Net clinical benefit of PFO closure versus medical treatment in patients with cryptogenic stroke: A systematic review and meta-analysis

Background: The ideal treatment for patent foramen ovale (PFO) in patients with cryptogenic stroke remains controversial and is being evaluated. The objective of this study was to evaluate the net clinical benefit (NCB) between PFO closure and medical treatment. Methods: We searched three electronic databases from inception until January 2022. The primary outcomes were the NCB-1, defined as the cumulative incidence of stroke, major bleeding, atrial fibrillation/flutter, and serious procedural or device complications; the NCB-2 and NCB-3 were defined as NCB1 but using a weighted factor of 0.5 and 0.25 for atrial fibrillation/flutter events, respectively. We also evaluated each component outcome of NCB as a secondary outcome. Risk ratios (RR) and 95% confidence intervals (CI) of each outcome were calculated (random-effects model). Results: Our analysis included six RCTs (n = 3750 patients). The rates of NCB-1, NCB-2, and NCB-3 were not different between PFO closure and medical treatment. The heterogeneity between trials was low to moderate. Stroke showed a significant relative decrease of 44% (95% CI, 21-60%), favoring the PFO closure arm. Atrial fibrillation/flutter increased by 4.04 times (95% CI, 1.57-8.89) in the PFO closure compared with the medical treatment group. In a meta-regression analysis, the reduction in NCB-1 with PFO closure increased as the proportion of patients treated with the Amplatzer device increased (p = 0.02), and the reduction in NCB-1, NCB-2, and NCB-3 with PFO closure increased as the proportion of patients treated with substantial PFO size increased (p = 0.03). Conclusion: The NCB between PFO closure and medical treatment was not different, suggesting individualized treatment to maximize benefit

Επίδραση της τιμής της γλυκόζης στην ενδονοσοκομειακή πρόγνωση ασθενών με έμφραγμα μυοκαρδίου υποβληθέντων σε πρωτογενή αγγειοπλαστική

Εισαγωγή: Οι ασθενείς με οξύ έμφραγμα μυοκαρδίου συχνά εμφανίζουν υπεργλυκαιμία λόγω στρες κατά τη προσέλευση στο τμήμα επειγόντων περιστατικών. Από τη βιβλιογραφία φαίνεται ότι η παρουσία υπεργλυκαιμίας αποτελεί φτωχό προγνωστικό δείκτη θνητότητας για αυτούς τους ασθενείς. Σκοπός: H συσχέτιση της γλυκόζης εισόδου με την επίπτωση του πρωτογενούς μείζονος καταληκτικού σημείου και της θνητότητας, σε ασθενείς με οξύ έμφραγμα του μυοκαρδίου που υποβλήθηκαν σε πρωτογενή αγγειοπλαστική. Υλικό και Μέθοδος: Το δείγμα της μελέτης αποτελείται από 127 ασθενείς, οι οποίοι προσήλθαν στο ΤΕΠ με οξύ έμφραγμα του μυοκαρδίου και υπεβλήθησαν σε πρωτογενή αγγειοπλαστική. Οι ασθενείς κατηγοριοποιήθηκαν σε δύο ομάδες ανάλογα με τη γλυκόζη εισόδου. Στην ομάδα της φυσιολογικής γλυκόζης, όσοι είχαν γλυκόζη <180 mg/dl και στην ομάδα της υπεργλυκαιμίας όσοι είχαν >180mg/dl. Με τη δοκιμασία χ2 εκτιμήθηκε κατά πόσο διαφέρουν οι δύο ομάδες στην επίπτωση του πρωτογενούς μείζονος καταληκτικού συμβάντος και τη θνητότητα. Επίσης πραγματοποιήθηκε ανάλυση λογιστικής παλινδρόμησης για να εκτιμηθεί η αιτιατή σχέση της υπεργλυκαιμίας στην εμφάνιση του πρωτογενούς συμβάντος. Τέλος με τη δοκιμασία t-test ελέγχθηκε κατά πόσο διαφέρει σημαντικά ο μέσος όρος νοσηλείας στις δύο ομάδες. Αποτελέσματα: Υπήρξε στατιστικά σημαντική διαφορά στην επίπτωση του πρωτογενούς καταληκτικού σημείου και του θανάτου, με την ομάδα της υπεργλυκαιμίας να υπερέχει χ2(1,Ν=127)=10,9, p=0,002. Όταν έγινε διαχωρισμός του δείγματος σε διαβητικούς και μη, μόνο η ομάδα των διαβητικών συνέχισε να έχει στατιστικά σημαντική υπεροχή στην επίπτωση των παραπάνω μεταβλητών χ2(1,Ν=89)=8,4, p=0,023. Στην ανάλυση λογιστικής παλινδρόμησης η υπεργλυκαιμία φάνηκε να επηρεάζει σημαντικά την επίπτωση του πρωτογενούς καταληκτικού σημείου OR=3,95 95% CI [1,11, 14,02], p<0,05. Τέλος ο μέσος όρος ημερών νοσηλείας ήταν σημαντικά μεγαλύτερος στην ομάδα της υπεργλυκαιμίας t(116)=0,51, p=0,023, 95%C.I.[.033-2,49 ημέρες]. Συμπεράσματα: Η παρουσία υπεργλυκαιμίας συσχετίζεται και επηρεάζει την επίπτωση του πρωτογενούς καταληκτικού σημείου. Επίσης η υπεργλυκαιμία συσχετίζεται με αύξηση του μέσου όρου νοσηλείας.Introduction: Patients with acute myocardial infarction tend to have significant hyperglycemia on admission in the emergency department. In literature, the presence of hyperglycemia consists a poor prognostic factor for these patients. Purpose: To test the relationship of hyperglycemia on admission with the incidence of primary end point (composite of all cause death, myocardial infarction, stroke and acute renal failure) and mortality in patients with myocardial infarction, who underwent primary coronary intervention (PCI). Material and Method: Study’s sample consists of 127 patients, who admitted to the emergency department of Naval Hospital of Athens with myocardial infarction and underwent PCI. Based on glucose on admission, these patients organized in two groups. In normal glucose group patients with glucose levels <180mg/dl and in hyperglycemia group with glucose >180mg/dl. A chi square test was performed to examine the difference concerning the incidence of primary end point and all cause death. In addition, a logistic regression analysis was performed to test hyperglycemia’s causal effect on primary end point’s incidence. Moreover, the difference of days staying at hospital between the two groups was checked by using independent sample T test. Results: The relation between glucose and the incidence of primary end point was significant between the two groups χ2(1, Ν=127) =10.9, p=.002 Data sample was divided, based on the prevalence of diabetes and the abovementioned relation continued to be significant only for non- diabetic patients χ2(1, Ν=89) =8.4, p=.023. In logistic regression analysis, hyperglycemia significantly affected the incidence of the primary end point OR=3.95 95% CI [1.11, 14.02], p<0.05. The mean of days at hospital was significantly bigger in hyperglycemia group t(116)=.51, p=.023, 95%C.I.[.033-2.49 days]. Conclusion: The presence of hyperglycemia is related and affects the incidence of primary end point. Furthermore, hyperglycemia is related with longer hospitalization

The Role of Pediatric BCG Vaccine in Type 1 Diabetes Onset

Introduction Bacille Calmette-Guerin (BCG) vaccination has shown promising therapeutic effects for type 1 diabetes (T1D). According to recent studies, immunometabolism modification and regulation of T lymphocytes constitute the proposed mechanisms by which BCG vaccination may delay T1D onset. Clinical trial evidence from Turkey supports that two to three doses of the BCG vaccine in childhood, with the first dose administered in the first year of life, may prevent T1D. In the same study, one or zero vaccinations appeared to have no effect in T1D onset prevention. In Greece, the BCG vaccine was administered in a single dose at the age of 9 years in elementary school. BCG vaccination was not performed on a mandatory basis, creating one BCG vaccinated and one non-vaccinated population. The aim of our study was to investigate the possible effect of a single dose of BCG vaccine, at the age of 9 years, on the time of T1D onset, in a population of BCG vaccinated and non-vaccinated patients with diagnosed T1D. Methods To test this hypothesis, a survey through the Pan-Hellenic Federation of People with Diabetes (PFPD) was performed. In this observational, retrospective study, participating patients provided information regarding age, gender, time of diagnosis, and BCG vaccination status. Patients diagnosed with T1D before the age of 9 years were excluded from the analysis. Results The final sample included 196 patients (73 male and 123 female) with a mean age of 42.2 +/- 14.3 years and a mean duration of diabetes of 16.8 +/- 12.9 years. Mean age of T1D diagnosis in the BCG vaccinated group was 24.0 +/- 19.0 years, while the mean age of T1D diagnosis in the BCG non-vaccinated group was 21.5 +/- 14.3 years (p = 0.03). No interaction was found between gender and the age of diagnosis for BCG vaccinated and unvaccinated patients (p = 0.86). Conclusion The results of our study suggest that a single dose of BCG vaccine, performed at the age of 9 years, may delay the onset of T1D by 2.5 years. Additional studies of children receiving multiple doses of BCG should be conducted to possibly prove prolongation of the disease-free interval

Immunologic Dysregulation and Hypercoagulability as a Pathophysiologic Background in COVID-19 Infection and the Immunomodulating Role of Colchicine

In 2020, SARS-COV-2 put health systems under unprecedented resource and manpower pressure leading to significant number of deaths. Expectedly, researchers sought to shed light on the pathophysiologic background of this novel disease (COVID-19) as well as to facilitate the design of effective therapeutic modalities. Indeed, early enough the pivotal role of inflammatory and thrombotic pathways in SARS-COV-2 infection has been illustrated. The purpose of this article is to briefly present the epidemiologic and clinical features of COVID-19, analyze the pathophysiologic importance of immunologic dysregulation and hypercoagulability in developing disease complications and finally to present an up-to-date systematic review of colchicine's immunomodulating capacity in view of hindering coronavirus complications