scholarly journals The Association Between Fluoroquinolones and Aortic Dissection and Aortic Aneurysms: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Ian Wee ◽  
Brian Chin ◽  
Nicholas Syn ◽  
Keng Siang Lee ◽  
Jun Jie Ng ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Meta Analysis ◽  
Final Analysis ◽  
Aneurysm Rupture ◽  
Aortic Aneurysms ◽  
Additional Patient ◽  
Cochrane Library ◽  
Future Research ◽  
Baseline Incidence

Abstract Previous studies have drawn causal associations between fluoroquinolone use and collagen pathologies including tendon rupture and retinopathy. This meta-analysis attempted to assess the association between fluoroquinolone use and the risk of aortic dissection or aortic aneurysm. A systematic search was performed on Medline, EMBASE, and the Cochrane library. 9 studies were included in final analysis. Primary random-effects meta-analysis of 7 studies, excluding 2 pharmacovigilance studies demonstrated statistically increased odds of aortic dissection (OR, 2.38; 95% CI, 1.71 – 3.32) aortic aneurysm (OR, 1.98; 95% CI, 1.59 – 2.48), and aortic aneurysm or dissection (OR, 1.47; 95% CI, 1.13 – 1.89; I2 = 72%) with current use of fluoroquinolones compared to their nonuser counterparts. Based on the “number needed-to-harm” analysis, 7246 (95% CI: 4329 to 14085) patients would need to be treated with fluoroquinolones for a duration of at least three days in order for one additional patient to be harmed, assuming a population baseline incidence of aortic dissection and aneurysm rupture to be 10 per 100,000 patient-years. With strong statistical association, these findings suggest a causal relationship, warranting future research to elucidate the pathophysiological and mechanistic plausibility of this association. These findings however, should not cease prescription of fluoroquinolones, especially when clinically indicated.

scholarly journals The association between fluoroquinolones and aortic dissection and aortic aneurysms: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ian Wee ◽  
Brian Chin ◽  
Nicholas Syn ◽  
Keng Siang Lee ◽  
Jun Jie Ng ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Meta Analysis ◽  
Final Analysis ◽  
Aneurysm Rupture ◽  
Aortic Aneurysms ◽  
Additional Patient ◽  
Cochrane Library ◽  
Future Research ◽  
Baseline Incidence

AbstractPrevious studies have drawn causal associations between fluoroquinolone use and collagen pathologies including tendon rupture and retinopathy. This meta-analysisattempted to assess the association between fluoroquinolone use and the risk of aortic dissection or aortic aneurysm. A systematic search was performed on Medline, EMBASE, and the Cochrane library. 9 studies were included in final analysis. Primary random-effects meta-analysis of 7 studies, excluding 2 pharmacovigilance studies demonstrated statistically increased odds of aortic dissection (OR, 2.38; 95% CI, 1.71–3.32) aortic aneurysm (OR, 1.98; 95% CI, 1.59–2.48), and aortic aneurysm or dissection (OR, 1.47; 95% CI, 1.13–1.89; I2 = 72%) with current use of fluoroquinolones compared to their nonuser counterparts. Based on the “number needed-to-harm” analysis, 7246 (95% CI: 4329 to 14,085) patients would need to be treated with fluoroquinolones for a duration of at least three days in order for one additional patient to be harmed, assuming a population baseline incidence of aortic dissection and aneurysm rupture to be 10 per 100,000 patient-years. With strong statistical association, these findings suggest a causal relationship, warranting future research to elucidate the pathophysiological and mechanistic plausibility of this association. These findings however, should not cease prescription of fluoroquinolones, especially when clinically indicated.

scholarly journals Fluoroquinolones and the Risk of Aortic Aneurysm or Aortic Dissection: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 17 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Prashanth Rawla ◽  
Marie Line El Helou ◽  
Anantha R. Vellipuram
Keyword(s):  
Systematic Review ◽  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Response Analysis ◽  
Adjusted Relative Risk ◽  
Risk Increase ◽  
Increased Risk

Objective: We performed a systematic review and meta-analysis to explore the risk of an aortic aneurysm or aortic dissection following fluoroquinolone administration. Methods: PubMed, Cochrane library, ClinicalTrials.gov, Embase and Google Scholar were systematically reviewed for controlled studies including adult patients exposed to fluoroquinolones with a primary outcome of aortic aneurysm or aortic dissection. Results: The meta-analysis was conducted by pooling the effect estimates of four controlled observational studies (one case-control, one case-crossover and two cohort studies). Fluoroquinolone administration more than doubled the risk to develop aortic aneurysm or aortic dissection within 60 days following fluoroquinolone exposure (adjusted Relative Risk [RR] (95% confidence interval [CI]) = 2.14 (1.93 - 2.36); I2 = 15.8%). The quality of the finding was rated as moderate. : The risk increase for aortic aneurysm alone was found to be significant (adjusted RR (95% CI) = 2.23 (2.01 - 2.45); I2 = 0%) while the risk increase for aortic dissection alone was not found to be significant (adjusted RR = 1.88 (0.11 - 3.65); I2 = 74%). : In subgroup analysis, the risk increase for aortic aneurysm or aortic dissection appeared to be higher in females compared to males (RR = 1.87 (1.24 - 2.51); I2 = 0% versus RR = 1.58 (1.25 - 1.92); I2 = 0%, respectively) and higher in older patients compared to younger patients (RR = 1.72 (1.37 - 2.07); I2 = 0% versus RR = 1.47 (0.91 - 2.04); I2 = 0%, respectively). : Subgroup analysis of two studies which measured the duration-response analysis found that as the duration of fluoroquinolone therapy increased from 3 to 14 days to greater than 14 days, there was an increased risk of aortic aneurysm or dissection. Conclusion: The findings of this meta-analysis confirm the positive association between fluoroquinolones and the development of aortic aneurysm or dissection. The data tend to show that this association may be majorly driven by aortic aneurysm. Additionally, some risk factors appear to prevail including prolonged fluoroquinolone treatment and older age.

scholarly journals The Protective Effect of Metformin on Abdominal Aortic Aneurysm: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhen Yuan ◽  
Zhijian Heng ◽  
Yi Lu ◽  
Jia Wei ◽  
Zhejun Cai
Keyword(s):  
Systematic Review ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Meta Analysis ◽  
Aneurysm Rupture ◽  
Cochrane Library ◽  
Annual Growth Rate ◽  
Abdominal Aortic

BackgroundType 2 diabetes mellitus (T2DM) patients have a lower risk of abdominal aortic aneurysm (AAA) and its comorbidities, which might be associated with the usage of metformin. The objective of the study was to evaluate the role of metformin in the process of AAA development.MethodPubMed, Embase and Cochrane Library were searched up to May 15th, 2021. We implemented several methods including the risk of bias graph, GRADE system and funnel plot to assess the quality and possible bias of this study. Subgroup analysis and sensitivity analysis were applied to address quality differences and validate the robustness of the final results.ResultTen articles were enrolled after screening 151 articles searched from databases. The pooled results showed that, compared with T2DM patients without metformin, metformin prescription was associated with a slower annual growth rate of the aneurysm (mean difference (MD) -0.67 cm [95% confidence interval (CI) -1.20 ~ -0.15 cm]). Besides, metformin exposure was associated with a lower frequency of AAA events (odds ratio (OR) 0.61 [95% CI 0.41-0.92]).ConclusionMetformin alleviated both annual expansion rate and aneurysm rupture frequency in AAA patients with T2DM.Systematic Review RegistrationPROSPERO, identifier https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=217859 (CRD42020217859).

scholarly journals An integrative systematic review of creative arts interventions for older informal caregivers of people with neurological conditions

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243461
Author(s):  
J. Yoon Irons ◽  
Gulcan Garip ◽  
Ainslea J. Cross ◽  
David Sheffield ◽  
Jamie Bird
Keyword(s):  
Meta Analysis ◽  
Informal Caregivers ◽  
Small Sample ◽  
Cochrane Library ◽  
Future Research ◽  
Creative Arts ◽  
Qualitative Synthesis ◽  
Current Review ◽  
Neurological Conditions ◽  
Creative Interventions

Objective We aimed to assess and synthesise the current state of quantitative and qualitative research concerning creative arts interventions for older informal caregivers of people with neurological conditions. Methods A systematic search was employed to identify studies that examined creative arts interventions for older informal caregivers, which were synthesised in this integrative review. We searched the following databases: MEDLINE, PubMed, EBSCO, CINAHL, EMBASE, PsycINFO, Cochrane Library, Scopus, Web of Science, and Google Scholar. We also backwards searched references of all relevant studies and inspected trials registers. Results Of the 516 studies identified, 17 were included: one was quantitative, nine were qualitative and seven used mixed methods. All included quantitative studies were pilot or feasibility studies employing pre- and post-test design with small sample sizes. Studies varied in relation to the type of creative intervention and evaluation methods, which precluded meta-analysis. Large effect sizes were detected in wellbeing measures following singing and art interventions. The qualitative synthesis highlighted that interventions created space for caregivers to make sense of, accept and adapt to their identity as a caregiver. Personal developments, such as learning new skills, were viewed positively by caregivers as well as welcoming the opportunity to gain cognitive and behavioural skills, and having opportunities to unload emotions in a safe space were important to caregivers. Group creative interventions were particularly helpful in creating social connections with their care-recipients and other caregivers. Conclusions The current review revealed all creative interventions focused on caregivers of people living with dementia; subsequently, this identified gaps in the evidence of creative interventions for informal caregivers of other neurological conditions. There are encouraging preliminary data on music and art interventions, however, little data exists on other art forms, e.g., drama, dance. Creative interventions may appeal to many caregivers, offering a range of psycho-social benefits. The findings of the current review open the way for future research to develop appropriate and creative arts programmes and to test their efficacy with robust tools.

scholarly journals Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Yu Chen ◽  
Jinning Ye ◽  
Wu Song ◽  
Jianhui Chen ◽  
Yujie Yuan ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Meta Analysis ◽  
Final Analysis ◽  
Fascial Closure ◽  
Cochrane Library ◽  
Optimal Time ◽  
Closure Rate ◽  
Abdominal Closure ◽  
Abdominal Fascia ◽  
Delayed Closure

Up to the present, the optimal time to close an open abdomen remains controversial. This study was designed to evaluate whether early fascial abdominal closure had advantages over delayed approach for open abdomen populations. Medline, Embase, and Cochrane Library were searched until April 2013. Search terms included “open abdomen,” “abdominal compartment syndrome,” “laparostomy,” “celiotomy,” “abdominal closure,” “primary,” “delayed,” “permanent,” “fascial closure,” and “definitive closure.” Open abdomen was defined as “fail to close abdominal fascia after a laparotomy.” Mortality, complications, and length of stay were compared between early and delayed fascial closure. In total, 3125 patients were included for final analysis, and 1942 (62%) patients successfully achieved early fascial closure. Vacuum assisted fascial closure had no impact on pooled fascial closure rate. Compared with delayed abdominal closure, early fascial closure significantly reduced mortality (12.3% versus 24.8%, RR, 0.53,P<0.0001) and complication incidence (RR, 0.68,P<0.0001). The mean interval from open abdomen to definitive closure ranged from 2.2 to 14.6 days in early fascial closure groups, but from 32.5 to 300 days in delayed closure groups. This study confirmed clinical advantages of early fascial closure over delayed approach in treatment of patients with open abdomen.

Improvement of Acupuncture Therapy on Relapse of P atients with G outy A rthritis: A Pairwise and Bayesian Network Meta analysis

2021 ◽  
Author(s):  
Zhihui Li ◽  
Min Chen ◽  
Chunzhi Tang
Keyword(s):  
Acupuncture Therapy ◽  
Bayesian Network ◽  
Meta Analysis ◽  
Gouty Arthritis ◽  
Serum Urate ◽  
Cochrane Library ◽  
Future Research ◽  
Fire Needle ◽  
The Impact

Objective: The aim of this study is to investigate the impact of acupuncturetherapy on relapse of patients with gouty arthritis (GA). Methods: “gout ORgouty arthritis” AND “a cupuncture therapy OR acupuncture OR moxibustionOR electroacupuncture OR fire needle OR acupotomology OR blood lettingpuncture OR plum blossom needle” were used as search strategies forsearching related studies. Twenty two studies involving 2394 patient s wereenrolled in this research through the analysis of databases of CNKI, Wanfang,VIP, PubMed, Embase and Cochrane Library. Results: The results of pairwise metaanalysis and network meta analysis (NMA) indicated that patients withacupuncture therapy had a significantly lower relapse rate (RR) compared withthose without acupuncture therapy (OR = 0.21, 95% CI: 0.16 0.26, P <0.00001); the follow up time (TFU) and serum urate concentration (SUA)before treatment had no significant effect on the reductio n of RR caused byacupuncture therapy (P > 0.05); and patients treated with acupuncture plusWestern medicine (WM) had the lowest RR (surface under the cumulativeranking [SUCRA] = 85.0%), followed by acupuncture plus traditional Chinesemedicine (TCM, SUC RA = 73.5%), acupuncture only (SUCRA = 72.8%),fourthly acupuncture plus TCM and WM (SUCRA = 33.0%), then TCM(SUCRA = 28.7%), finally WM (SUCRA = 7.0%). Conclusion: Our findingmay facilitate the application of acupuncture therapy in patients with GA. Ourresearch also offered some information for the future research.

Aortic Aneurysm

2018 ◽  
Author(s):  
Christine E Lee ◽  
Leily Naraghi ◽  
Beatrice Hoffmann
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Intramural Hematoma ◽  
Aortic Disease ◽  
Magnetic Resonance Images ◽  
Aortic Aneurysms ◽  
High Morbidity ◽  
Aortic Diseases ◽  
Decision Algorithm ◽  
Type B Dissection

Aortic diseases are relatively rare but are associated with high morbidity and mortality. Emergency physicians (EPs) should consider aortic disease in all patients with pain in the torso, particularly those with other diverse or seemingly unconnected complaints. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for patients with abdominal aortic aneurysms (AAAs), thoracic aortic aneurysms (TAAs), and aortic dissection. Figures show a transverse image of an AAAs with a transmural hematoma, a three-dimensional computed tomographic angiogram (CTA) rendering of a thoracic aneurysm associated with a bicuspid aortic valve in the typical ascending aortic location, a chest x-ray film demonstrating prominent and blurred aortic knob due to TAA, acute aortic dissection subtypes, an electrocardiogram and transesophageal echocardiography of a patient with acute ascending aortic dissection, magnetic resonance images of a patient with dissection of the proximal descending aorta, CT representations of a type A dissection involving a dilated ascending aorta and a type B dissection involving the descending thoracic aorta, and a decision algorithm for evaluation and treatment of a suspected aortic dissection. Tables list normal aortic dimensions by CTA and echocardiography, average annual rate of expansion and rupture of AAA based on current diameter, and the etiology of TAA. Key words: AAA, aorta, aortic dissection, ascending aortic dissection, descending aortic dissection, intimal tear, intramural hematoma, thoracic aortic aneurysm

Usefulness of Suita score to predict deaths from aortic aneurysm rupture and aortic dissection in general population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Otaki ◽  
T.W Watanabe ◽  
T.K Konta ◽  
M.W Watanabe ◽  
K.A Asahi ◽  
...  
Keyword(s):  
Heart Disease ◽  
Aortic Aneurysm ◽  
General Population ◽  
Aortic Dissection ◽  
Ischemic Heart Disease ◽  
Risk Score ◽  
Framingham Risk Score ◽  
Aneurysm Rupture ◽  
Ischemic Heart ◽  
Framingham Risk

Abstract Background Deaths from aortic aneurysm rupture and aortic dissection are the major causes of sudden death in Japan. Suita score developed in Japan, as well as Framingham risk score, is reportedly associated with ischemic heart disease. However, it remains undetermined whether Suita score is associated with aortic aneurysm rupture and aortic dissection deaths in general population. Purpose To examine whether Suita score could predict aortic aneurysm rupture and aortic dissection deaths in general population. Methods and results We used a database of 534,414 subjects (age 40–75 years) who participated in the annual “Specific Health Check and Guidance in Japan” check-up between 2008 and 2013. The univariate and multivariate Cox proportional hazard regression analyses demonstrated that Suita score was associated with both deaths from aortic aneurysm rupture and aortic dissection after adjustment for confounding risk factors. The C indices in Suita score for aortic aneurysm rupture deaths, aortic dissection deaths and ischemic heart disease deaths were 0.8295, 0.6689, and 0.7039, respectively. The C indices in Suita score to predict aortic aneurysm rupture deaths and aortic dissection deaths were significantly greater than those in Framingham risk score. Conclusion Suita score was superior to Framingham risk score and a feasible marker for aortic aneurysm rupture and aortic dissection deaths in general population, indicating that it could serve as an identification of high-risk subjects for aortic aneurysmal rupture and aortic dissection as well as ischemic heart disease. Funding Acknowledgement Type of funding source: None

Nonthyroidal Illness Syndrome and Hypothyroidism in Ischemic Heart Disease Population: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 105 (8) ◽  
pp. 2830-2845
Author(s):  
Chun-Yu Chang ◽  
Yung-Jiun Chien ◽  
Po-Chen Lin ◽  
Chien-Sheng Chen ◽  
Meng-Yu Wu
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Meta Analysis ◽  
Ischemic Heart ◽  
Cochrane Library ◽  
Future Research ◽  
Sufficient Information ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
All Cause Mortality

Abstract Context The association of non-thyroidal illness syndrome (NTIS) and hypothyroidism with the prognosis in ischemic heart disease (IHD) population is inconclusive. Objective We aimed to evaluate the influence of NTIS and hypothyroidism on all-cause mortality and major adverse cardiac events (MACE) in IHD population. Data Sources We searched PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library from inception through February 17, 2020. Study Selection Original articles enrolling IHD patients, comparing all-cause mortality and MACE of NTIS and hypothyroidism with those of euthyroidism, and providing sufficient information for meta-analysis were considered eligible. Data Extraction Relevant information and numerical data were extracted for methodological assessment and meta-analysis. Data Synthesis Twenty-three studies were included. The IHD population with NTIS was associated with higher risk of all-cause mortality (hazard ratio [HR] = 2.61; 95% confidence interval [CI] = 1.89-3.59) and MACE (HR = 2.22; 95% CI = 1.71-2.89) than that without. In addition, the IHD population with hypothyroidism was also associated with higher risk of all-cause mortality (HR = 1.47; 95% CI = 1.10-1.97) and MACE (HR = 1.53; 95% CI = 1.19-1.97) than that without. In the subgroup analysis, the acute coronary syndrome (ACS) subpopulation with NTIS was associated with higher risk of all-cause mortality (HR = 3.30; 95% CI = 2.43-4.48) and MACE (HR = 2.19; 95% CI = 1.45-3.30). The ACS subpopulation with hypothyroidism was also associated with higher risk of all-cause mortality (HR = 1.67; 95% CI = 1.17-2.39). Conclusions The IHD population with concomitant NTIS or hypothyroidism was associated with higher risk of all-cause mortality and MACE. Future research is required to provide evidence of the causal relationship and to elucidate whether normalizing thyroid function parameters can improve prognosis.

scholarly journals Cerebrovascular Complications After Upper Extremity Access for Complex Aortic Interventions: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 43 (2) ◽  
pp. 186-195 ◽  
Author(s):  
Max M. Meertens ◽  
Charlotte C. Lemmens ◽  
Gustavo S. Oderich ◽  
Geert W. H. Schurink ◽  
Barend M. E. Mees
Keyword(s):  
Systematic Review ◽  
Endovascular Treatment ◽  
Upper Extremity ◽  
Meta Analysis ◽  
Aortic Aneurysms ◽  
Cochrane Library ◽  
Cerebrovascular Event ◽  
Cerebrovascular Complications ◽  
Increased Risk ◽  
Aortic Interventions

Abstract Purpose The purpose of this study was to review the risk of developing cerebrovascular complications from upper extremity access during endovascular treatment of complex aortic aneurysms. Methods A systematic review and meta-analysis were conducted according to the PRISMA guideline. An electronic search of the public domains Medline (PubMed), Embase (Ovid), Web of Science and Cochrane Library was performed to identify studies related to the treatment of aortic aneurysms involving upper extremity access. Meta-analysis was used to compare the rate of cerebrovascular event after left, right and bilateral upper extremity access. Results are presented as relative risk (RR) and 95% confidence intervals (CIs). Results Thirteen studies including 1276 patients with complex endovascular treatment of aortic aneurysms using upper extremity access were included in the systematic review. Left upper extremity access (UEA) was used in 1028 procedures, right access in 148 and bilateral access in 100 procedures. The rate of cerebrovascular complications for patients treated through left UEA was 1.7%, through right UEA 4% and through bilateral UEA 5%. In the meta-analysis, we included seven studies involving 645 patients treated with a left upper extremity access, 87 patients through a right and 100 patients through a bilateral upper extremity access. Patients, who underwent right-sided (RR 5.01, 95% CI 1.51–16.58, P = 0.008) or bilateral UEA (RR 4.57, 95% CI 1.23–17.04, P = 0.02), had a significantly increased risk of cerebrovascular events compared to those who had a left-sided approach. Conclusion Left upper extremity access is associated with a significantly lower rate of cerebrovascular complications as compared to right or bilateral upper extremity access.

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