Antioxidant supplementations for prevention of atrial fibrillation after cardiac surgery: an updated comprehensive systematic review and meta-analysis of 23 randomized controlled trials

This systematic review with meta-analysis sought to determine the impact of antioxidants (N-acetylcysteine [NAC], polyunsaturated fatty acids [PUFAs] and vitamins) on incidence of postoperative atrial fibrillation (POAF) and duration of length of hospital stay. Medline, Embase, Elsevier, Sciences online database and Google Scholar literature search was made for studies in randomized controlled trials. The effect sizes measured were odds ratio (OR) for categorical variable and standard mean difference (SMD) with 95% confidence interval (CI) for calculating differences between mean values of duration of hospitalization in intervention and control groups. A value of P 50% indicated significant heterogeneity between the studies. Literature search of all major databases retrieved 355 studies. After screening, a total of 23 trials were identified that reported outcomes of 4278 patients undergoing cardiac surgery. Pooled effects estimates on POAF showed a significant reduction after NAC (OR: 0.56, 95% CI: 0.40-0.77, P < 0.001), PUFA (OR: 0.84, 95% CI: 0.71-0.99, P = 0.03) and vitamin C treatment (OR: 0.50, 95% CI: 0.27-0.91, P = 0.02). Hospital length of stay was not reduced after NAC therapy (SMD: 0.082, 95% CI -0.09 to 0.25, P = 0.3), but could be decreased with PUFA (SMD: -0.185, 95% CI: -0.35 to -0.018, P = 0.03) and vitamin C (SMD: -0.325, 95% CI -0.50 to -0.14, P < 0.01). In conclusion, perioperative antioxidant supplementations with NAC, PUFA and vitamin C prevent atrial fibrillation after cardiac surgery. Moreover, PUFA and vitamin C are capable to reduce hospital stay, whereas NAC lacks this capacity

Nutritional status of patients hospitalized in the intensive care unit:A comprehensive report from Iranian hospitals, 2018

Introduction and aim: Malnutrition is a complication of hospitalization in critically ill patients. This event is occurred because of disease and therapeutic processes for curing the patients. Determination of nutritional status helps physicians and clinical nutritionists decide on the best regimen which should be prescribed for a patient. In the current study, we aimed to report the nutritional status ofpatientshospitalizedin the intensive care unit (ICU). Method of study: We used three standard tolls, including Subjective global assessment (SGA), Nutrition Risk in the Critically Ill (NUTRIC) Score and nutrition risk screening (NRS) questionnaires via a multi-stage sampling for different ICU wards of 32 university hospitals in Iran. Frequencies and rates of nutritional scores, comparative studies, and determined agreement of scoring systems and nutritional status in any ward of hospitals were evaluated. Results: There were 771 males and 540 female Cancer and trauma patients had the best and worst nutritional scores, respectively. Using NRS and NUTRIC, the low-risk scores were more frequent than thehigh-riskscores among ICU patients. SGA showed that most patients were in grades A (well nutritional status) or B (moderate nutritional status), andfew caseswere in grade C (poor nutritional status).The high-risk nutritional score wasobtained for older patients. NUTRIC and NRS had better agreement for diagnosis and differentiation of malnutrition than NUTRIC-SGA or NRS-SGA pairs. However, there was no strong agreement between the mentioned pairs. Conclusion: Nutritional status of patients hospitalized in ICU wards in Iran wassomewhat better than other countries that this could be due to the highly observed guidelines of patient's care in Iran. Anyway,it is suggested that a more precise tool of nutritional scoresto be validated for patients hospitalized in ICU·In addition, better medical care needs a well evaluation of nutritional insufficiencies and what is necessary for compensation using complementary regimens.</p

Current Status of Sodium Bicarbonate in Coronary Angiography: An Updated Comprehensive Meta-Analysis and Systematic Review

This systematic review with meta-analysis sought to determine comparison of efficacy and safety of hydration with sodium bicarbonate versus sodium chloride on contrast induced nephropathy and clinical outcomes. We searched major electronic databases for studies in randomized controlled trials. A value of P<0.1 for Q test or I2>50% indicated significant heterogeneity between the studies. Literature search of all databases retrieved 650 studies. 29 studies enrolled in meta-analysis. Pooled analysis indicated about the incidence of CIN (OR of 0.718; 95% CI: 0.60 to 0.85; P=0.000), requirement of hemodialysis (OR of 1.00; 95% CI: 0.49 to 2.01; P=0.9), mean changes of serum creatinine (WMD of 2.321; 95% CI: 1.995 to 2.648; P=0.000), length of hospital stays (WMD of −0.774; 95% CI: −1.65 to 0.10; P=0.08), major adverse cardiovascular events (OR = 1.075, 95% CI: 0.59 to 1.95; P=0.8), and mortality (OR of 0.73; 95% CI: 0.42 to 1.26; P=0.2). Overall, hydration with sodium bicarbonate could significantly reduce CIN and the length of hospital stay compared to sodium chloride. In addition NAC added as a supplement to sodium bicarbonate could increase prophylactic effects against nephropathy

Odpowiednia droga podania w bolusie inhibitorów glikoproteiny IIb/IIIa u chorych z ostrymi zespołami wieńcowymi poddanych przezskórnej interwencji wieńcowej: dowieńcowo czy dożylnie? Metaanaliza i przegląd systematyczny dostępnych obecnie badań

Background and aim: This systematic review with meta-analysis sought to compare the efficacy and safety of intracoronary (IC) vs. intravenous (IV) administration of glycoprotein (GP) IIb/IIIa receptor inhibitors on clinical outcomes following per­cutaneous coronary intervention in patients with acute coronary syndromes (ST-segment elevation myocardial infarction or non-ST-segment-elevation acute coronary syndrome). Methods: Medline, Embase, Elsevier, and Sciences online databases as well as Google Scholar literature were used to select appropriate studies with randomised controlled design. The primary end-points were mortality and target vessel revascularisation (TVR), whereas the secondary end points were incidence of thrombolysis in myocardial infarction score 3 flow (TIMI 3 flow means complete perfusion in distal coronary artery bed), re-myocardial infarction (re-MI), major bleeding, stent thrombosis left ventricular ejection fraction (LVEF), and heart failure (HF). The literature search of all major databases retrieved 1006 stud­ies. After screening, a total of 18 trials (5812 patients) were identified with reported outcomes. Results: Pooled analysis showed IC administration of GP IIb/IIIa receptor inhibitors can significantly increase LVEF (WMD 4.97; 95% CI 3.34–6.60; p = 0.000) and the incidence of TIMI 3 flow (OR of 0.77; 95% CI 0.64–0.92; p = 0.005), and significantly decrease in incidence of HF (OR of 1.927; 95% CI 1.189–3.124; p = 0.008). Incidences of TVR, re-MI, major bleeding, stent thrombosis, and mortality showed no significant differences between the IC and IV groups. Conclusions: Overall, the most appropriate route of administration of GP IIb/IIIa inhibitors for patients with acute coronary syndromes appeared to be an IC injection that could increase LVEF and TIMI 3 flow and decrease the incidence of HF. Furthermore, the IC administration was not associated with increased adverse event rates when compared to IV injection.Wstęp i cel: W niniejszym przeglądzie systematycznym z metaanalizą autorzy porównali skuteczność i bezpieczeństwo dowieńcowego i dożylnego stosowania inhibitorów receptora glikoproteinowego (GP) IIb/IIIa, oceniając ich wpływ na efekty terapii po przezskórnej interwencji wieńcowej u chorych z ostrymi zespołami wieńcowymi (zawał serca z uniesieniem odcinka ST lub ostry zespół wieńcowy bez uniesienia odcinka ST). Metody: Do wyszukania odpowiednich randomizowanych badań z grupą kontrolną wykorzystano internetowe bazy bibliograficzne Medline, Embase, Elsevier i Sciences oraz wyszukiwarkę Google Scholar. Pierwszorzędowymi punktami końcowymi były śmiertelność i rewaskularyzacja naczynia docelowego (TVR), natomiast drugorzędowe punkty końcowe obejmowały częstość trombolizy u osób z zawałem serca, u których przepływ oceniono na 3 w skali TIMI (TIMI 3 oznacza prawidłową perfuzję w dy­stalnych naczyniach wieńcowych), dorzut zawału serca (re-MI), poważne krwawienie, zakrzepicę w stencie, frakcję wyrzutową lewej komory (LVEF) i niewydolność serca (HF). Po przeszukaniu wszystkich najważniejszych baz literatury medycznej wytypowano 1006 badań. Ostatecznie wybrano 18 badań (5812 chorych), w których były opisane odpowiednie punkty końcowe. Wyniki: Łączna analiza danych wykazała, że dowieńcowe podawanie inhibitorów receptora GP IIb/IIIa może spowodować istotne zwiększenie LVEF (średnia ważona różnic 4,97; 95% CI 3,34–6,60; p = 0,000) oraz odsetka osób z oceną przepływu TIMI 3 (iloraz szans [OR] 0,77; 95% przedział ufności [CI] 0,64–0,92; p = 0,005) i istotne zmniejszenie zapadalności na HF (OR 1,927; 95% CI 1,189–3,124; p = 0,008). Nie zaobserwowano różnic między grupą otrzymującą lek dowieńcowo a grupą, której podawano lek dożylnie, pod względem liczby przypadków TVR, re-MI, poważnych krwawień, zakrzepicy w stencie i zgonów. Wnioski: Stwierdzono, że najwłaściwszą drogą podania inhibitorów receptora GP IIb/IIIa u chorych z ostrymi zespołami wieńcowymi jest wstrzyknięcie dowieńcowe, co pozwoliło zwiększyć LVEF i odsetek chorych z przepływem TIMI 3 oraz zmniejszyć zapadalność na HF. Dowieńcowe podanie leków nie wiązało się ze zwiększeniem częstości zdarzeń niepożądanych w porównaniu ze wstrzyknięciem dożylnym

Baseline and postoperative levels of C-reactive protein and interleukins as inflammatory predictors of atrial fibrillation following cardiac surgery: a systematic review and meta-analysis

Background: Postoperative atrial fibrillation (POAF) is a leading arrhythmia with high incidence and serious clinical implications after cardiac surgery. Cardiac surgery is associated with systemic inflammatory response including increase in cytokines and activation of endothelial and leukocyte responses. Aim This systematic review and meta-analysis aimed to determine the strength of evidence for evaluating the association of inflammatory markers, such as C-reactive protein (CRP) and interleukins (IL), with POAF following isolated coronary artery bypass grafting (CABG), isolated valvular surgery, or a combination of these procedures. Methods: We conducted a meta-analysis of studies evaluating measured baseline (from one week before surgical procedures) and postoperative levels (until one week after surgical procedures) of inflammatory markers in patients with POAF. A comprehensive search was performed in electronic medical databases (Medline/PubMed, Web of Science, Embase, Science Direct, and Google Scholar) from their inception through May 2017 to identify relevant studies. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity. Results: A literature search of all major databases retrieved 1014 studies. After screening, 42 studies were analysed including a total of 8398 patients. Pooled analysis showed baseline levels of CRP (standard mean difference [SMD] 0.457 mg/L, p < 0.001), baseline levels of IL-6 (SMD 0.398 pg/mL, p < 0.001), postoperative levels of CRP (SMD 0.576 mg/L, p < 0.001), postoperative levels of IL-6 (SMD 1.66 pg/mL, p < 0.001), postoperative levels of IL-8 (SMD 0.839 pg/mL, p < 0.001), and postoperative levels of IL-10 (SMD 0.590 pg/mL, p < 0.001) to be relevant inflammatory parameters significantly associated with POAF. Conclusions: Perioperative inflammation is proposed to be involved in the pathogenesis of POAF. Therefore, perioperative assessment of CRP, IL-6, IL-8, and IL-10 can help clinicians in terms of predicting and monitoring for POAF