A Comparative Effectiveness Systematic Review and Meta-Analysis of Drugs for the Prophylaxis of Junctional Ectopic Tachycardia

2021 ◽  
Vol 17 ◽  
Author(s):  
Brian Mendel ◽  
Christianto ◽  
Moira Setiawan ◽  
Radityo Prakoso ◽  
Sisca Natalia Siagian
Keyword(s):  
Systematic Review ◽  
Risk Ratio ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Meta Analysis ◽  
Congenital Heart Surgery ◽  
Small Sample ◽  
Junctional Ectopic Tachycardia ◽  
Drug Of Choice ◽  
Small Sample Sizes

Background: Junctional ectopic tachycardia (JET) is an arrhythmia originating from the AV junction, which may occur following congenital heart surgery, especially when the intervention is near the atrioventricular junction. Objective: The aim of this systematic review and meta-analysis is to compare the effectiveness of amiodarone, dexmedetomidine and magnesium in preventing JET following congenital heart surgery. Methods: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, where 11 electronic databases were searched from date of inception to August 2020. The incidence of JET was calculated with the relative risk of 95% confidence interval (CI). Quality assessment of the included studies was assessed using the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement. Results: Eleven studies met the predetermined inclusion criteria and were included in this meta-analysis. Amiodarone, dexmedetomidine and magnesium significantly reduced the incidence of postoperative JET [Amiodarone: risk ratio 0.34; I2= 0%; Z=3.66 (P=0.0002); 95% CI 0.19-0.60. Dexmedetomidine: risk ratio 0.34; I2= 0%; Z=4.77 (P<0.00001); 95% CI 0.21-0.52. Magnesium: risk ratio 0.50; I2= 24%; Z=5.08 (P<0.00001); 95% CI 0.39-0.66]. Conclusion: All three drugs show promise in reducing the incidence of JET. Our systematic review found that dexmedetomidine is better in reducing the length of ICU stays as well as mortality. In addition, dexmedetomidine also has the least pronounced side effects among the three. However, it should be noted that this conclusion was derived from studies with small sample sizes. Therefore, dexmedetomidine may be considered as the drug of choice for preventing JET.

Junctional Ectopic Tachycardia: Recognition and Modern Management Strategies

2020 ◽  
Vol 40 (1) ◽  
pp. 46-55
Author(s):  
Kirsti G. Catton ◽  
Jennifer K. Peterson
Keyword(s):  
Risk Factors ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Early Recognition ◽  
Treatment Options ◽  
Age Groups ◽  
Atrioventricular Node ◽  
Congenital Heart Surgery ◽  
Junctional Ectopic Tachycardia ◽  
Perioperative Morbidity

Junctional ectopic tachycardia is a common dysrhythmia after congenital heart surgery that is associated with increased perioperative morbidity and mortality. Risk factors for development of junctional ectopic tachycardia include young age (neonatal and infant age groups); hypomagnesemia; higher-complexity surgical procedure, especially near the atrioventricular node or His bundle; and use of exogenous catecholamines such as dopamine and epinephrine. Critical care nurses play a vital role in early recognition of dysrhythmias after congenital heart surgery, assessment of hemodynamics affecting cardiac output, and monitoring the effects of antiarrhythmic therapy. This article reviews the underlying mechanisms of junctional ectopic tachycardia, incidence and risk factors, and treatment options. Currently, amiodarone is the pharmacological treatment of choice, with dexmedetomidine increasingly used because of its anti-arrhythmic properties and sedative effect.

Prevalence of tuberculosis, brucellosis and trypanosomiasis in cattle in Tanzania: a systematic review and meta-analysis

2016 ◽  
Vol 17 (1) ◽  
pp. 16-27 ◽  
Author(s):  
Silvia Alonso ◽  
Ian Dohoo ◽  
Johanna Lindahl ◽  
Cristobal Verdugo ◽  
Isaiah Akuku ◽  
...  
Keyword(s):  
Systematic Review ◽  
Production Systems ◽  
Strong Predictor ◽  
Meta Analysis ◽  
Small Sample ◽  
Skin Tests ◽  
Prevalence Studies ◽  
Prevalence Estimates ◽  
Using Data ◽  
Small Sample Sizes

AbstractA meta-analysis was performed to derive prevalence estimates for Brucella spp., Mycobacterium spp. and Trypanosoma spp. in cattle in Tanzania using data derived from a systematic review of zoonotic hazards in cattle production systems. Articles published before 2012 reporting prevalence and considered at least moderate in quality were included in the analysis. Results showed high heterogeneity between studies, with wide ranges in the reported prevalence: Brucella (0.3–60.8%), Mycobacterium (0.1–13.2%) and Trypanosoma (0.82–33.3%). Overall meta-analytic mean prevalence estimates were 8.2% (95% CI 6.5–10.2), 1.28% (95% CI 0.35–4.58) and 10.3% (95% CI 6.20–16.70) respectively, for Brucella spp., Mycobacterium spp. and Trypanosoma spp. Time and region were predictors of variability of Brucella spp. prevalence, while diagnostic test was a strong predictor of Mycobacterium spp. prevalence, with higher prevalence estimates given by skin tests compared with post-mortem inspection. None of the studied factors were associated with prevalence of Trypanosoma spp. The small sample sizes, range of study locations, study designs and diagnostics used, contributed to high variability among prevalence estimates. Larger and more robust prevalence studies are needed to adequately support risk assessment and management of animal and public health threats.

scholarly journals Looking for crumbs in the obesity forest: anti-obesity interventions in the Mexican population. History, and systematic review with Meta-Analysis

2021 ◽  
Author(s):  
Esperanza M. Garcia-Oropesa ◽  
Yoscelina E. Martinez-Lopez ◽  
Sonia Maria Ruiz-Cejudo ◽  
Jose Dario Martinez-Ezquerro ◽  
Alvaro Diaz-Badillo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Waist Circumference ◽  
Behavioral Interventions ◽  
Meta Analysis ◽  
Small Sample ◽  
Population History ◽  
Sample Sizes ◽  
Obesity And Diabetes ◽  
Small Sample Sizes

Mexicans and Mexican Americans share culture, genetic background, and predisposition for chronic complications associated with obesity and diabetes making imperative efficacious treatments and prevention. Obesity has been treated for centuries focused-on weight loss while other treatments on associated conditions like gout, diabetes (T2D), and hypertriglyceridemia. To date, there is no systematic review that synthetize the origin of obesity clinics in Mexico and the efforts to investigate treatments for obesity tested by randomized clinical trials (RCT). We conducted systematic searches in Pubmed, Scopus, and Web of Science to retrieve anti-obesity RCT through 2019 and without inferior temporal limit. The systematic review included RCT of anti-obesity treatments in the Mexican adult population, including alternative medicine, pharmacological, nutritional, behavioral, and surgical interventions reporting biometric outcomes such as BMI, weight, waist circumference, triglycerides, glucose, among others. Studies with at least three months of treatment were included in the meta-analysis. We found 634 entries, after removal of duplicates and screening the studies based on eligibility criteria, we analyzed 43, and 2 multinational-collaborative studies. Most of the national studies have small sample sizes, and the studied strategies do not have replications in the population. The nutrition/behavioral interventions were difficult to blind, and most studies have medium to high risk of bias. Nutritional/behavioral interventions and medications showed effects on BMI, waist circumference, and blood pressure. Simple measures like plain water instead of sweet beverages decrease triglycerides and systolic blood pressure. Participants with obesity and hypertension can have benefic effects with antioxidants, and treatment with insulin increase weight in those with T2D. The study of obesity in Mexico has been on-going for more than four decades, but the interest on RCT just increased until this millennium, but with small sample sizes and lack of replication. The interventions affect different metabolic syndrome components, which should be analyzed in detail with the population living on the U.S.-Mexico border; therefore, bi-national collaboration is desirable to disentangle the cultural effects on this population's treatment response.

Effectiveness of Outdoor Exercise Parks on Health Outcomes in Older Adults—A Mixed-Methods Systematic Review and Meta-Analysis

2020 ◽  
pp. 1-13
Author(s):  
Yoke Leng Ng ◽  
Keith D. Hill ◽  
Pazit Levinger ◽  
Elissa Burton
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Older Adults ◽  
Meta Analysis ◽  
Small Sample ◽  
Activity Levels ◽  
Single Leg Stance ◽  
Small Sample Sizes ◽  
Meta Analyses

The objective of this systematic review was to examine the effectiveness of outdoor exercise park equipment on physical activity levels, physical function, psychosocial outcomes, and quality of life of older adults living in the community and to evaluate the evidence of older adults’ use of outdoor exercise park equipment. A search strategy was conducted from seven databases. Nine articles met the inclusion criteria. The study quality results were varied. Meta-analyses were undertaken for two physical performance tests: 30-s chair stand test and single-leg stance. The meta-analysis results were not statistically significant. It was not possible to conclude whether exercise parks were effective at improving levels of physical activity. The review shows that older adults value the benefits of health and social interaction from the use of exercise parks. Findings should be interpreted with caution due to the small sample sizes and the limited number of studies.

Abstract P180: Hospital Readmission After Pediatric Congenital Heart Surgery: A Systematic Review And Meta-analysis Of Potential Risk Factors

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Meagan E Stabler ◽  
Devin M Parker ◽  
Sarina Kothari ◽  
Mahalia Dalmage ◽  
Heather Johnson ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Meta Analysis ◽  
Hospital Readmissions ◽  
Congenital Heart Surgery ◽  
Risk Of Bias ◽  
Factors Associated ◽  
Short And Long Term

Objective: Over 40,000 infants are born annually with a heart defect; 25% require surgery and of those 20% result in hospital readmissions. We sought to identify risk factors for short- and long-term readmission following pediatric congenital heart surgery (CHS) to reduce avoidable future admissions. Methods: A systematic approach was used to search four electronic databases and retrieve articles published through 05/2020. We included observational and experimental studies that observed factors associated with 30-day or 1-year readmission after CHS. Studies with a composite outcome of readmission and death were excluded. For each independent risk factor, we assessed the pooled effect size and heterogeneity using a random-effects model. Risk of bias was assessed via the Newcastle-Ottawa scale. Results: After removing 970 duplicates, we screened 5,084 studies; 17 were included in the systematic review and 15 (N= 82,794; 9,856 readmitted) in the meta-analysis. Hospital readmission was significantly and positively associated with gestational age, non-white race, Hispanic ethnicity, government insurance, genetic abnormality, renal dysfunction, failure to thrive, mechanical ventilation, intraoperative ventricular dysfunction, RACHS score, STAT mortality score, cross clamp time, gastroesophageal reflux disease, postoperative arrhythmia, valve regurgitation, feeding difficulties, and ICU and hospital length of stay (LOS). Readmission definition (i.e., 1-yr vs 30-day) and LOS dichotomization (i.e., ≥ 10 or ≥ 14) resulted in significant subgroup differences for age at surgery and LOS. Five studies had higher potential for risk of bias. Conclusions: This is the first meta-analysis to identify patient and clinical factors associated with short and long-term readmission after pediatric CHS. Findings may support clinical decisions before undergoing surgery and identify patients that may benefit from receiving more aggressive care transitions prior to discharge to reduce avoidable hospital readmissions.

Junctional Ectopic Tachycardia After Congenital Heart Surgery in the Current Surgical Era

2012 ◽  
Vol 34 (2) ◽  
pp. 370-374 ◽  
Author(s):  
Majd Makhoul ◽  
Matthew Oster ◽  
Peter Fischbach ◽  
Srikant Das ◽  
Shriprasad Deshpande
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Junctional Ectopic Tachycardia

scholarly journals Systematic review and meta-analysis: does colonic mural thickening on CT correlate with endoscopic findings at colonoscopy?

2018 ◽  
Vol 9 (4) ◽  
pp. 278-284 ◽  
Author(s):  
Subashini Chandrapalan ◽  
Faraz Tahir ◽  
Peter Kimani ◽  
Rakesh Sinha ◽  
Ramesh Arasaradnam
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Positive Predictive Value ◽  
Search Strategy ◽  
Meta Analysis ◽  
Small Sample ◽  
Limiting Factors ◽  
Endoscopic Findings ◽  
Registration Number ◽  
Small Sample Sizes

BackgroundColonic mural thickening (MT) is often reported on standard CT examinations of the abdomen and pelvis. It often presents a dilemma for the clinician on whether any further evaluation is needed, especially in the absence of any set guidelines.ObjectiveTo evaluate the significance of colonic MT and to assess its correlation with colonoscopy.MethodsThe search strategy was initially developed in Medline and adapted for use in Embase, Medline, NHS Evidence and TRIP. Studies were included if they had reported colonic MT and subsequent colonoscopy in adults.ResultsA total of 9 cohort studies examining 1252 patients were selected having undergone both CT and colonoscopy. Of the 1252 patients with MT, 950 had an abnormal colonoscopy. In the presence of MT, the pooled positive predictive value (PPV) of having any abnormal findings at colonoscopy was 0.73 (95% CI 0.60 to 0.84). The pooled PPV for colorectal cancer, in the presence of MT reporting suspicion of cancer, was 0.63 (95% CI 0.49 to 0.75), and MT suggestive of inflammation confirmed at colonoscopy was 0.97.ConclusionThe probability of having an abnormal colonoscopy in the presence of MT identified on CT is high, especially for inflammation. Asymptomatic cancers may also be detected; hence, further endoscopic confirmation is reasonable when a finding of MT is demonstrated on CT examinations. Small sample sizes of the available studies and lack of data on the description of MT detected are the main limiting factors in this review.Trial registration numberCRD42016039378.

scholarly journals Ivabradine for junctional ectopic tachycardia in post congenital heart surgery

2017 ◽  
Vol 69 (5) ◽  
pp. 666-667 ◽  
Author(s):  
Vivek Kumar ◽  
Gaurav Kumar ◽  
Sajan Joshi ◽  
Vipul Sharma
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Junctional Ectopic Tachycardia
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