Satesh Kumar

Atrial fibrillation (AF) is a major sequela after bioprosthetic valve replacement (BPVR) in patients with valvular heart disease. This study evaluates the data compiled from different meta-analyses in an umbrella review. We investigated the anticoagulation efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients with AF and BPVR. A comprehensive search of the Cochrane Database of Systematic Reviews, EMBASE, and PubMed was completed to find papers published up until June 2024 that could be included in this umbrella review. Randomized controlled trials (RCTs) and retrospective observational/cohort studies were primarily identified as the foundation of meta-analyses and peer-reviewed systematic reviews. The quality of the included publications was determined using the AMSTAR 2 tool and the Cochrane Collaboration’s risk-of-bias tool, while the overall certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. A total of 20 systematic reviews and meta-analyses of RCTs and observational studies were included in this umbrella review. Among the primary outcomes, the pooled analysis exhibited a significant reduction in all-cause mortality (risk ratio [RR], 0.95; 95% confidence interval [CI], 0.91–1.00; P = .05; I2 = 0%), risk of major/life-threatening bleeding (RR, 0.73; 95% CI, 0.66–0.82; P ≤ .00001; I2 = 66%), and stroke/thromboembolism (RR, 0.74; 95% CI, 0.67–0.82; P = .00001; I2 = 0%) in patients who were administered DOAC pharmacotherapy as compared to VKAs. The only primary outcome that demonstrated clinically insignificant results was all-cause stroke (RR, 0.9; 95% CI, 0.79–1.04; P = .16; I2 = 54%). Secondary outcomes such as intracranial bleeding, any bleeding, and minor or clinically insignificant bleeding all showed a significantly decreased risk in the DOAC group versus the VKA group. Only two outcomes revealed an increased risk of cardiovascular events and risk of ischemic stroke in patients who received DOACs; however, these outcomes were statistically insignificant. According to our analysis, DOACs exhibit a superior safety and efficacy profile to that of VKAs when it comes to treating patients with BPVR. DOACs do not require continuous monitoring; therefore, they could be an effective substitute for VKAs in these individuals.

Striae distensae (SD), commonly known as stretch marks, are a prevalent cosmetic concern, particularly among women, with potential psychological impact. This meta-analysis aims to compare the effectiveness, safety, and patient satisfaction of two common SD treatments: Fractional CO2 10,064 nm (Fr CO2) laser and micro-needling. The primary focus is on clinical improvement, post-inflammatory hyperpigmentation (PIH) incidence, and morphological changes, specifically the cross-sectional area of the largest striae. Six randomized controlled trials (RCTs), including 166 patients were analyzed. A comprehensive literature search was conducted using PubMed, Google Scholar, and Embase. Systematic statistical analysis was performed using Review Manager 5.4 to gauge the comparative effectiveness and safety of Fr CO2 laser and micro-needling. Meticulous Cochrane risk-of-bias assessments were conducted to ascertain the quality of included RCTs. Both Fr CO2 laser and micro-needling treatments demonstrated significant clinical improvements in SD appearance, benefiting over 70% of patients. However, no significant difference in clinical improvements (Relative Risk (RR) = 0.97 [0.74, 1.28], p = 0.85, I2 = 17%) and patient satisfaction scores (RR = 0.91 [0.52, 1.58], p = 0.10, I2 = 39%). A comparison of the cross-sectional area of the largest striae between the groups revealed no significant disparity (Mean Difference = 0.22 [-0.15, 0.58], p = 0.24, I2 = 0%). However, the CO2 group experienced significantly higher post-inflammatory hyperpigmentation (RR = 8.37 [1.42, 49.44], p = 0.02, I2 = 68%). Both treatments are effective for SD, with similar clinical improvements and patient satisfaction. Micro-needling emerges as the safer option due to its lower risk of PIH. Treatment choice should be tailored to individual patient needs and preferences. Future research should focus on long-term outcomes and patient-reported measures in aesthetic dermatology.

Background A cough that remains unresolved for longer than 8 weeks is referred to as chronic cough, and it is estimated that 10% of the adult population of the world suffers from chronic cough. Gefapixant is a purinergic receptor P2x3 receptor antagonist. P2x3 receptors are ATP-gated ion channels on the peripheral sensory C fibers in the airways. Objective We conducted a systematic review and meta-analysis of RCTs to investigate whether the chronic cough patients would benefit from gefapixant administration or not when compared to placebo. Methods We selected only those double-arm randomized controlled trials (RCTs) which included participants presenting with a chronic cough in patients 18 years or older. We excluded all the articles published in languages other than English Language. Furthermore, all the studies other than RCTs were also omitted. Articles yielded from the electronic search were exported to EndNote Reference Library software to remove any duplicates. Analyses were done using the Review Manager 5.4 tool. Mean values and standard deviations were retrieved for the continuous outcomes given as raw data. Results 8 RCTs selected for the statistical analysis consisted of 2024 participants (1011 in the intervention group and 1013 in the placebo group). The outcomes resulted to be significant with 24-hour cough frequency, the mean difference [MD] = -5.26, 95% confidence interval [CI] -7.18 to -3.33; p = 0.00001; n = 3518, awake cough frequency (c/h) [MD] = -6.78, 95% confidence interval [CI] -9.46 to -4.09; p = 0.00001; n = 3472 patients., night cough frequency (c/h) [MD] = -4.07, 95% confidence interval [CI] -5.49 to -2.65; p = 0.00001; n = 479, patients cough severity VAS (mm) [MD] = -14.84, 95% confidence interval [-19.92, -9.76], p = 0.00001, n= 1297, cough severity diary difference [MD] = -0.85; 95% confidence interval [CI]: -1.14, -0.56; p-value = 0.00001; n = 1219, Total LCQ score MD=2.04, 95% CI = 1.09 to 2.98, p<0.0001, n =869. Conclusion To conclude, the lowest efficacious dose was 50 mg twice daily and helped reduce 24-hour cough frequency, awake cough frequency, night cough frequency, and cough severity using VAS in a dose-dependent manner. Gefapixant showed a significant risk of adverse events which include dysgeusia, hypogeusia, nausea, any adverse event, taste-related and drug-related adverse events, and serious AEs

Background The growing incidence of obesity has led to a proportionate rise in type 2 diabetes mellitus (T2DM) and its associated complications. We aimed to compare the long-term outcomes of Roux-en-y Gastric Bypass surgery (RYGB) and conventional medical management in T2DM obese patients. Methods PubMed, Google Scholar, and Clinicaltrial.gov were searched from inception to September 2023. Randomized Controlled Trials (RCTs) and cohort studies were included in this meta-analysis. The primary outcomes were the T2DM remission at 1, 2, 3, and 5 years and the accomplishment of the ADA composite triple treatment goal. The revised Cochrane risk of bias tool 2.0 and New-Castle Ottawa scale were used to assess the quality of the studies. This meta-analysis was registered prospectively on PROSPERO CRD42023466324. Results Of the 3,323 studies yielded from our initial search, 22 were included in this evidence analysis, with 5,176 total patients (1,984 and 3,192 patients in RYGB and conventional medical management groups). A significant increase in the accomplishment in the ADA’s composite triple treatment goal was observed in RYGB group as compared to the conventional medical management group (RR 2.41, 95% CI 1.39–4.15, p-value 0.002, I² 35%). Diabetes remission was a clinically successful outcome after 1, 2, 3, and 5 years of the RYGB surgery in the patients (1 year; RR 4.74, 95%CI 2.46–9.12, p-value < 0.00001, I² 0%, 2 years; RR 8.95, 95% CI 1.71–46.71, p-value 0.009, I² 92%3 years; RR 18.18 95%CI 7.57–43.62, p-value < 0.00001, I² 0%, 5 years; RR 0.22, 95% CI 2.31–16.75, p-value 0.0003, I² = 71%). Conclusion The pooled analysis of the given data concluded that the RYGB surgery was more effective in treating T2DM in patients than conventional medical management.

Efficacy and Safety of Intravenous Diltiazem Versus Metoprolol in the Management of Atrial Fibrillation with Rapid Ventricular Response in the Emergency Department: A Comprehensive Umbrella Review of Systematic Reviews and Meta-analyses