Strain ◽  
Vulnerable Plaque ◽  
Meta Analysis ◽  
Necrotic Core ◽  
Core Area ◽  
Plaque Area ◽  
Central Registry ◽  
Wall Shear ◽  
The Impact

Abstract Background and Aim Arterial wall strain has been proposed to impact the features of developed plaques. The aim of this meta-analysis is to assess the impact of different types of wall shear strain (WSS) on the changes of vulnerable plaque in coronary artery disease (CAD). Methods We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, from 1989 up to May 2019 in order to select clinical trials and observational studies, which assessed the relationship between WSS measured by intravascular ultrasound (IVUS) and morphology of plaque in CAD. Results In 7 studies, a total of 724 patients with 32,083 segments were recruited, with mean follow up 8.4 months. The pooled analysis showed that low WSS was associated with larger baseline lumen area WMD 2.55 [1.34 to 3.76, p &lt; 0.001], smaller plaque area WMD -1.16 [-0.1.84 to -0.49, p = 0007] and necrotic core area WMD -0.45 [-0.78 to 0.14, p = 0.004], dense calcium score WMD -0.18 [-0.46 to 0.10, p = 0.01], and fibrous area WMD -0.79 [-1.84 to 0.30, p = 0.02] as well as smaller fibro-fatty area WMD -0.22 [-0.57 to 0.13, p = 0.02] compared to high WSS. At follow-up, the high WSS had regression of fibrous area, WMD -0.12 [-0.22 to -0.02, p = 0.02] and fibro-fatty area WMD -0.11 [-0.23 to -0.01, p = 0.04], reduction of plaque area WMD -0.09 [-0.17 to -0.02, p = 0.01] and increased dense calcium WMD 0.08 [0.02 to 0.14, p = 0.006] and necrotic core area WMD 0.07 [0.01 to 0.13, p = 0.03] compared to low WSS (Figure 1). The high WSS developed more profound remodeling compared to low WSS (40 vs. 18%, p &lt; 0.05) with more constructive remodelling with low WSS (78%vs. 40 %, p &lt; 0.01). Conclusions. Baseline high WSS is associated with higher necrotic core, calcium, fibrous and fibro-fatty area compared with low WSS, and during follow up the high WSS resulted in the development of more profound remodeling compared with low WSS. These findings highlighted the role of IVUS in detecting the vulnerable plaque in CAD. Abstract 1178 Figure 1. Mean change of plaque morpholo

scholarly journals Postoperative bisphosphonate do not significantly alter the fusion rate after lumbar spinal fusion: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jun Mei ◽  
Xiaoxu Song ◽  
Xiaoming Guan ◽  
Dou Wu ◽  
Junjie Wang ◽  
...  
Keyword(s):  
Bone Formation ◽  
Spinal Fusion ◽  
Meta Analysis ◽  
Fusion Rate ◽  
Lumbar Spinal Fusion ◽  
Fusion Surgery ◽  
Number Of Patients ◽  
Cage Subsidence ◽  
Lumbar Spinal

Abstract Background To evaluate the effect of postoperative BP treatment on improving the fusion rate after lumbar spinal fusion surgery by performing a meta-analysis of randomized controlled trials (RCTs) and other comparative cohort studies. Methods A comprehensive search of PubMed, EMBASE, the Web of Science, and the Cochrane Central Register of Controlled Trials was performed for RCTs and other comparative cohort studies on the effect of BP treatment on improving the fusion rate after lumbar spinal fusion surgery. The primary outcome measures were the number of patients with bone formation grades A, B, and C at 12 months of follow-up; fusion rates at 12 and 24 months of follow-up; vertebral compression fracture (VCF) at 12 and 24 months of follow-up; pedicle screw loosening at 24 months of follow-up; and cage subsidence, the Oswestry disability index (ODI), and the visual analogue score (VAS) at 12 months of follow-up. The final search was performed in July 2020. Results Seven studies with 401 patients were included. Compared with the placebo, BP treatment did not significantly alter the number of patients with bone formation grades A, B, and C, or the VAS at the 12-month follow-up or the fusion rates at the 12- and 24-month follow-ups. In addition, compared with the placebo, BPs significantly reduced the risks of VCF at the 12- and 24-month follow-ups, pedicle screw loosening at the 24-month follow-up, and cage subsidence and the ODI at the 12-month follow-up. Conclusions Postoperative BPs do not clearly improve bone formation and the fusion rate, but they reduce VCF, cage subsidence, and loosening of pedicle screws after lumbar fusion surgery compared with the control treatment.

Sign in / Sign up

Export Citation Format

Share Document